Texas Hill Country ENT Symposium Scheduled for April 2018

Mark your calendars for the McGovern Medical School Department of Otorhinolaryngology-Head and Neck Surgery's two-day CME meeting in the Texas... Read the full article...

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Branchial Cleft Cyst Resection: A Pediatric Patient Benefits from Texas Medical Center Expertise and the Convenience of Follow-up ENT Care in Southeast Houston

When J. Caleb Simmons, MD, started medical school, he thought he might be a pediatrician. Today as an otolaryngologist, nearly... Read the full article...

https://ift.tt/2pCONIu

Dr. Michael Byrd Named 2017 Physician of the Year at Memorial Hermann Southeast Hospital

Otolaryngologist Michael Byrd, MD, has been recognized as 2017 Physician of the Year at Memorial Hermann Southeast Hospital, a 274-bed... Read the full article...

https://ift.tt/2pCiWZs

2017 Lone Star Rhinology Course Recap

More than 80 physicians participated in Lone Star Rhinology 2017, an intensive two-day CME program dedicated to the study of... Read the full article...

https://ift.tt/2IPlc7m

Modulating ion channel function with antibodies and nanobodies

Catelijne Stortelers | Carolina Pinto-Espinoza | Diane Van Hoorick | Friedrich Koch-Nolte

https://ift.tt/2IQ5gSH

Diffuse Gastric Ganglioneuromatosis: Novel Presentation of PTEN Hamartoma Syndrome—Case Report and Review of Gastric Ganglioneuromatous Proliferations and a Novel PTEN Gene Mutation

Gastrointestinal ganglioneuromatous proliferations are rare, most often found in the colon, and are three types: polypoid ganglioneuromas, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. We present a case of diffuse ganglioneuromatosis in the posterior gastric wall in a nine-year-old female. To our knowledge, this is the first reported case of diffuse ganglioneuromatosis located in the stomach. Only six cases of gastric ganglioneuromatous proliferations have previously been reported, two in English and none were diffuse ganglioneuromatosis. A diagnosis of diffuse ganglioneuromatosis is relevant for patient care because, unlike sporadic polypoid ganglioneuromas or ganglioneuromatous polyposis, most are syndromic. Diffuse ganglioneuromatosis is commonly associated with neurofibromatosis type 1, multiple endocrine neoplasia type 2b, and Cowden Syndrome, one of the phenotypes of PTEN hamartoma tumor syndrome. The patient had the noted gastric diffuse ganglioneuromatosis, as well as other major and minor criteria for Cowden syndrome. Genetic testing revealed a novel frameshift mutation in the PTEN gene in the patient, her father, paternal aunt, and the aunt's son who is a paternal first cousin of the patient.

https://ift.tt/2G4NkpC

Effect of Cathodal Transcranial Direct Current Stimulation on a Child with Involuntary Movement after Hypoxic Encephalopathy

The aim of the study was to investigate the effect of cathodal transcranial direct current stimulation to the supplementary motor area to inhibit involuntary movements of a child. An 8-year-old boy who developed hypoxic encephalopathy after asphyxia at the age of 2 had difficulty in remaining standing without support because of involuntary movements. He was instructed to remain standing with his plastic ankle-foot orthosis for 10 s at three time points by leaning forward with his forearms on a desk. He received cathodal or sham transcranial direct current stimulation to the supplementary motor area at 1 mA for 10 min. Involuntary movements during standing were measured using an accelerometer attached to his forehead. The low-frequency power of involuntary movements during cathodal transcranial direct current stimulation significantly decreased compared with that during sham stimulation. No adverse effects were observed. Involuntary movement reduction by cathodal stimulation to supplementary motor areas suggests that stimulations modulated the corticobasal ganglia motor circuit. Cathodal stimulation to supplementary motor areas may be effective for reducing involuntary movements and may be safely applied to children with movement disorders.

