Medicine by Sfakianakis Alexandros: 09/09/18

Κυριακή 9 Σεπτεμβρίου 2018

Nasal challenges in allergen immunotherapy trials

Purpose of review The nasal allergen challenge (NAC) model can be a valuable diagnostic tool for allergic rhinitis. Alongside its clinical use, NACs can be used as primary and secondary endpoints in studies evaluating allergen immunotherapy (AIT) products for allergic rhinitis treatment. This review will discuss the technical aspects of the NAC model and provide a summary of recent studies using NACs to assess existing and new AIT treatments. Recent findings Over the last 2 years, both titrated and single-dose nasal challenge protocols have been used to evaluate immunotherapies targeting grass, birch, house dust mite, and cat allergens. Early efficacy and dose-finding trials showed improvements in allergic symptoms and nasal tolerance to allergens after AIT treatment with standardized extracts or modified forms of whole allergen. NACs were also used in two proof-of-concept studies to illustrate the efficacy of intralymphatic immunotherapy with two concomitant allergens and subcutaneous immunotherapy with Fel d 1-specific IgG-blocking antibodies. Summary Along with existing therapies, nasal challenges are useful in evaluating AIT treatments in the very early stages of clinical development. However, because of the variety in challenge techniques and symptom assessments available, special attention must be placed in the protocol design in order to compare the study results with existing NAC publications. Correspondence to Anne K. Ellis, MD, MSc, FRCPC, Professor and Chair, Division of Allergy and Immunology, Allergy Research Unit, Kingston General Health Research Institute, Watkins 1D, 76 Stuart Street, Kingston, ON K7L 2V7, Canada. Tel: +1 613 548 2336; fax: +1 613 546 3079; e-mail: ellisa@queensu.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2MfWopS

Pediatric Otolaryngological Emergency: An Experience from a Tertiary Care Teaching Institution at Kolkata, India

Abstract

Otolaryngological conditions constitute a major share of emergency medical problem among children. The present study was conducted to assess the patient profiles, incidences morbidities, mode of presentation and managements of different otolaryngological emergencies among pediatric patients presented in a tertiary care hospital. Descriptive cross-sectional study by analysing retrospectively collected information pertaining to the patients attended ENT emergency service department of a tertiary care hospital, Kolkata. Data were collected using predesigned proforma and were analysed with the help of SPSS version 20. About 39.0% of total ENT emergency attendance was contributed by pediatric age group. The male female ratio was 1:1.33 with average age of 58.95 ± 34.42 (mean ± SD) months. Half of the attendees had ear problem and almost one-third reported complaints related to nose. The major complaints at the time of presentation were earache (32.3%), nasal foreign body (24.0%) and aural foreign body (13.3%) closely followed by aero-digestive tract foreign body (12.0%). Inflammatory conditions affected the ears more, foreign bodies found most commonly in nose and miscellaneous condition such as impacted wax was found to be related to ear in significantly higher proportion. Conservative management was provided to 96.25% of patients. Foreign body insertion was found to be associated with lower age group. Most of the emergencies were managed conservatively which might be done at subdivision or district level to reduce the undesirable burden on the tertiary care medical colleges.

https://ift.tt/2MfFacc

Ossifying Fibroma of Maxilla in a Female Affected by Neurofibromatosis Type 1

Abstract

Ossifying fibroma is a benign fibro-osseous lesion found exclusively in jaws. It has a predilection for premolar–molar region in the mandible. The occurrence of OF as solitary lesions with no underlying disease is common in jaws. However its co-existence in patients with neurofibromatosis type 1 (NF1) has not been described in jaws. NF1, also known as von Recklinghausen's disease or peripheral neurofibromatosis, is an autosomal dominant multisystem disorder that approximately affects 1 in 2500–3000 births. The common manifestations of this disease include Café-au-lait macules, skinfold freckling, cutaneous neurofibromas, blue-red and pseudoatrophic macules on skin, plexiform neurofibroma, scoliosis, optic glioma. So far only one case of ossifying fibroma (OF) in such patients has been reported in the skull but not in the maxillofacial region. We report a case of OF of the maxilla in a 45 year old female suffering from NF1. To the best of our knowledge this is the first case report where OF occurred in the maxilla in patient with NF1.

