Prevalence of chronic ear disease among HIV+ children in Sub-Saharan Africa

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): David C. Ianacone, Alden F. Smith, Margaretha L. Casselbrant, Robbert J.H. Ensink, Farrel Buchinsky, Abebe Melaku, Glenn Isaacson
ObjectivesTo determine the prevalence of chronic ear disease in HIV+, highly active anti-retroviral therapy (HAART)-treated children and compare this to the prevalence in healthy children of similar age living in a similar setting.IntroductionFrom previous clinical work in Ethiopia, we suspected that chronic middle ear disease was common both in the general pediatric population and especially among children with HIV/AIDS. Few studies have examined the prevalence of chronic ear disease in HIV + children, particularly in those treated with HAART.MethodsFull examination of the head and neck was performed by otolaryngologists. This including cleaning of cerumen, otoscopy and microscopic otoscopy when needed. Patient's medical records were reviewed. Presence or absence of tympanic membrane (TM) perforation (unilateral or bilateral), tympanosclerosis, TM atrophy, otorrhea and/or cholesteatoma was documented.Results112 HIV+ and 162 healthy (HIVU) children were included. Prevalence of TM perforations was 17% in the HIV + infected versus 3% in the HIVU (Fisher's-Exact-Test; OR: 7.2, 95% CI 2.5–20, p-value <0.0001). Presence of unilateral TM perforations was 12% in the HIV + population and 2% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 2.0–22, p-value 0.002). The presence of bilateral perforations was 4% in the HIV + population and 1% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 1.1–42, p-value 0.088).In the HIV + cohort, 2% were diagnosed with cholesteatoma compared to 0% in the HIVU population (95% CI HIV+ 0.002–0.06; HIVU 0.0–0.02) and 8% of HIV + subjects had active middle ear discharge, compared to 0% in the HIVU population (95% CI HIV+ 0.04–0.1; HIVU 0.0–0.02). Neither tympanosclerosis nor tympanic membrane atrophy was more frequent in the HIV + population compared to the HIVU population. Persistent or recurrent TM perforation was not more frequent in children with prior tympanoplasty in the HIV + population compared to the HIVU population.ConclusionTM perforations are significantly more common in HAART-treated HIV + children than in healthy, age-matched HIVU population. Otorrhea and cholesteatoma were found only in the HIV + cohort.



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Revisits after pediatric tracheotomy: Airway concerns result in returns

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Sophie Shay, Nina L. Shapiro, Neil Bhattacharyya
ObjectivesChildren undergoing tracheotomy represent a medically vulnerable patient population, and understanding the reasons for revisiting the hospital setting following tracheotomy is critical for improving the quality of care for these patients. This study aims to investigate the incidence and characteristics of revisits following pediatric tracheotomy.MethodsCross-sectional, population-based study using state databases. The State Inpatient Databases and State Emergency Department Databases for California, Florida, Iowa and New York 2010–11 were linked and examined for cases of pediatric tracheotomy (patients < 18.0 years) and corresponding subsequent 30-day post-discharge revisits. Demographic and descriptive data were analyzed determining the revisit rate, revisit diagnoses, procedures, and discharge dispositions.Results2,248 pediatric tracheotomy cases were extracted (60.8% male, mean age 8.3 years). There were 373 inpatient or emergency department revisits (30-day revisit rate, 16.6%), of which 34.3% occurred within 48 h after discharge. Of these, 59.2% were inpatient readmissions. There were ≤10 deaths during these revisits (30-day revisit mortality rate, ≤2.7%). The most common primary revisit diagnoses were "fitting of prosthesis and adjustment of devices" (25.7%, likely representing adjustment/replacement of the tracheotomy tube), respiratory failure (11.0%), intracranial injury (5.4%), pneumonia (4.0%), "other upper respiratory disease" (3.8%), and "complications of surgical procedures or medical care" (3.8%). The most common revisit procedures were endotracheal intubation (11.4%), mechanical ventilation (8.8%), and replacement of tracheostomy tube (≤2.7%). Children discharged to a skilled care facility (47.1%) were more likely than those discharged to home (52.9%) to have a revisit (23.3% versus 12.0%, respectively; p < 0.001).ConclusionsChildren undergoing tracheotomy have a substantial 30-day revisit rate, most notably during the first 48 h after discharge, often involving tracheotomy tube or pulmonary complications. Improvements in discharge planning should target prevention of these complications.



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Targeted next generation sequencing identified a novel mutation in MYO7A causing Usher syndrome type 1 in an Iranian consanguineous pedigree

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Daniz Kooshavar, Masoumeh Razipour, Morteza Movasat, Mohammad Keramatipour
BackgroundUsher syndrome (USH) is characterized by congenital hearing loss and retinitis pigmentosa (RP) with a later onset. It is an autosomal recessive trait with clinical and genetic heterogeneity which makes the molecular diagnosis much difficult. In this study, we introduce a pedigree with two affected members with USH type 1 and represent a cost and time effective approach for genetic diagnosis of USH as a genetically heterogeneous disorder.MethodsTarget region capture in the genes of interest, followed by next generation sequencing (NGS) was used to determine the causative mutations in one of the probands. Then segregation analysis in the pedigree was conducted using PCR-Sanger sequencing.ResultsTargeted NGS detected a novel homozygous nonsense variant c.4513G > T (p.Glu1505Ter) in MYO7A. The variant is segregating in the pedigree with an autosomal recessive pattern.ConclusionIn this study, a novel stop gained variant c.4513G > T (p.Glu1505Ter) in MYO7A was found in an Iranian pedigree with two affected members with USH type 1. Bioinformatic as well as pedigree segregation analyses were in line with pathogenic nature of this variant. Targeted NGS panel was showed to be an efficient method for mutation detection in hereditary disorders with locus heterogeneity.



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Branchial anomalies in children: A report of 105 surgical cases

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Wanpeng Li, Hongming Xu, Liming Zhao, Xiaoyan Li
BackgroundBranchial anomalies (BAs) account for 20% of all congenital masses in children. We sought to review the incidence of involvement of individual anomalies, diagnostic methods, surgical treatment, and complications of BAs in children. In addition, we also classified our study and analyzed a congenital lower neck cutaneous fistula near the sternoclavicular joint that was thought to be the skin-side remnant of the fourth BAs.MethodsWe conducted a retrospective analysis of 105 children who were referred to our hospital from June 2009 to December 2016 for the treatment of BAs.ResultsIn this series, there were 51 males and 54 females. The age at the time of operation varied from 19 days to 13 years, and the mean age was 4.5 years. A total of 33 (31.4%) cases presented with first BAs, 13 (12.4%) presented with second BAs, and 59 (56.2%) presented with third and fourth BAs, including 6 cases of congenital lower neck cutaneous fistula. Fistulectomy under general anesthesia was performed on all of them. For postoperative complications, 2 cases had temporary facial paralysis, 1 case had permanent facial paralysis, 4 cases had temporary recurrent laryngeal nerve injury. Recurrence occurred in 2 patients with first BAs after medium follow-up time of 3.6 years (6 months–8 years).ConclusionsBAs are common congenital head and neck lesions in children, and there are four distinct types (first, second, third and fourth anomalies). The incidence of third and fourth BAs in Asia maybe higher when compared with literature reports, second BAs seem rare in this population, but more research is needed to confirm this perspective. Diagnosis is not difficult with a proper knowledge of the anatomy of the BAs. The surgical procedures should be tailored depending on the various types, and complete excision of the fistula is the key to prevent recurrence.



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Adaptation and validation of Mandarin Chinese version of the pediatric Voice Handicap Index (pVHI)

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Dan Lu, Mengjie Huang, Zhen Li, Edwin M.-L. Yiu, Ivy K.-Y. Cheng, Hui Yang, Estella P.-M. Ma
ObjectiveThe aim of this study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Mandarin Chinese.
MethodsA cross-sectional study was performed from May 2016 to April 2017. A total of 367 parents participated in this study, and 338 parents completed the translated questionnaire without missing data, including 213 parents of children with voice disorders (patients group), and 125 parents of children without voice disorders (control group). The internal consistency, test-retest reliability, contents validity, construct validity, clinical validity, and cutoff point were calculated.ResultsThe most common voice disorder in the patients group was vocal fold nodules (77.9%), followed by chronic laryngitis (18.8%), and vocal fold polyps (3.3%). The prevalence for voice disorders was higher in boys (67.1%) than girls (32.9%). The most common vocal misuse and abuse habit was shouting loudly (n = 186, 87.3%), followed by speaking for a long time (n = 158, 74.2%), and crying loudly (n = 99, 46.5%). The internal consistency for the Mandarin Chinese version of pVHI was excellent in patients group (Cronbach α = 0.95). The inter-class correlation coefficient indicated strong test-retest reliability (ICC = 0.99). The principal-component analysis demonstrated three-factor eigenvalues greater than 1, and the cumulative proportion was 66.23%. The mean total scores and mean subscales scores were significantly higher in the patients group than the control group (p < 0.05). The physical domain had the highest mean score among the three subscales (functional, physical and emotional) in the patients group. The optimal cutoff point of the Mandarin Chinese version of pVHI was 9.5 points with a sensitivity of 80.3% and a specificity of 84.8%.ConclusionThe Mandarin Chinese version of pVHI was a reliable and valid tool to assess the parents' perception about their children's voice disorders. It is recommended that it can be used as a screening tool for discriminating between children with and without dysphonia.