https://ift.tt/2uihHn0

“Tumulus” stabilization of a total ossicular replacement prosthesis

Publication date: Available online 24 March 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): T. Mom, C. Caburet, N. Saroul, L. Gilain, M. Gersdorff
Functional failure of total ossicular replacement prostheses (TORP) is often due to secondary displacement, ranging from simple subluxation to prosthesis extrusion following recurrence of severe tympanic membrane retraction. Several surgical techniques have been proposed to stabilize a TORP, mostly using superimposed non-organic or resorbable heterologous materials. We describe a simple so-called "tumulus" surgical technique that limits prosthesis displacement and extrusion, regardless of the type of TORP, by using a few fragments of autologous cartilage that are always available and perfectly tolerated at no cost. Review of 31 cases treated by this technique did not reveal any cases of prosthesis displacement and only one case (3.2%) of prosthesis extrusion with audiometric results comparable to the best results reported in the literature.



https://ift.tt/2DQioU3

In-clinic secondary tracheoesophageal puncture and voice prosthesis placement in laryngectomees

Publication date: Available online 24 March 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Ricci, G. Riva, F. Dagna, E. Seglie, A.L. Cavalot
Secondary tracheoesophageal puncture (TEP) with voice prosthesis placement represents one of the possibility to restore vocal function after total laryngectomy. However, some patients have comorbidities that contraindicate general anesthesia. In our department, an in-clinic TEP procedure for retrograde voice prosthesis placement was developed. It allows the immediate placement of the prosthesis and the avoidance of the use of dilators. We described our technique with advantages and pitfalls. The Provox Vega Puncture Set was used. Our technique for in-clinic secondary TEP without general anesthesia or target controlled infusion was a safe and effective procedure. It allows the use of the traditional TEP set, with possibility of voice prosthesis placement after previous TEP closure.



https://ift.tt/2IRobMy

Association between impaired IL-10 production following exposure to Staphylococcus aureus enterotoxin B and disease severity in eosinophilic chronic rhinosinusitis

Publication date: Available online 23 March 2018
Source:Allergology International
Author(s): Takenori Haruna, Shin Kariya, Tazuko Fujiwara, Takaya Higaki, Seiichiro Makihara, Kengo Kanai, Rumi Fujiwara, Satoshi Iwasaki, Yoshihiro Noguchi, Kazunori Nishizaki, Mitsuhiro Okano
BackgroundIL-10 is a major anti-inflammatory cytokine that prevents inflammation-mediated tissue damage. We characterized the production of IL-10 by sinonasal tissue cells following exposure to Staphylococcus aureus enterotoxin B (SEB), which elicits cellular responses and is associated with the pathogenesis of eosinophilic chronic rhinosinusitis (ECRS).MethodsDispersed nasal polyp (NP) cells and uncinate tissue (UT) cells were prepared from patients with CRS with and without NP, respectively. Cells were incubated with SEB, and then the levels of IL-10 in the cell supernatants were determined. The effect of neutralizing IL-10 on SEB-induced IL-5, IL-13, IFN-γ, and IL-17A production was examined. Expression of IL-10 in NPs was also determined.ResultsIL-10 was expressed in infiltrating inflammatory cells in NPs. NP cells, especially non-adherent NP cells, produced substantial amounts of IL-10 in response to SEB. Although baseline production of IL-10 was significantly higher in NP cells than UT cells, the degree of IL-10 response to SEB was not significantly different between the cell types. The degree of IL-10 production was negatively correlated with the degree of eosinophilia both in tissues and peripheral blood whereas positively correlated with the 1-s forced expiratory volume/forced vital capacity ratio. Patients with severe ECRS displayed a significant decrease in IL-10 production compared with those with non-ECRS. IL-10 neutralization significantly augmented SEB-induced IL-13 and IFN-γ production by NP cells.ConclusionsImpaired IL-10 production in response to SEB in NP may exacerbate the pathophysiology of ECRS including eosinophilia and lower airway obstruction.