https://ift.tt/2wZmsAH

Ahila’s Diathermy Round Knife for Endoscopic Ear Surgery

Abstract

As endoscopic ear surgery is evolving day by day there is a constant need for improvisation in terms of instrumentation, visualization and clear bloodless surgical field. The applications of Ahila's Diathermy Round Knife for Endoscopic Ear Surgery are presented. The development of Ahila's diathermy round knife will prevent shifting to two handed ear surgery or the need for Endo holders. This new instrument is a game changer in endoscopic ear surgery creating a clean incision and bloodless field to operate. Surgical Instruments represent a major financial asset to the healthcare facility. Careful attention to care, handling and sterilization is essential to avoid costly replacements, enhance patient and surgeon satisfaction, reduce costs and delays in the Operating room and enhance patient safety. Ahila's round diathermy knife may facilitate the performance of surgery and advance the art of Endoscopic surgery to a higher level.

https://ift.tt/2Oa7bU0

Cystic Myoepithelioma of Parapharyngeal Space

Abstract

Myoepitheliomas are rare tumours of salivary glands arising from myoepithelial cells, which are normal constituent of the salivary acini and ducts and are found between the epithelial cells and the basement membrane. The most common site of origin of Myoepitheliomas are the salivary glands and rarely other sites in the head and neck have been described in literature. Myoepithelioma arising from parapharyngeal space provide both a diagnostic and therapeutic challenge. We present such a case and discuss its diagnostic and therapeutic aspects.

https://ift.tt/2x19eDv

The safety and efficacy of daylight photodynamic therapy in the treatment of actinic keratoses: a systematic review and meta‐analysis

International Journal of Dermatology, EarlyView.

https://ift.tt/2CDmhQS

Leukemic arthritis and severe hypercalcemia in a man with chronic myeloid leukemia: a case report and review of the literature

Patients with chronic myeloid leukemia typically present with high white blood cell counts revealed during annual checkups. Leukemic arthritis and hypercalcemia are rare manifestations in patients with chronic...

https://ift.tt/2NsBZCA

Paediatric mastocytosis: long‐term follow‐up of 53 patients with whole sequencing of KIT. A prospective study

British Journal of Dermatology, EarlyView.

https://ift.tt/2Qia8n5

A multi-stakeholder perspective on asthma care in Canada: findings from a mixed methods needs assessment in the treatment and management of asthma in adults

Although several aspects of asthma care have been identified as being sub-optimal in Canada, such as patient education, practice guideline adoption, and access to care, there remains a need to determine the ex...

https://ift.tt/2x0TeBr

Cutaneous epidermotropic metastasis of an oesophageal squamous cell carcinoma: Wound healing and transepidermal elimination as possible mechanisms for epidermotropism

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2Qi5PrN

A case of lymphomatoid papulosis, pityriasis lichenoides acuta, and mycosis fungoides coexistence

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2CDjWW8

Modulation of the gut microbiota to improve innate resistance

Pamela Schnupf | Valérie Gaboriau-Routhiau | Nadine Cerf-Bensussan

https://ift.tt/2CyNzYB

Endoscopic laryngo-pharyngeal surgery for elderly patients

Publication date: Available online 8 September 2018

Source: Auris Nasus Larynx

Author(s): Yo Kishimoto, Hiroyuki Harada, Makiko Funakoshi, Shin-ichi Miyamoto, Atsushi Suehiro, Morimasa Kitamura, Manabu Muto, Ichiro Tateya, Koichi Omori

Abstract

Objective

Due to the rising number of elderly patients and advances in endoscopic devices, early laryngeal and pharyngeal cancers are increasingly found in elderly patients. In these cases, minimally invasive endoscopic larygo-pharyngeal surgery (ELPS) may be indicated. However, the safety and efficacy of ELPS in elderly populations has not been established. The purpose of this study was to investigate the safety, outcomes and feasibility of ELPS in very elderly patients.