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Coblation versus microdebrider in pediatric adenoidectomy

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Chris Mularczyk, David L. Walner, Katherine K. Hamming
ObjectiveTo compare and contrast coblation and microdebrider with touch-up electrocautery (ME) for adenoidectomy in children.MethodsPatients <18 years old undergoing adenoidectomy without tonsillectomy were selected for this prospective, single-blinded, randomized controlled trial. Participants were enrolled into one of two groups based on birth date: coblation or ME. The surgeons completed a standard survey about intraoperative factors for each method. Recovery nurses filled out a standardized survey postoperatively. A third standardized survey was completed via a phone interview with the parent or patient caregiver on postoperative day 3 to assess procedure outcomes. The survey results were then compared using ANOVA statistical analysis.Results50 patients were enrolled in the coblation group and 51 were enrolled in the ME group. There was no significant difference in mean age between the coblation (4.96 years) and ME groups (4.58 years) (p = 0.525). The mean time (in minutes) for coblation (5.50) was significantly lower than ME (9.47) when controlling for the confounder: surgical site exposure (p < 0.001). The surgical time was significantly influenced by the quality of exposure/visualization (p = 0.037). The coblator method had significantly less intraoperative blood loss compared to ME (p < 0.001). There was a statistically significant difference between coblation (1.53) and ME (2.05) for days of pain (p = 0.045) when controlling for the confounder adenoid size.ConclusionIn our study we found that coblation demonstrated significantly less intraoperative time and less blood loss, as well as a shorter duration of postoperative pain, when compared to ME for adenoidectomy.



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Congenital respiratory tract disorders in 22q11.2 deletion syndrome

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Emmy Verheij, Lucienne Speleman, Aebele B. Mink van der Molen, Henricus G.X.M. Thomeer
ObjectiveRespiratory tract disorders have been reported in patients with 22q11.2 deletion syndrome, however infrequently. This study describes the respiratory tract disorders encountered in a cohort of 278 patients with 22q11.2 deletion syndrome.MethodsWe conducted a retrospective, cross-sectional, study at a single tertiary referral center. We identified the patients with 22q11.2 deletion syndrome and with an upper and/or lower respiratory tract disorder at our otorhinolaryngologic department. The different disorders were described.ResultsOut of 278 patients referred to the otorhinolaryngologic department, we identified 14 patients with a laryngeal and/or tracheal disorder. Nine patients had more than one congenital disorder in this anatomical area. Disorders included a choanal stenosis (n = 1), laryngeal web (n = 5), laryngeal cleft (n = 2), subglottic stenosis (n = 3), pharyngo-, laryngo-, tracheo- and/or bronchomalacia (n = 11) and tracheal stenosis (n = 1).ConclusionDifferent types of respiratory tract disorders can be present in patients with 22q11.2 deletion syndrome. Clinicians should be aware of this clinical association for timely and accurate diagnosis and treatment. In addition, the diagnosis 22q11.2 deletion syndrome should be considered in patients presenting with a congenital respiratory tract disorder.



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Effect of preoperative visiting operation room on emergence agitation in preschool children under sevoflurane anesthesia

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Qiaosheng Zhong, Xianfeng Qu, Chuanhua Xu
BackgroundEmergence agitation (EA) is a common complication in children during recovery from sevoflurane anesthesia with an high incidence. The main objective of this study was to compare the effects of preoperative visiting operation room (PVOR) to administration of propofol at the end of anesthesia on EA in preschool children under sevoflurane anesthesia.MethodsSixty-nine preschool children aged from 3 to 6 years scheduled for tonsillectomy under sevoflurane anesthesia were randomly allocated to one of the three groups to receive either PVOR (Group PV), routine preoperative visit (Group RV) or routine preoperative visit plus propofol (Group RP), 23 patients were included in each group. General anesthesia was induced and maintained with sevoflurane. Parental separation status score, mask acceptance score, Aono's four point score and pediatric anesthesia emergence delirium (PAED) score and incidence of EA were recorded. PAED score >10 were regarded as EA. Recovery profile and adverse events were also recorded.ResultParental separation status score and mask acceptance score in group PV was significantly lower than that in group RV and group RP (P < 0.05); Aono's four point score, PAED score and incidence of EA in group PV and group RP was significantly lower than that in group RV (P < 0.05); Time to extubation and time to interaction in group PV and group RV was significantly shorter than that in group RP (P < 0.05); POV and rescue by fentanyl in group PV and group RP was significantly lower than that in group RV(P < 0.05).ConclusionPVOR can effectively reduce the incidence of EA as well as administration of propofol without additional medical expenses and other adverse effects.



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Evaluation and remediation of central auditory processing disorders in children with autism spectrum disorders

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Hesham Kozou, Hanan Galal Azouz, Rania M. Abdou, Alyaa Shaltout
ObjectivesThis study was carried out to assess various skills of central auditory processing (CAP) in children with autism spectrum disorders (ASD) and to evaluate the efficacy of auditory training in these children.MethodsThis study is a non-randomized clinical experiment. 30 high functioning ASD children aged from 7 to 12 years were included in the study. They underwent behavioral assessments of CAP skills with subsequent remediation by dichotic training therapy for the children who revealed dichotic deficits.ResultsScores of CAP skills in ASD children are wide-ranging from completely normal to substantially defective and generally lower than those of typically developing children. By auditory training, ASD children improved their dichotic deficits as well as other untrained areas of auditory and language processing skills.ConclusionsA group of ASD children showed different degrees of abnormalities in CAP that could be measured behaviorally and achieved benefits from auditory training in improving their dichotic listening, auditory and language processing skills.



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Closure of fistula of the hard palate with two layers of mucoperiosteum

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Mosaad Abdel-Aziz, Ahmed Kamel, Mohamed Fawaz, Ibrahim Rezk, Mohamed Kamel
ObjectiveOronasal fistula represents a functional problem, as it may result in nasal regurgitation of food and fluids and it also leads to hypernasal speech. Many methods have been proposed for its closure with a high recurrence rate. The aim of this study was to assess the efficacy of closure of hard palate fistula by two layers of mucoperiosteal flaps.MethodsEighteen patients with fistula of the hard palate were included. The fistula was repaired by two layers of mucoperiosteal flaps; the first layer was created from the mucoperiosteum surrounding the fistula as bilateral hinge flaps and the second layer was formed of a rotational flap based on the greater palatine artery. Pre- and postoperative clinical assessment was performed.ResultsThe etiology of fistulas was previous cleft palate repair in 13 patients, previous nasal septal surgery in 3 patients, and untreated sharp accidental trauma to the palate in 2 patients. All patients presented with nasal regurgitation and hypernasal speech. Complete closure of all fistulas was achieved at first attempt, with no recurrence through the follow up period.ConclusionsClosure of oronasal fistula by two layers of mucoperiosteal flaps is an effective method and it has neither complications nor recurrence.



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A novel splicing mutation in SMPX is linked to nonsyndromic progressive hearing loss

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Zhijie Niu, Denise Yan, Sara Bressler, Lingyun Mei, Yong Feng, Xuezhong Liu
ObjectiveX-linked nonsyndromic hearing impairment is the rarest form of genetic hearing loss and represents only a minor fraction of all cases. The aim of this study was to investigate the cause of X-linked nonsyndromic sensorineural hearing loss in a three-generation American family.MethodsWhole-exome sequencing and co-segregation analysis were used to identify disease-causing genes.ResultsIn this study, we described in detail the clinical characteristics of the family and identified a novel frameshift mutation creating a premature stop codon (c.133-1 G > A, p.(Gly45fs*36)) of SMPX. The loss-of-function mutation was co-segregated with the progressive hearing loss phenotype and was absent in 200 normal controls.ConclusionsWe report the first SMPX (DFNX4) mutation in a North American family. Our findings contribute to the existing genotypic and phenotypic spectrum of SMPX associated hearing loss. Furthermore, our data suggest that exome sequencing is promising in the genetic diagnosis of hearing loss.