Methods

Between February 2010 and April 2016, 29 pharyngeal cancerous or pre-cancerous lesions in 19 patients aged 75 years or older were treated with ELPS. Twenty-six resections were performed in total, and the patients' clinical courses were reviewed.

Results

Sixteen patients had multiple comorbidities and moderate to severe comorbidities were observed in 17 patients. The average surgical time and hospitalization period was 54.3 min and 18.8 days, respectively. On average, oral intake began 4.4 days after the procedure, and all patients eventually received nourishment by mouth; no percutaneous endoscopic gastrostomy dependency was observed. Complications included post-operative bleeding and aspiration pneumonia in two cases each, and all complications were safely managed. The 3-year overall survival rate was 90.2% and the 3-year disease-specific survival rate was 100%.

Conclusion

ELPS was safely performed in elderly patients, suggesting that it is a feasible treatment option for pharyngeal lesions in very elderly patients.

https://ift.tt/2O2c95r

Endolymphatic hydrops severity in magnetic resonance imaging evidences disparate vestibular test results

Publication date: Available online 8 September 2018

Source: Auris Nasus Larynx

Author(s): Nicolas Pérez-Fernández, Pablo Dominguez, Raquel Manrique-Huarte, Diego Calavia, Lorea Arbizu, Reyes Garcia-Eulate, Laura Alvarez-Gomez, Carlos Guajardo, Jose Luis Zubieta

Abstract

Objectives

It has been suggested that in Ménière's disease (MD) a dissociated result in the caloric test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this study is that based on endolymphatic hydrops' cochleocentric progression, hydrops should also be more severe in the vestibule of these patients than in those for whom both tests are normal.

Methods

22 consecutive patients with unilateral definite MD were included and classified as NN if both tests were normal or AN if the caloric test was abnormal. MRI evaluation of endolymphatic hydrops was carried out with a T2-FLAIR sequence performed 4 h after intravenous gadolinium administration. The laterality and degree of vestibular endolymphatic hydrops and the presence or absence of cochlear endolymphatic hydrops were recorded. Demographic data, audiometric and vestibular evoked myogenic potentials were collected, and video head-impulse and caloric tests were performed.

Results

Patients in both groups (NN and AN) were similar in terms of demographic data and hearing loss. The interaural asymmetry ratio was significantly higher for ocular and cervical VEMP in patients in the AN group. There was a significantly higher degree of hydrops in the vestibule of the affected ear of AN patients (χ²; p = 0.028).

Conclusion

Significant canal paresis in the caloric test is associated with more severe endolymphatic hydrops in the vestibule as detected with gadolinium-enhanced MRI and with a more severe vestibular deficit.

Level of evidence: 2a

https://ift.tt/2QhDvWM

Impact of Unilateral Congenital Aural Atresia on Academic Performance:a Systematic Review

Publication date: Available online 8 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): C.V.A. van Hövell tot Westerflier, J.A.A. van Heteren, C.C. Breugem, A.L. Smit, I. Stegeman

Abstract

Background

Little is known about the academic performance of children with unilateral congenital aural atresia (CAA).

Objective

of review: Our objective was to summarize what is known about the academic performance of children with hearing loss by unilateral congenital aural atresia, in order to provide pragmatic recommendations to clinicians who see children with this entity.

Type of review

Systematic review.

Search strategy

We conducted a systematic search in PubMed Medline, EMBASE, and Cochrane Library combining the terms "atresia" and synonyms with "unilateral hearing loss" and synonyms. Date of the most recent search was 16 May 2018.