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Changes in the epidemiology and clinical features of acute mastoiditis following the introduction of the pneumococcal conjugate vaccine

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Oren Cavel, Riva Tauman, Eli Simsolo, Danny Yafit, Efrat Reindorf-Kfir, Oshri Wasserzug, Omer Unger, Ophir Handzel, Gadi Fishman, Yael Oestreicher-Kedem, Ari DeRowe
ObjectivesSeven years after the introduction of the pneumococcal conjugate vaccines (PCV) in Israel, its effect on the incidence and severity of episodes of acute mastoiditis (AM) remains unclear. The primary objective of this study was to determine the incidence of AM and describe its clinical features in children during the years that followed the introduction of the PCV13 in comparison with the pre-PCV period.MethodsIncluded in this retrospective comparative case series were all pediatric patients diagnosed with AM between Jan. 2007 and Dec. 2015 in one tertiary medical center. The patients were divided into 3 groups: pre-PCV, post-PCV7 (July 2009 through Dec. 2010) and post-PCV13 (Jan. 2011 through Dec. 2015). The patients' medical records were reviewed, and data on age at presentation, gender, presenting signs, bacterial ear cultures, hospitalization course, complications, surgical interventions, inflammatory response and outcome were retrieved and compared between the groups. Comparison was made between the pre-PCV and the post-PCV13 groups.Results216 children were identified for analysis, 80 children in the pre-PCV period, 31 in the post-PCV7 period and 105 in the post-PCV13 period. Their mean age was 2.6 years. The number of AM cases per 1000 visits at the emergency room decreased by 46% in the post-PCV13 period compared to the pre-PCV period. There was no difference in the rate of AM between the post-PCV7 and post-PCV13 periods. No differences were found in age, gender, hospitalization length, C-reactive protein level, white blood cell count, rate of surgical interventions (mastoidectomy and incision and drainage) and rate of complications between the 3 groups.ConclusionThe incidence of AM was lower in the post-PCV13 period compared to the pre-PCV period. The rate of AM complications, however, has not changed, nor has the number of mastoidectomies.



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Incidence and factors associated with revision adenoidectomy: A retrospective study

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): James Johnston, Murali Mahadevan, Richard G. Douglas
IntroductionAdenoidectomy is one of the most commonly performed pediatric operations worldwide. There are a proportion of children who require revision adenoidectomy. Yet there is little in the literature about the incidence, associated factors and etiology of adenoidal regrowth. The aim of this retrospective cohort study was to determine incidence and factors associated with revision adenoidectomy.MethodsAn extraction of all hospital morbidity records belonging to patients under the age of 18 years who underwent one or more adenoidectomy procedures (with or without tonsillectomy) between January 1, 2000 and June 2016 at a tertiary care children's hospital was performed. Demographic, diagnostic, and procedural data were included in the analysis. Community prescribing information was examined for the number of courses of antibiotics prescribed to each patient prior to initial adenoidectomy.ResultsThere were 8260 patients under the age of 18 years who underwent primary adenoidectomy from 2000 to 2016 at a tertiary pediatric hospital. 2.5% (n = 212) of patients underwent revision adenoidectomy in our cohort during the same time period. A higher proportion of females underwent revision adenoidectomy when compared to male counterparts (p = 0.007). Patients who were prescribed more than five courses of antibiotics prior to initial adenoidectomy were more likely to undergo revision adenoidectomy (p = 0.003). Patients with a diagnosis of otitis media with effusion were more likely to undergo revision adenoidectomy (p=<0.001). A diagnosis of asthma (p=<0.001), gastroesophageal reflux disease (GERD) (p=<0.001), and allergic rhinitis (p=<0.001) was associated with revision adenoidectomy. An age of over 4 years at the time of initial adenoidectomy was associated with revision adenoidectomy (p=<0.001). Adenoids that obstructed over 75% of the nasal choanae were associated with revision adenoidectomy in this cohort (p=<0.001).ConclusionThis study has identified several factors associated with revision adenoidectomy.



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Endonasal endoscopic nasopharyngectomy for the treatment of nasopharyngeal papillary adenocarcinoma: Report of a rare case

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Selin Ünsaler, Bora Başaran, Ismet Aslan, Dilek Yilmazbayhan
We report a case of low-grade nasopharyngeal papillary adenocarcinoma in a 9 year-old male that was diagnosed incidentally after an adenoidectomy procedure and treated with endonasal endoscopic nasopharyngectomy without any adjuvant therapy. The patient has been followed up for 3 years with no evidence of recurrence. We point out the importance of preoperative fiberoptic nasopharyngoscopy in the absence of longstanding symptoms in school-aged children and histopathologic examination of adenoidectomy specimens in the presence of atypical findings. We also suggest endonasal endoscopic resection in case of papillary adenocarcinoma.



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Microarray analysis of lncRNA and mRNA expression profiles in mice with allergic rhinitis

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Yue Ma, Le Shi, Chunquan Zheng
ObjectivesWe aimed to identify the effect of lncRNAs in CD4⁺ T cells on Allergic rhinitis (AR).MethodsThe present study conducted a microarray to identify the expression profiles of lncRNA and mRNA in CD4⁺ T cells in both AR murine models and normal controls. And qRT-PCR was used to confirm the results. GO and KEGG enrichment analysis were used to show all related pathways and a co-expression network was conducted to find lncRNAs which have high correlation with these pathways.ResultsThe results showed that the two groups contained a total of 158 deregulated lncRNAs, of which 110 were upregulated and 48 were downregulated. And positive regulation of calcium ion transport, B cell activation, chemokine-signaling pathways and calcium-signaling pathways may be involved in the development of T cells in AR pathology. Finally, we can find the differentially expressed mRNA in the pathways related to T cell differentiation correlated with many deregulated lncRNAs.ConclusionsThe present study was the first to show the differential expression profiles of lncRNAs in the CD4⁺ T cells of an AR murine model, which may provide significant insights into AR pathogenesis and offer new treatment targets to alleviate it.



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Effects of transient auditory deprivation during critical periods on the development of auditory temporal processing

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Bong Jik Kim, Jungyoon Kim, Il-Yong Park, Jae Yun Jung, Myung-Whan Suh, Seung-ha Oh
ObjectivesThe central auditory pathway matures through sensory experiences and it is known that sensory experiences during periods called critical periods exert an important influence on brain development. The present study aimed to investigate whether temporary auditory deprivation during critical periods (CPs) could have a detrimental effect on the development of auditory temporal processing.Materials and methodsTwelve neonatal rats were randomly assigned to control and study groups; Study group experienced temporary (18–20 days) auditory deprivation during CPs (Early deprivation study group). Outcome measures included changes in auditory brainstem response (ABR), gap prepulse inhibition of the acoustic startle reflex (GPIAS), and gap detection threshold (GDT). To further delineate the specific role of CPs in the outcome measures above, the same paradigm was applied in adult rats (Late deprivation group) and the findings were compared with those of the neonatal rats.ResultsSoon after the restoration of hearing, early deprivation study animals showed a significantly lower GPIAS at intermediate gap durations and a larger GDT than early deprivation controls, but these differences became insignificant after subsequent auditory inputs. Additionally, the ABR results showed significantly delayed latencies of waves IV, V, and interpeak latencies of wave I-III and wave I-V in study group. Late deprivation group didn't exhibit any deterioration in temporal processing following sensory deprivation.ConclusionTaken together, the present results suggest that transient auditory deprivation during CPs might cause reversible disruptions in the development of temporal processing.



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Low rate of positive bronchoscopy for suspected foreign body aspiration in infants

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Cameron C. Sheehan, Joseph Lopez, Charles A. Elmaraghy
ObjectivesTo describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body.Study DesignRetrospective chart review.MethodsA retrospective review was performed of patients at a tertiary children's hospital with suspected inhalation of a foreign body. Charts were reviewed for demographic information, radiologic findings, operative reports, and respiratory viral panels were reviewed.ResultsSixteen pediatric patients under 12 months of age were identified from 2008 to 2016 with a diagnosis of possible airway foreign body inhalation who underwent emergent bronchoscopy. Of these patients, only one was positive for a foreign body present in the airway. The remaining 15 children were found to have a negative direct laryngoscopy and bronchoscopy evaluation for a foreign body. Of these fifteen patients, 14 were found to have structural airway abnormalities and 7 tested positive for a respiratory viral infection.ConclusionsOur institution has a low rate of positive bronchoscopy for highly suspected foreign body inhalation in a group of patients less than 12 months of age. Patients presenting with respiratory distress, stridor, or other airway symptoms were often found to have an underlying airway abnormality or viral infection, which coupled with an unclear history, would increase the suspicion for an airway foreign body and subsequent decision to perform bronchoscopy. In stable patients, diagnostic evaluation for an underlying respiratory infection should be performed in these cases.Level of EvidenceCase Series.



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Cardiac complications in diphtheria and predictors of outcomes

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Sunil Samdani, Avani Jain, Vinod Meena, C.B. Meena
ObjectiveTo study the cardiac complications in diphtheria patients and to study the predictors of outcomes.Study DesignSingle centre prospective analysis of cardiac complications in diphtheria patients.ResultsIn this study, there were 60 patients diagnosed with diphtheria with ECG changes. The ECG changes seen were sinus tachycardia (68.3%), T wave inversion (20%), ST segment depression (13.3%), right bundle branch block (5%), multiple atrial ectopics (3.3%). The case fatality rate in our study was 25% (15 patients). High CPK-MB, myoglobulin and cardiac troponin levels were associated with cardiac mortality. In our study, cardiac troponin T had the highest sensitivity (80%) and CK-MB had the highest specificity (95.56%).ConclusionCardiac involvement is a common complication of infection with C. diphtheria and is associated with high mortality. As diphtheria can be prevented by adequate vaccination, efforts should be maximized for high vaccine coverage with booster doses.



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Management trends of infantile hemangioma: A national perspective

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Mana Espahbodi, Ke Yan, Robert H. Chun, Michael E. McCormick
IntroductionThe primary management of infantile hemangioma (IH) has changed since 2008, with the initiation of propranolol. The change that propranolol has affected on resource utilization is unknown.Materials and methodsThe Kids' Inpatient Database (KID) in 2003, 2006, 2009, and 2012 was queried for ICD-9 codes for IH in children under age three. The number of patients undergoing the following procedures of interest: tracheostomy, tracheoscopy and laryngoscopy with biopsy, and excision of skin lesion were evaluated. Data was analyzed for demographics and details on the admission. Trends were identified. Weighted statistical analyses were performed with SAS 9.4.ResultsThe number of qualified admissions significantly increased over the years (9271 in 2003–12029 in 2012, OR 1.042 per year increase, p < 0.001). The mean age at admission ranged from 26 to 28 days but did not vary over time (p = 0.54). The percentage undergoing tracheostomy significantly decreased from 1.05% in 2003 to 0.27% in 2012 (p = 0.0055), and the percentage undergoing tracheoscopy and laryngoscopy with biopsy significantly decreased from 7.29% in 2003 to 4.20% in 2012 (p = 0.011) among those with IH of unspecified or other sites. The percentage undergoing skin lesion excision also significantly decreased from 1.87% in 2003 to 1.03%, in 2012 (p = 0.0038) among those with IH of skin and subcutaneous tissue. These findings suggest a potential impact of propranolol. After adjusting for inflation, the total hospital charges increased from a mean of $17,838 in 2003 to an adjusted mean of $41,306 in 2012 (p < 0.0001).ConclusionsTotal admissions and hospital charges in children with IH has increased from 2003 to 2012. The percentage of patients undergoing tracheostomy, tracheoscopy and laryngoscopy with biopsy, and skin lesion excision significantly decreased in 2012 compared to 2003, suggesting a potential impact of propranolol. Further studies are needed to examine these changes more closely.



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A novel mutation of the EYA4 gene associated with post-lingual hearing loss in a proband is co-segregating with a novel PAX3 mutation in two congenitally deaf family members

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Federica Cesca, Elisa Bettella, Roberta Polli, Elona Cama, Pietro Scimemi, Rosamaria Santarelli, Alessandra Murgia
ObjectivesThis work was aimed at establishing the molecular etiology of hearing loss in a 9-year old girl with post-lingual non-syndromic mild sensorineural hearing loss with a complex family history of clinically heterogeneous deafness.MethodsThe proband's DNA was subjected to NGS analysis of a 59-targeted gene panel, with the use of the Ion Torrent PGM platform. Conventional Sanger sequencing was used for segregation analysis in all the affected relatives. The proband and all the other hearing impaired members of the family underwent a thorough clinical and audiological evaluation.ResultsA new likely pathogenic mutation in the EYA4 gene (c.1154C > T; p.Ser385Leu) was identified in the proband and in her 42-year-old father with post-lingual non-syndromic profound sensorineural hearing loss. The EYA4 mutation was also found in the proband's grandfather and uncle, both showing clinical features of Waardenburg syndrome type 1. A novel pathogenic splice-site mutation (c.321+1G > A) of the PAX3 gene was found to co-segregate with the EYA4 mutation in these two subjects.ConclusionThe identified novel EYA4 mutation can be considered responsible of the hearing loss observed in the proband and her father, while a dual molecular diagnosis was reached in the relatives co-segregating the EYA4 and the PAX3 mutations. In these two subjects the DFNA10 phenotype was masked by Waardenburg syndrome.The use of NGS targeted gene-panel, in combination with an extensive clinical and audiological examination led us to identify the genetic cause of the hearing loss in members of a family in which different forms of autosomal dominant deafness segregate. These results provide precise and especially important prognostic and follow-up information for the future audiologic management in the youngest affected member.



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Sulfites: No Longer a Zebra?

No abstract available

http://ift.tt/2yVhJiy

Piercing and Metal Sensitivity: Extended Analysis of the North American Contact Dermatitis Group Data, 2007–2014

Background Body piercing provides a unique route of metal exposure. Objective The aim of this study was to update previous analyses using the North American Contact Dermatitis Group data comparing pierced and unpierced individuals. Methods This was a retrospective cross-sectional analysis of 17,912 patients patch tested by the North American Contact Dermatitis Group from 2007 to 2014 for demographics, positive reactions to metals (nickel, cobalt, chromium), and detailed analysis of nickel reactions by age, sex, and source of exposure. Results Piercing was significantly associated with female sex, being older than 18 years, and atopy (P

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Sigfrid Fregert

No abstract available

http://ift.tt/2yYR18r

Patch Testing with Decyl and Lauryl Glucoside: How Well Does One Screen for Contact Allergic Reactions to the Other?

Background Alkyl glucoside surfactants, present in many cosmetic products, can cause allergic contact dermatitis. Decyl glucoside has been part of the North American Contact Dermatitis Group standard allergen panel since 2009. Objectives This study aimed to identify rates and relevance of positive patch test reactions to decyl and lauryl glucosides and to determine how well one of these glucosides screens for contact allergic reactions to the other. Methods A retrospective analysis was performed on 897 patients suspected of having a cosmetic-related dermatitis and patch tested with both decyl and lauryl glucosides between 2009 and 2016. Results Forty-eight patients (5%) had positive reactions to decyl glucoside and/or lauryl glucoside. Among the alkyl glucoside–allergic patients, 65% had positive reactions to both decyl and lauryl glucosides. In 41% of cases, reactions were of definite or probable relevance. In approximately 55% of cases, reactions were of possible relevance. Conclusions Sixty-five percent of glucoside-allergic patients exhibited co-reactions to decyl and lauryl glucosides. Thus, neither glucoside is an adequate screen for allergy to the other. Given that these reactions are often relevant, clinicians should patch test with decyl, lauryl, and other alkyl glucosides in cases of suspected cosmetic allergy.

http://ift.tt/2yYR04n

CrossFit-Associated Allergic Contact Dermatitis

No abstract available

http://ift.tt/2yYQYth

Benzalkonium Chloride: An Irritant and Sensitizer

Background Benzalkonium chloride (BAK) is a known irritant, and potentially cross-reacting quaternary ammonium compounds are commonly used as preservatives in personal care products. Objective The aim of the study was to review positive reactions to BAK in 615 patients patch tested for suspected allergic contact dermatitis. Methods A retrospective chart review was performed in 615 patients patch tested from June 2015 to October 2016. All patients were tested to a Modified American Contact Dermatitis Society core series of 70 allergens including BAK (0.1% aqueous). Initial readings were performed at 48 hours with final readings performed between 72 and 168 hours. Results were graded as + (weak: papules and erythema), ++ (strong: papules and edema or vesicles), or +++ (extreme: coalescing vesicles, spreading or bullous reactions). Results A total of 141 men (23%) and 475 women (77%) were tested (mean age, 49 years). Four hundred thirty-two (70%) were atopic. Of 615 patients, 198 (32%) tested positive to BAK, and 64 (10%) had ++ or +++ reactions at their final reading. On average, BAK-positive patients were using at least 1 product containing BAK or possible cross-reactors. Conclusions Widespread exposure to irritants in dermatitis patients can predispose to sensitization. Products containing BAK or potential cross-reactors should be used carefully in patients with compromised skin barriers.