Evaluation method

Two independent authors identified studies, extracted data, and assessed risk of bias. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies on the academic achievements of patients of any age with unilateral conductive hearing loss of any level due to congenital aural atresia were included. We considered grade retention, special education, individualized education plans, and parental report of school performance as outcome measures for academic achievement.Results: Two studies reporting on academic performance of patients with unilateral CAA, which both had a significant risk of bias. One study (n = 140) showed a grade retention rate of 3.6% (n = 5) in total. 15.7 % (n = 22) needed special education, and 36.4% (n = 51) used an individualized education program. The second study, reporting on 67 patients with unilateral CAA, showed that 29.9% (n = 20) of the patients received school intervention, and 25.4% (n = 17) had learning problems.

Conclusion

Current evidence regarding the effect of unilateral congenital aural atresia on academic performance is sparse, inconclusive and has a significant risk of bias. High quality observational studies assessing the effects of aural atresia on academic performance in these patients should be initiated.

https://ift.tt/2Cza6Vh

Primary Hyperparathyroidism due to Parathyroid Adenoma Originated from Supernumerary Gland

Introduction. The variability of the location of the parathyroid glands is directly related to the events that occur during embryonic development. The impact that an individual submits more than four parathyroid glands is close to 13%. However the presentation of a parathyroid adenoma in a supernumerary gland is an uncommon event. Case report. A 30-year-old man diagnosed with primary hyperparathyroidism with matching findings on ultrasonography and scintigraphy for parathyroid adenoma localization lower left regarding the thyroid gland. A cervicotomy explorer showed four orthotopic parathyroid glands. The biopsy of the inferior left gland was normal. No signs of adenoma were seen in the biopsy. Following mobilization of the ipsilateral thyroid lobe, fifth parathyroid gland was found increased significantly in size than proceeded to remove, confirming the diagnosis of adenoma. After the excision, the levels of serum calcium and parathyroid hormone were normalized. Conclusions. The presentation of a parathyroid adenoma in a supernumerary gland is a challenge for the surgeon. The high sensitivity having different imaging techniques has been a key to locate preoperatively the pathological parathyroid gland. Analytical or clinical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland location.

https://ift.tt/2MgguAe

Revisiting the dose constraints for head and neck OARs in the current era of IMRT

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): N.Patrik Brodin, Wolfgang A. Tomé

Abstract

Head and neck cancer poses a particular challenge in radiation therapy, whilst being an effective treatment modality it requires very high doses of radiation to provide effective therapy. This is further complicated by the fact that the head and neck region contains a large number of radiosensitive tissues, often resulting in patients experiencing debilitating normal tissue complications. In the era of intensity-modulated radiation therapy (IMRT) treatments can be delivered using non-uniform dose distributions selectively aimed at reducing the dose to critical organs-at-risk while still adequately covering the tumor target. Dose-volume constraints for the different risk organs play a vital role in one's ability to devise the best IMRT treatment plan for a head and neck cancer patient. To this end, it is pivotal to have access to the latest and most relevant dose constraints available and as such the goal of this review is to provide a summary of suggested dose-volume constraints for head and neck cancer RT that have been published after the QUANTEC reports were made available in early 2010.

https://ift.tt/2O33ZKa

‘Meditation Training Intervention’ – A necessary shift for head and neck cancer patients

Publication date: Available online 8 September 2018

Source: Oral Oncology

Author(s): Prashanth Panta

https://ift.tt/2N2yl2M

Oral vaccine based on a surface immunogenic protein mixed with alum promotes a decrease in Streptococcus agalactiae vaginal colonization in a mouse model

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): D.A. Diaz-Dinamarca, D.A. Soto, Y.Y. Leyton, M.J. Altamirano-Lagos, M.J. Avendaño, A.M. Kalergis, A.E. Vasquez