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SELF-ASSESSMENT

No abstract available

http://ift.tt/2AZm3P3

Allergenic Ingredients in Facial Wet Wipes

Background Allergic contact dermatitis commonly occurs on the face. Facial cleansing wipes may be an underrecognized source of allergens. Objective The aim of this study was to determine the frequency of potentially allergenic ingredients in facial wet wipes. Methods Ingredient lists from name brand and generic facial wipes from 4 large retailers were analyzed. Results In the 178 facial wipes examined, a total of 485 ingredients were identified (average, 16.7 ingredients per wipe). Excluding botanicals, the top 15 potentially allergenic ingredients were glycerin (64.0%), fragrance (63.5%), phenoxyethanol (53.9%), citric acid (51.1%), disodium EDTA (44.4%), sorbic acid derivatives (39.3%), tocopherol derivatives (38.8%), polyethylene glycol derivatives (32.6%), glyceryl stearate (31.5%), sodium citrate (29.8%), glucosides (27.5%), cetearyl alcohol (25.8%), propylene glycol (25.3%), sodium benzoate (24.2%), and ceteareth-20 (23.6%)/parabens (23.6%). Of note, methylisothiazolinone (2.2%) and methylchloroisothiazolinone (1.1%) were uncommon. The top potential allergens of botanical origin included Aloe barbadensis (41.0%), chamomile extracts (27.0%), tea extracts (21.3%), Cucumis sativus (20.2%), and Hamamelis virginiana (10.7%). Conclusions Many potential allergens are present in facial wet wipes, including fragrances, preservatives, botanicals, glucosides, and propylene glycol.

http://ift.tt/2AZm2KZ

Dermoscopic Findings of Irritant “Poral” Reactions to Cobalt During Patch Testing

No abstract available

http://ift.tt/2AYVIk6

Contact Allergy to Neem Oil

A case of allergic contact dermatitis from neem oil is presented. Neem oil (synonyms: Melia azadirachta seed oil [INCI name], nim oil, margosa oil) is a vegetable (fixed) oil obtained from the seed of the neem tree Azadirachta indica by cold pressing. Contact allergy to neem oil has been described previously in only 3 patients. The allergen(s) is/are unknown.

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Occupationally Induced Allergic Contact Dermatitis to Aerosolized Quaternary Ammonium Compounds

No abstract available

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Tan in a Can: Proceed With Patch Testing

No abstract available

http://ift.tt/2yXeGq7

Defining Gaps in Dermatitis Care

No abstract available

http://ift.tt/2yYBwO1

Radiological Anatomy of Inner Ear Malformation in Hearing Impaired Children and it’s Correlation with Hearing Loss: A Hospital Based Observational Study

Abstract

To see the radiological anatomy of inner ear malformations in hearing impaired children. This study was a prospective observational study done at a tertiary care teaching hospital in north India. The included were children of 1–7 years with first time detected severe to profound SNHL. The evaluation of hearing was done by brainstem evoked response audiometry. Those with history of chronic suppurative otitis media and conductive hearing loss were excluded. The all included were undergone high resolution computed tomography of the tympano-mastoid region. A written informed consent was taken. The institutional ethics committee approved the study protocol. We screened 130 children of 1–7 years of age with complaints of severe to profound hearing impairment (SNHL) by BERA. We excluded 38 and 14 children who had conductive hearing loss with or without CSOM and did not give consent, respectively. Among recruited 78 children, 47 (60.3%) had severe (71–90 dB) and 31 (39.7%) had profound (> 90 dB) SNHL. The majority of children (60/78, 76.9%) had a bilateral hearing impairment, only 18 (23.1%) had unilateral hearing impairment. The mean ± SD of age was 3.9 ± 1.3 years (95% CI = 3.6–4.2). The incidence of severe to profound SNHL was higher, though not statistically significant among the girls. Only 7.7% children with severe to profound SNHL were detected within first 2 years of life. Most of the children (92.3%) with severe to profound SNHL were detected after 2 years of age. Among 78 with severe to profound SNHL, 16 (20.5%) children had structural anomalies in their internal ears. Only 2 (6.9%) ears had single anomaly, others (27, 93.1%) had multiple anomalies. A maximum number of anomalies found in one ear were 5. The most common anomalies were found in the vestibule. The total number of anomalies were 115. Five children (6.4%) with severe to profound SNHL had craniofacial dysmorphism. Approximately 20% of children with severe to profound SNHL have congenital anomalies in their internal ears. It is crucial to know these anomalies before planning of CI. HRCT of tympano-mastoid is the first modality to know these anomalies. MRI should also be included to know the details of vestibulocochlear nerve. Since, the neurocognitive outcome would be the best if CI will be done as early as possible preferably around 1 year of age. Therefore, children must be screened at the appropriate age, firstly by OAE followed by BERA.

http://ift.tt/2j4JXjX

Radiological Anatomy of Inner Ear Malformation in Hearing Impaired Children and it’s Correlation with Hearing Loss: A Hospital Based Observational Study

Abstract

To see the radiological anatomy of inner ear malformations in hearing impaired children. This study was a prospective observational study done at a tertiary care teaching hospital in north India. The included were children of 1–7 years with first time detected severe to profound SNHL. The evaluation of hearing was done by brainstem evoked response audiometry. Those with history of chronic suppurative otitis media and conductive hearing loss were excluded. The all included were undergone high resolution computed tomography of the tympano-mastoid region. A written informed consent was taken. The institutional ethics committee approved the study protocol. We screened 130 children of 1–7 years of age with complaints of severe to profound hearing impairment (SNHL) by BERA. We excluded 38 and 14 children who had conductive hearing loss with or without CSOM and did not give consent, respectively. Among recruited 78 children, 47 (60.3%) had severe (71–90 dB) and 31 (39.7%) had profound (> 90 dB) SNHL. The majority of children (60/78, 76.9%) had a bilateral hearing impairment, only 18 (23.1%) had unilateral hearing impairment. The mean ± SD of age was 3.9 ± 1.3 years (95% CI = 3.6–4.2). The incidence of severe to profound SNHL was higher, though not statistically significant among the girls. Only 7.7% children with severe to profound SNHL were detected within first 2 years of life. Most of the children (92.3%) with severe to profound SNHL were detected after 2 years of age. Among 78 with severe to profound SNHL, 16 (20.5%) children had structural anomalies in their internal ears. Only 2 (6.9%) ears had single anomaly, others (27, 93.1%) had multiple anomalies. A maximum number of anomalies found in one ear were 5. The most common anomalies were found in the vestibule. The total number of anomalies were 115. Five children (6.4%) with severe to profound SNHL had craniofacial dysmorphism. Approximately 20% of children with severe to profound SNHL have congenital anomalies in their internal ears. It is crucial to know these anomalies before planning of CI. HRCT of tympano-mastoid is the first modality to know these anomalies. MRI should also be included to know the details of vestibulocochlear nerve. Since, the neurocognitive outcome would be the best if CI will be done as early as possible preferably around 1 year of age. Therefore, children must be screened at the appropriate age, firstly by OAE followed by BERA.

http://ift.tt/2j4JXjX

Adjuvant radiotherapy in sinonasal mucosal melanoma: A retrospective analysis

Abstract

Objectives

Evaluation of outcome after curative treatment for sinonasal mucosal melanoma, focused on the effect of adjuvant radiotherapy on recurrence and survival. Design. Retrospective chart analysis. Setting. Tertiary referral hospital. Participants. 51 patients with primary sinonasal mucosal melanoma who underwent surgical resection with curative intention between 1980 and 2016 at Erasmus Medical Center Rotterdam. Main outcome measures. Patients were categorised into two groups: surgery alone and surgery with adjuvant radiotherapy. Log-rank test was used to compare rates of recurrence and survival between treatment groups. Predictors for treatment modality, recurrence and survival were assessed with multivariate statistical analysis.

Results

Of all patients, 23.5% developed local recurrence and 47.1% developed distant metastasis. Estimated 5-year disease free survival was 25.2% and 5-year overall survival was 38.1%. 43 patients (84.3%) were treated with postoperative radiotherapy. Patients who underwent surgery with adjuvant radiotherapy presented more often with high tumour stage, tumour involving multiple sites and positive margins. Postoperative radiotherapy seemed to be associated with better local control (p=0.549). No effect was found on occurrence of distant metastasis and overall survival. Positive margin status was an independent negative predictor for distant metastasis-free survival and overall survival

Conclusions

Our treatment outcomes are consistent with literature. Postoperative radiotherapy seems to be associated with improved local control despite advanced disease and positive margin status in this treatment group.

This article is protected by copyright. All rights reserved.

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General illness and psychological factors in patients with chronic nasal symptoms

Abstract

Objectives

Only a minority of patients referred to specialists with sinonasal symptoms have clear evidence of chronic rhinosinusitis. This study aims to estimate the prevalence of and associations between (i) general illness factors (fatigue, autonomic dysfunction) and (ii) psychological factors (anxiety, depression, somatisation, personality traits) in patients presenting with sinonasal symptoms.

Design

The following validated questionnaires were administered to patients: the Sino-Nasal Outcome Test-22 (SNOT-22) to identify symptom burden, Composite Autonomic Symptom Score-31 (COMPASS-31) measuring autonomic function, Chalder fatigue questionnaire, Patient Health Questionnaire-15 (PHQ-15) addressing somatisation symptoms, Hospital Anxiety and Depression Scale (HADS), and the International Personality Item Pool-50 (IPIP-50). Comparisons were made with normative and general population data, and relationships were analysed using nonparametric correlation.

Setting

Secondary care ENT outpatients.

Participants

Adults referred with chronic sinonasal symptoms.

Main outcome measures

SNOT-22, COMPASS-31, Chalder, PHQ-15, HADS, and IPIP-50 questionnaire scores.

Results

Sixty-one patients were included. There was a high prevalence of all general and psychological factors assessed compared with controls. Total SNOT-22 scores showed significant correlation with Chalder fatigue scores, total autonomic dysfunction score, anxiety, depression, somatisation tendencies, and the emotionally unstable personality trait. Emotional instability and psychological dysfunction correlated significantly with sleep and psychological subscales of SNOT-22 but not the rhinological or ear/facial subscales.

Conclusion

Patients with sinonasal symptoms demonstrate high prevalence and complex associations of general illness factors, psychological distress and certain personality traits. The SNOT-22 is a valuable tool, but it's utility is limited by correlations with these confounding factors (e.g. psychological factors) that may exaggerate the total score. Use of the SNOT-22 component subscales is likely to provide more clinically meaningful and discriminant information.

This article is protected by copyright. All rights reserved.

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Hypermethylated ZNF582 and PAX1 genes in oral scrapings collected from cancer-adjacent normal oral mucosal sites are associated with aggressive progression and poor prognosis of oral cancer

Publication date: December 2017
Source:Oral Oncology, Volume 75
Author(s): Shih-Jung Cheng, Chi-Feng Chang, Hui-Hsin Ko, Yi-Ching Liu, Hsin-Hui Peng, Huei-Jen Wang, Hsiao-Shan Lin, Chun-Pin Chiang
ObjectiveThis study assessed whether hypermethylated ZNF582 and PAX1 genes in oral scrapings are correlated with the progression and prognosis of oral squamous cell carcinoma (OSCC).Materials and methodsMethylation levels of ZNF582 and PAX1 genes in oral scrapings, collected from the cancer and adjacent normal oral mucosal sites of 80 OSCC patients before surgical cancer excision, were quantified using real-time methylation-specific PCR after bisulfite conversion.ResultsBoth the mean methylation (M)-indices of ZNF582 and PAX1 genes in oral scrapings were significantly higher at the cancer sites than at the adjacent normal oral mucosal sites (both P < .001). In the oral scrapings collected from the adjacent normal oral mucosal sites, the higher M-index of methylated ZNF582 (ZNF582^m) was significantly correlated with a more advanced clinical stage (P = .04). Moreover, the higher M-index of methylated PAX1 (PAX1^m) was significantly related to larger tumor size (P = .046). When the 80 OSCC patients were classified based on gene methylation tests, using the oral scrapings collected from the adjacent normal oral mucosal sites, we found a significantly shorter 3-year overall survival in ZNF582^m-positive, PAX1^m-positive, and ZNF582^m/PAX1^m-positive OSCC patients than in ZNF582^m-negative (P = .02), PAX1^m-negative (P = .04), and ZNF582^m/PAX1^m-negative OSCC patients (P = .02), respectively. Multivariate Cox regression analyses identified ZNF582^m and ZNF582^m/PAX1^m as independent unfavorable prognostic factors.ConclusionHypermethylated ZNF582 and PAX1 genes in the oral scrapings collected from adjacent normal oral mucosal sites rather than cancer sites are associated with aggressive progression and poor prognosis of OSCC.



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Risk Factors in Preschool Children for Predicting Asthma During the Preschool Age and the Early School Age: a Systematic Review and Meta-Analysis

Abstract

Purpose of Review

The aim of this study was to identify risk factors of asthma among children < 6 years old (preschool age) for predicting asthma during the preschool age and early school age (≤ 10 years of age).

Method of the study

MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched until June 30, 2017. Prospective or retrospective cohort and case-control studies were included. Studies had to have evaluated risk factors or a predictive model for developing asthma in children ≤ 6 years of age or persistent asthma in early school age.

Recent Findings

A total of 17 studies were included in the analysis. Factors associated with developing asthma in children ≤ 10 years of age (both pre-school and early school age) included male gender (pooled OR = 1.70, P < 0.001), atopic dermatitis (pooled OR = 2.02, P < 0.001), a family history of asthma (pooled OR = 2.20, P < 0.001), and serum IgE levels ≥ 60 kU/l or having specific IgE (pooled OR = 2.36, P < 0.001). A history of exposure to smoke or wheezing was also associated with persistent asthma in early school age (pooled OR = 1.51, P = 0.030 and pooled OR = 2.59, P < 0.001, respectively). In general, asthma predictive models (e.g., API, PIAMA, PAPS) had relatively low sensitivity (range, 21% to 71.4%) but high specificity (range, 69% to 98%).

Summary

The study found that male gender, exposure to smoke, atopic dermatitis, family history of asthma, history of wheezing, and serum IgE level ≥ 60 kU/l or having specific IgE were significantly associated with developing asthma by either preschool or early school age. Asthma predictive models can be developed by those risk factors.

http://ift.tt/2zcTdgV

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 01;143(11):1068

Authors:

PMID: 29145654 [PubMed - in process]

http://ift.tt/2hAIW2J

Highlights.

Highlights.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 01;143(11):1067

Authors:

PMID: 29145653 [PubMed - in process]

http://ift.tt/2zO1cQI

Error in Byline.

Error in Byline.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 01;143(11):1150

Authors:

PMID: 29145652 [PubMed - in process]

http://ift.tt/2hAhy4W

Rethinking the Growth Pattern of Thyroid Cancer in Young Patients Based on the Fukushima Database.

Rethinking the Growth Pattern of Thyroid Cancer in Young Patients Based on the Fukushima Database.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 16;:

Authors: Manning SC

PMID: 29145558 [PubMed - as supplied by publisher]

http://ift.tt/2zPjfpM

Comparative Analysis of the Growth Pattern of Thyroid Cancer in Young Patients Screened by Ultrasonography in Japan After a Nuclear Accident: The Fukushima Health Management Survey.

Comparative Analysis of the Growth Pattern of Thyroid Cancer in Young Patients Screened by Ultrasonography in Japan After a Nuclear Accident: The Fukushima Health Management Survey.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 16;:

Authors: Midorikawa S, Ohtsuru A, Murakami M, Takahashi H, Suzuki S, Matsuzuka T, Shimura H, Ohira T, Suzuki SI, Yasumura S, Yamashita S, Ohto H, Tanigawa K, Kamiya K

Abstract
Importance: Thyroid cancer generally grows at a very slow rate in adults, and overdiagnosis is a global issue. However, the detection of early-stage thyroid cancer by screening is not well described in young patients. To prevent overdiagnosis, it is essential to understand the natural course of thyroid cancer growth detection by ultrasonography screening in young patients.
Objective: To evaluate the natural progression of thyroid cancer in young patients.
Design, Setting, and Participants: An observational study evaluated changes in the diameter of malignant or suspected malignant thyroid tumors on 2 occasions. Changes in malignant thyroid tumor diameter were estimated during the observation period between the screening and confirmatory examinations in the first-round thyroid ultrasonography examination of the Fukushima Health Management Survey in patients younger than 21 years after a nuclear accident at a power plant in Fukushima, Japan. In total, 116 patients cytologically diagnosed with or suspected to have thyroid cancer were classified into 3 groups based on a greater than 10% reduction, a change of -10% to +10% in diameter, and a greater than 10% increase in tumor diameter. The association between tumor growth rate and tumor diameter was analyzed. The study was conducted from March 1, 2016, to August 6, 2017.
Main Outcomes and Measures: Tumor volume changes, the coefficient of growth of thyroid cancer in young patients, and the association between the observation period or tumor diameter and them.
Results: Of 116 patients, 77 were female; the mean age was 16.9 years (median, 17.5 years). The mean observation period was 0.488 (range, 0.077-1.632) years. No significant differences in age, sex, tumor diameter, observation period, or serum levels of thyrotropin and thyroglobulin were observed among the groups. Whereas tumor volume changes were not linearly correlated with the observation period (Pearson R = 0.121; 95% CI, -0.062 to 0.297), the coefficient of growth was significantly and negatively correlated with the tumor diameter in the screening examination (Spearman ρ = -0.183; 95% CI, -0.354 to -0.001), suggesting growth arrest after the initial proliferation phase.
Conclusions and Relevance: Ultrasonography screening could reveal asymptomatic thyroid cancer that is falling into a growth arrest pattern in many young patients. Considering the long life expectancy, prevention of overdiagnosis necessitates careful long-term monitoring without immediate diagnosis for suspected noninvasive thyroid cancer.