Abstract

The Surface Immunogenic Protein (SIP) of Group B Streptococcus (GBS) had been described as a good target for vaccine development. To date, SIP has been reported as a highly conserved protein, and in a mouse model it induces protection against lethal GBS challenge. Also, similar effects have been described by intranasal immunization with a SIP-based vaccine. In this study, we show the immune response induced by an oral SIP-based vaccine formulated on alum in a mouse model. Our vaccine can reduce vaginal GBS colonization and induce specific SIP-antibodies with opsonophagocytosis activities against GBS. Moreover, we observed the activation of T-cells producing IFN-γ, TNF-α, IL-10, IL-2, and increased expression of the transcription factor T-bet, suggesting a Th1-type humoral response. The oral SIP-based vaccine is a novel alternative in the development of a vaccine against GBS.

https://ift.tt/2wYbjiL

Lower Perinatal Exposure to Proteobacteria is an Independent Predictor of Early Childhood Wheezing

Publication date: Available online 8 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Benjamin A. Turturice, Diane R. Gold, Augusto A. Litonjua, Emily Oken, Sheryl Rifas-Shiman, David L. Perkins, Patricia W. Finn

https://ift.tt/2oSFUuo

STAT5B deficiency due to a novel missense mutation in the coiled-coil domain

Publication date: Available online 8 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Meghan J. Acres, Florian Gothe, Angela Grainger, Andrew J. Skelton, David J. Swan, Joseph D.P. Willet, Suzy Leech, Sonya Galcheva, Violeta Iotova, Sophie Hambleton, Karin R. Engelhardt

https://ift.tt/2x5qsz1

Tobacco smoke as a risk factor for allergic sensitization in adults: conclusions of a systematic review and meta-analysis

Publication date: Available online 8 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Beatriz Mónico, Jorge M.R. Gama, M. Ramiro Pastorinho, Olga Lourenço

https://ift.tt/2oRi1DB

Differential expression of functional chemokine receptors on human blood and lung group 2 innate lymphoid cells (ILC2s)

Publication date: Available online 8 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Cathryn Weston, Batika M.J. Rana, David J. Cousins

https://ift.tt/2wVtEgw

Anti-IL5 treatments in severe asthma by blood eosinophil thresholds: indirect treatment comparison

Publication date: Available online 8 September 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): William Busse, Geoffrey Chupp, Hiroyuki Nagase, Frank C. Albers, Scott Doyle, Qin Shen, Daniel J. Bratton, Necdet B. Gunsoy

Abstract

Background

Three anti-interleukin (IL)5 pathway-directed therapies are approved for use in severe eosinophilic asthma (SEA); however, no head-to-head comparison data are available.

Objective

To compare the efficacy of licensed doses of mepolizumab, benralizumab and reslizumab in patients with SEA, according to baseline blood eosinophil count.

Methods

This indirect treatment comparison (ITC) used data from a Cochrane review and independent searches. Eligible studies were randomized, controlled trials in patients aged ≥12 years with SEA. Endpoints included annualized rate of clinically significant exacerbations and change from baseline in Asthma Control Questionnaire (ACQ) score and forced expiratory volume in 1 second. An ITC was performed in patients with ACQ ≥1.5 and stratified by baseline blood eosinophil counts.

Results

Eleven studies were included. All treatments significantly reduced the rate of clinically significant exacerbations and improved asthma control versus placebo in all blood eosinophil subgroups. Mepolizumab reduced clinically significant exacerbations by 34%–45% versus benralizumab across subgroups (rate ratio[RR] [95%CI]: ≥400 cells/μL: 0.55[0.35,0.87]; ≥300 cells/μL: 0.61[0.37,0.99]; ≥150 cells/μL: 0.66[0.49,0.89]; all p<0.05) and by 45% versus reslizumab in the ≥400 cells/μL subgroup (RR[95%CI]: 0.55[0.36,0.85], p=0.007). Asthma control was significantly improved with mepolizumab versus benralizumab (all subgroups: p<0.05), and versus reslizumab in the ≥400 cells/μL subgroup (p=0.004). Benralizumab significantly improved lung function versus reslizumab in the ≥400 cells/μL subgroup (p=0.025).