PMID: 29145557 [PubMed - as supplied by publisher]

http://ift.tt/2hBA3Gs

Congenital Fistulae of the Stapedial Footplate and Round Window Membrane: An Unusual Cause of Recurrent Meningitis.

Congenital Fistulae of the Stapedial Footplate and Round Window Membrane: An Unusual Cause of Recurrent Meningitis.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 16;:

Authors: Ruhl DS, Koehn HA, Mahaney KB, Kesser BW

PMID: 29145546 [PubMed - as supplied by publisher]

http://ift.tt/2zQaM5G

Risk Factors in Preschool Children for Predicting Asthma During the Preschool Age and the Early School Age: a Systematic Review and Meta-Analysis

Abstract

Purpose of Review

The aim of this study was to identify risk factors of asthma among children < 6 years old (preschool age) for predicting asthma during the preschool age and early school age (≤ 10 years of age).

Method of the study

MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched until June 30, 2017. Prospective or retrospective cohort and case-control studies were included. Studies had to have evaluated risk factors or a predictive model for developing asthma in children ≤ 6 years of age or persistent asthma in early school age.

Recent Findings

A total of 17 studies were included in the analysis. Factors associated with developing asthma in children ≤ 10 years of age (both pre-school and early school age) included male gender (pooled OR = 1.70, P < 0.001), atopic dermatitis (pooled OR = 2.02, P < 0.001), a family history of asthma (pooled OR = 2.20, P < 0.001), and serum IgE levels ≥ 60 kU/l or having specific IgE (pooled OR = 2.36, P < 0.001). A history of exposure to smoke or wheezing was also associated with persistent asthma in early school age (pooled OR = 1.51, P = 0.030 and pooled OR = 2.59, P < 0.001, respectively). In general, asthma predictive models (e.g., API, PIAMA, PAPS) had relatively low sensitivity (range, 21% to 71.4%) but high specificity (range, 69% to 98%).

Summary

The study found that male gender, exposure to smoke, atopic dermatitis, family history of asthma, history of wheezing, and serum IgE level ≥ 60 kU/l or having specific IgE were significantly associated with developing asthma by either preschool or early school age. Asthma predictive models can be developed by those risk factors.

http://ift.tt/2zcTdgV

Liver fibrosis is associated with cutaneous inflammation in the imiquimod-induced murine model of psoriasiform dermatitis

Summary

Background

Psoriasis associates several extra-cutaneous manifestations. Little is known about hepatic parameters specifically associated with psoriasis.

Objective

To study whether psoriasiform dermatitis is associated with liver injury.

Methods

We studied liver parameters of inflammation and fibrosis in a murine model of psoriasiform dermatitis induced by topical application of imiquimod for nine weeks.

Results

Topical treatment with imiquimod induced a form of psoriasiform dermatitis reminiscent of the human disorder, characterized by thickened and scaly skin, psoriasiform epidermal hyperplasia, altered keratinocyte differentiation, and cutaneous overexpression of interleukin-17A. Mice with dermatitis displayed hepatitis, as shown by elevation of plasma transaminase levels, as well as portal and periportal hepatitis characterized by T lymphocyte (CD3ε⁺) and polymorphonuclear cell (Gr1⁺) infiltrates. The hepatitis progressed toward liver fibrogenesis, as shown by excessive Sirius red staining, consistent with the expression of alpha-smooth muscle actin by hepatic stellate cells.

Conclusions

These results indicate that liver inflammation and fibrosis is associated with experimental psoriasiform dermatitis. Our results suggest that psoriatic inflammation may be associated with specific liver injury.

This article is protected by copyright. All rights reserved.

http://ift.tt/2is4bov

Serum thymus and activation-regulated chemokine (TARC) is associated with the severity of drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DIHS)

Abstract

Drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DIHS) is a severe adverse drug-induced reaction with reactivation of human herpesvirus 6 (HHV-6).^1-3 We previously reported that serum thymus and activation-regulated chemokine (TARC) levels were markedly increased in patients with DIHS and suggested TARC as a useful diagnostic marker of DIHS in the early stage.^4,5 In this study, we determined whether serum TARC levels correlate with the severity of clinical symptoms and laboratory data in patients with DRESS/DIHS.

This article is protected by copyright. All rights reserved.

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A Phase I Randomised Controlled Trial to Evaluate Safety and Clinical Effect of Topically Applied GSK2981278 Ointment in a Psoriasis Plaque Test

Abstract

RORγt, a truncated isoform of retinoic acid receptor-related orphan receptor gamma (RORγ), is a transcription factor involved in Th17 cell differentiation. It is expressed in a few distinct types of immune cells and described as the master regulator of Th17 cytokine expression¹. RORγ has identical ligand-binding domains as RORγt²; consequently, compounds targeting RORγ are also expected to modulate Th17 cell activity.

This article is protected by copyright. All rights reserved.

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Poor agreement in questionnaire-based diagnostic criteria for adult atopic dermatitis is a challenge when examining cardiovascular comorbidity

Abstract

Background

The association between atopic dermatitis (AD) and cardio-metabolic risk factors is not yet established. Furthermore, no validated questionnaire-based method of identifying adults with AD is currently available.

Objectives

To assess the cardio-metabolic risk in adults with a history of AD by using three different questionnaire-based diagnostic criteria.

Methods

We utilized data from a general population study including questionnaire data and objective measurements of 9,656 Danish adults. To identify adults with a history of AD, we used a question regarding physician-diagnosed AD, and two versions of the UK Working Party Diagnostic Criteria. Associations between AD status and cardio-metabolic endpoints were estimated using survey weighted logistic and linear regression analysis.

Results

We identified 462 (4.8%) adults with self-reported physician-diagnosed AD, whereas 903 (9.4%) and 226 (2.3%) had AD according to the UK Working Party Criteria when at least two and three of four minor criteria were fulfilled. The populations were not comparable in terms of occurrence of cardio-metabolic risk factors. For example, the prevalence of obesity was lower in participants with physician-diagnosed AD but overall higher in UK 2/4 and UK 3/4.

Conclusion

Due to the heterogeneity in the captured study populations in terms of the studied outcomes and absence of a gold standard, no conclusions regarding the cardio-metabolic risk in adults with AD in a general population could be made. This study serves as an example of the challenges that are often encountered in questionnaire-based epidemiologic studies and highlights the need of better definitions for this patient group.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ispZAk

Rhinitis and its Impact on Quality of Life in Swimmers

Abstract

Introduction

Limited data suggest that swimmers might be affected by rhinitis significantly more often than the general population. This can have impact on quality of life but also on performance. The aim of the present study was to determine the prevalence and impact of QOL of rhinitis in swimming compared to non-swimming athletes and controls.

Materials and methods

This was an observational case control, questionnaire based study involving elite (n=101) and non-elite swimming athletes (n=107), non-swimming athletes (n = 38) and sex and age-matched controls (n = 50). The survey instrument consisted of a general and the miniRQLQ questionnaire. Main question used to assess the prevalence of rhinitis was from the ISAAC study.

Results

Rhinitis was reported significantly more often by the elite swimmers (45%) than non-elite swimmers (31%), non-swimming athletes (32%) and controls (24%). Allergic rhinitis prevalence was similar in all groups (12-18%). The prevalence of non-allergic rhinitis was significantly higher in elite swimmers (33%) and non-elite swimmers (22%) compared to non-swimming athlethes and controls. Overall mean miniRQLQ score and all subdomains except the "eye" domain showed significantly reduced QOL in elite and non-elite swimmers compared to non-swimming athletes and controls. Regular nasal medication was used significantly less by elite swimmers (18%) compared to controls (67%) and non-swimming athletes (42%).