Conclusions

This ITC of the licensed doses suggests that, in patients with similar blood eosinophil counts, mepolizumab was associated with significantly greater improvements in clinically significant exacerbations and asthma control compared with reslizumab or benralizumab.

https://ift.tt/2N2Dc4b

Immunogenicity to cerliponase alfa intracerebroventricular enzyme replacement therapy for CLN2 disease: Results from a Phase 1/2 study

Publication date: Available online 8 September 2018

Source: Clinical Immunology

Author(s): Anu Cherukuri, Heather Cahan, Greg de Hart, Andrea Van Tuyl, Peter Slasor, Laurie Bray, Josh Henshaw, Temitayo Ajayi, Dave Jacoby, Charles A. O'Neill, Becky Schweighardt

Abstract

Treatment with intracerebroventricular (ICV)-delivered cerliponase alfa enzyme replacement therapy (ERT) in a Phase 1/2 study of 24 subjects with CLN2 disease resulted in a meaningful preservation of motor and language (ML) function and was well tolerated. Treatment was associated with anti-drug antibody (ADA) production in the cerebrospinal fluid (CSF) of 6/24 (25%) and in the serum of 19/24 (79%) of clinical trial subjects, respectively, over a mean exposure of 96.4 weeks (range 0.1–129 weeks). Neutralizing antibodies (NAb) were not detected in the CSF of any of the subjects. No events of anaphylaxis were reported. Neither the presence of serum ADA nor drug-specific immunoglobulin E was associated with the incidence or severity of hypersensitivity adverse events. Serum and CSF ADA titers did not correlate with change in ML score. Therefore, the development of an ADA response to cerliponase alfa is not predictive of an adverse safety profile or poor treatment outcome.

https://ift.tt/2wXNVSz

News and Notices

Clinical and Experimental Dermatology, Volume 43, Issue 7, Page 863-863, October 2018.

https://ift.tt/2NrS5fI

Issue Information

Clinical and Experimental Dermatology, Volume 43, Issue 7, Page i‐ii, 757-758, October 2018.

https://ift.tt/2CC3jKt

A Case Report of Sarcoidosis Mimicking Vertebral Metastasis

A 35-year-old African American male, previously healthy, presented with lower back and bilateral lower extremity pain associated with intermitted night sweats and weight loss. Imaging was concerning diffuse vertebral metastatic lesions. He underwent extensive workup to evaluate for metastatic disease. However, right iliac crest, mediastinal, and left inguinal lymph node biopsies were consistent with sarcoidosis. He was started on methotrexate, folic acid, and prednisone.

https://ift.tt/2O1O9iX

Combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma

The Laryngoscope, EarlyView.

https://ift.tt/2wZPnUk

Protopanaxatriol inhibits melanin synthesis through inactivation of the pCREB–MITF–tyrosinase signalling pathway in melanocytes

Clinical and Experimental Dermatology, EarlyView.

https://ift.tt/2CMGO5J

Effect of ingenol mebutate on actinic keratosis in a Korean population: A prospective clinical, dermoscopic and histopathological study from a single center

The Journal of Dermatology, EarlyView.

https://ift.tt/2Nt4kJ2

Monitoring serum cytokeratin 19 fragment 21‐1 to determine the efficacy of docetaxel chemotherapy in advanced extramammary Paget's disease

The Journal of Dermatology, EarlyView.

https://ift.tt/2Cx3R4d

Wound, pressure ulcer and burn guidelines – 2: Guidelines for the diagnosis and treatment of pressure ulcers, second edition

The Journal of Dermatology, EarlyView.

https://ift.tt/2Nt4ccw

Αρχειοθήκη ιστολογίου

Ετικέτες

Κυριακή 9 Σεπτεμβρίου 2018

Abstract

Abstract

Abstract

Abstract

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objectives

Methods

Results

Conclusion

Abstract

Background

Objective

Type of review

Search strategy

Evaluation method

Conclusion

Abstract

Abstract

Abstract

Background

Objective

Methods

Results

Conclusions

Abstract