Conclusion

This study revealed a high prevalence of non-allergic rhinitis in swimmers and related impact on QoL. These findings highlight the importance to increase the awareness toward upper airway disorders in the swimming athletes and to ensure adequate management.

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A randomized, double-blind, placebo-controlled, dose-finding trial with Lolium perenne peptide immunotherapy

Abstract

Background

A novel subcutaneous allergen immunotherapy formulation (gpASIT+^™) containing Lolium perenne peptides (LPP) and having a short up-dosing phase has been developed to treat grass pollen–induced seasonal allergic rhinoconjunctivitis. We investigated peptide immunotherapy containing the hydrolysate from perennial ryegrass allergens for the optimum dose in terms of clinical efficacy, immunogenicity, and safety.

Methods

This prospective, double-blind, placebo-controlled, phase IIb, parallel, four-arm, dose-finding study randomized 198 grass pollen–allergic adults to receive placebo or cumulative doses of 70, 170, or 370 μg LPP. All patients received weekly subcutaneous injections, with the active treatment groups reaching assigned doses within 2, 3, and 4 weeks, respectively. Efficacy was assessed by comparing conjunctival provocation test (CPT) reactions at baseline, after 4 weeks, and after completion. Grass pollen–specific immunoglobulins were analysed before and after treatment.

Results

CPT response thresholds improved from baseline to V7 by at least one concentration step in 51.2% (170 μg; P = .023), 46.3% (370 μg), and 38.6% (70 μg) of patients receiving LPP versus 25.6% of patients receiving placebo (modified per protocol set). Also, 39% of patients in the 170 μg-group became non-reactive to CPT versus 18% in the placebo group. Facilitated allergen-binding assays revealed a highly significant (P < .001) dose-dependent reduction in IgE allergen binding across all treatment groups (70 μg: 17.1%; 170 μg: 18.8%; 370 μg: 26.4%). Specific IgG₄ levels increased to 1.6-fold (70 μg), 3.1-fold (170 μg), and 3.9-fold (370 μg) (mPP).

Conclusion

Three-week immunotherapy with 170 μg LPP reduced CPT reactivity significantly and increased protective specific antibodies.

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Contents

Publication date: December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 6





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Editorial Board

Publication date: December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 6





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Male and Female Mice Lacking Neuroligin-3 Modify the Behavior of Their Wild-Type Littermates

Kalbassi, S; Bachmann, SO; Cross, E; Roberton, VH; Baudouin, SJ; (2017) Male and Female Mice Lacking Neuroligin-3 Modify the Behavior of Their Wild-Type Littermates. eNeuro , 4 (4) , Article e0145-17.2017. 10.1523/ENEURO.0145-17.2017 . Green open access

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Extrapolation or saturation – an exploration into growth patterns, development stages and decoupling

Bleischwitz, R; Nechifor, V; Winning, M; Beijia, H; Yong, G; (2018) Extrapolation or saturation – an exploration into growth patterns, development stages and decoupling. Global Environmental Change (In press).

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New evidence about the "dark side" of social cohesion in promoting binge drinking among adolescents

Martins, JG; de Paiva, HN; Paiva, PCP; Ferreira, RC; Pordeus, IA; Zarzar, PM; Kawachi, I; (2017) New evidence about the "dark side" of social cohesion in promoting binge drinking among adolescents. PLoS One , 12 (6) , Article e0178652. 10.1371/journal.pone.0178652 . Green open access

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Genome-wide association study of clinical parameters in immunoglobulin light chain amyloidosis in three patient cohorts

Meziane, I; Huhn, S; da Silva Filho, MI; Weinhold, N; Campo, C; Nickel, J; Hoffmann, P; ... Hemminki, K; + view all Meziane, I; Huhn, S; da Silva Filho, MI; Weinhold, N; Campo, C; Nickel, J; Hoffmann, P; Noethen, MM; Joeckel, K-H; Landi, S; Mitchell, JS; Johnson, D; Jauch, A; Morgan, GJ; Houlston, R; Goldschmidt, H; Milani, P; Merlini, G; Rowcieno, D; Hawkins, P; Hegenbart, U; Palladini, G; Wechalekar, A; Foersti, A; Schoenland, SO; Hemminki, K; - view fewer (2017) Genome-wide association study of clinical parameters in immunoglobulin light chain amyloidosis in three patient cohorts. [Letter]. Haematologica , 102 (10) e411-e414. 10.3324/haematol.2017.171108 . Green open access

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Cardiovascular health status between standard and nonstandard workers in Korea

Seon, JJ; Lim, YJ; Lee, HW; Yoon, JM; Kim, SJ; Choi, S; Kawachi, I; Seon, JJ; Lim, YJ; Lee, HW; Yoon, JM; Kim, SJ; Choi, S; Kawachi, I; Park, SM; - view fewer (2017) Cardiovascular health status between standard and nonstandard workers in Korea. PLoS One , 12 (6) , Article e0178395. 10.1371/journal.pone.0178395 . Green open access

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Association of maternal age with child health: A Japanese longitudinal study

Kato, T; Yorifuji, T; Yamakawa, M; Inoue, S; Doi, H; Eboshida, A; Kawachi, I; (2017) Association of maternal age with child health: A Japanese longitudinal study. PLoS One , 12 (2) , Article e0172544. 10.1371/journal.pone.0172544 . Green open access

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Multi-centre molecules driven by intense laser fields

Chen, Ahai; (2017) Multi-centre molecules driven by intense laser fields. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Resolving the clinico-radiological paradox in multiple sclerosis

Chard, D; Trip, SA; (2017) Resolving the clinico-radiological paradox in multiple sclerosis. F1000Research , 6 , Article 1828. 10.12688/f1000research.11932.1 . Green open access

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Neonatal antecedents of hearing loss in very preterm infants

Chant, KC; (2017) Neonatal antecedents of hearing loss in very preterm infants. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Zero Knowledge Protocols and Applications

Chaidos, Pavlos Ioannis Pyrros; (2017) Zero Knowledge Protocols and Applications. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Remembering the islands: Some responses to Shima's special issue on Submergence

Kelman, I; (2017) Remembering the islands: Some responses to Shima's special issue on Submergence. Shima , 11 (1) 10.21463/shima.11.1.03 . (In press).

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The Prestige Economy of a London Orchestra

Carpos, Francesca; (2017) The Prestige Economy of a London Orchestra. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Investigation Of The Role Of The KATP Channel In Vascular Hyporeactivity In Sepsis

Buckley, James Francis; (2017) Investigation Of The Role Of The KATP Channel In Vascular Hyporeactivity In Sepsis. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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It takes a village: Fixed-effects analysis of neighborhood collective efficacy and children's development

Ichikawa, K; Fujiwara, T; Kawachi, I; (2017) It takes a village: Fixed-effects analysis of neighborhood collective efficacy and children's development. Journal of Epidemiology , 27 (8) pp. 368-372. 10.1016/j.je.2016.08.018 . Green open access

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Dissociation between behavior and motor cortical excitability before and during ballistic wrist flexion and extension in young and old adults

Hortobágyi, T; Mieras, A; Rothwell, J; Del Olmo, MF; (2017) Dissociation between behavior and motor cortical excitability before and during ballistic wrist flexion and extension in young and old adults. PLoS One , 12 (10) , Article e0186585. 10.1371/journal.pone.0186585 . Green open access

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Robert Breer: Single-frame Aesthetics and Inherited Modernisms in Relation to the Neo-avant-garde and Debates on Film Animation

Bridge, Sonia; (2017) Robert Breer: Single-frame Aesthetics and Inherited Modernisms in Relation to the Neo-avant-garde and Debates on Film Animation. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Lipid-based Nanoparticles for Topical Delivery of Hair Growth Therapeutic Molecules

Mohamed Noor, Norhayati; (2017) Lipid-based Nanoparticles for Topical Delivery of Hair Growth Therapeutic Molecules. Doctoral thesis (Ph.D), UCL (University College London).

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DFT plus U study of the structures and properties of the actinide dioxides

Pegg, JT; Aparicio-Angles, X; Storr, M; de Leeuw, NH; (2017) DFT plus U study of the structures and properties of the actinide dioxides. JOURNAL OF NUCLEAR MATERIALS , 492 pp. 269-278. 10.1016/j.jnucmat.2017.05.025 . Green open access

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Political Liberalism and the Scientific Claims of Religion

Bellolio, Cristóbal; (2017) Political Liberalism and the Scientific Claims of Religion. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Patronage and the Royal Navy, 1775-1815

Beck, Catherine Susan; (2017) Patronage and the Royal Navy, 1775-1815. Doctoral thesis (Ph.D), UCL (University College London).

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