https://ift.tt/2pE8X5G

Reduced heart rate variability and increased saliva cortisol in patients with TMD

Publication date: Available online 23 March 2018
Source:Archives of Oral Biology
Author(s): Suruedee Chinthakanan, Kittipong Laosuwan, Pattriyaporn Boonyawong, Sirinart Kumfu, Nipon Chattipakorn, Siriporn C. Chattipakorn
Temporomandibular disorders (TMD) are the most common source of non-dental pain. The pathogenesis of TMD is multifactorial, involving biological, psychological and behavioral factors. Those factors are involved with alterations of the autonomic nervous system (ANS) and stressful conditions. Heart rate variability (HRV) has been used as a marker of ANS function. Increased cortisol level (a stress indicator), has been found in chronic pain. Therefore, the present study aimed to compare pain intensity, HRV, psychological factors, and salivary cortisol level between TMD patients and a control group. Twenty-one TMD patients and twenty-three healthy control subjects participated in the study. All participants underwent 24-hour-Holter monitoring to record HRV. Morning unstimulated saliva samples were collected from each participant for cortisol analysis. The pain intensity was assessed using a visual analog scale. The participants were evaluated for anxiety and depression via the Hospital Anxiety and Depression Scales. We found that pain intensity and psychological distress in the TMD group were significantly greater than those of the control (p < 0.01). Pain intensity showed a positive correlation with psychological distress (p < 0.01). HRV parameters in the TMD group were significantly lower than those in the control, suggesting reduced HRV in TMD patients. Pain intensity was negatively associated with HRV. Salivary cortisol level of the TMD group was greater than that of control. Our findings indicate that reduced HRV with higher psychological distress and increased salivary cortisol levels were observed in the TMD group. Therefore, TMD patients may benefit from interventions that can restore ANS function and stress balance.



https://ift.tt/2G3l072

Drug Treatment for Androgenetic Alopecia: First Italian Questionnaire Survey on What Dermatologists Think about Finasteride

Abstract

Introduction

Treatment with finasteride 1 mg/day represents the therapy of choice for androgenetic alopecia (AGA). We investigated how Italian dermatologists approach use of finasteride for treatment of AGA and common side effects reported by patients.

Methods

A tablet-based survey was conducted from February 2017 to January 2018 in Italy to investigating use of 1 mg/day finasteride in the treatment of AGA. Approximately 1153 Italian dermatologists were surveyed about prescription frequency, therapy duration, treatment practices, and side effects eventually reported.

Results

Dermatologists considered treatment with 1 mg/day finasteride to be the most efficacious treatment for AGA, as reflecting by its long-term (5 years) prescription. Data on sexual side effects from our survey are in line with previous scientific evidence, especially regarding loss of libido, erectile dysfunction, and problems with ejaculation, but also in the psychological sphere and regarding physical impairments such as myalgia and loss of muscle tone.

Conclusions

This is the first preliminary observational study on how Italian dermatologists approach use of finasteride to treat AGA. Although side effects have been reported, especially in the sexual sphere, lack of alternative treatments with the same efficacy leads dermatologists to prescribe 1 mg/day finasteride with a tendency to prolong therapy in the long term.

Funding

Giuliani S.p.A.

https://ift.tt/2ubWdb6

Occupational exposure and asthma

Publication date: Available online 23 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anh Dao, David I. Bernstein




https://ift.tt/2pFKYCe

Barriers to medication adherence in asthma: the importance of culture and context

Publication date: Available online 23 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Elizabeth L. McQuaid
ObjectiveSignificant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.Data SourcesData were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials.Study Selection. Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity.ResultsThere is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of Complementary and Alternative Medicine (CAM) use, difficulties communicating with patients and caregivers with limited English proficiency (LEP), and implicit biases regarding cultural differences. Systems issues (e.g., insurance status, cost) and social context factors (e.g. exposure to violence) also present challenges. Culturally-informed strategies that capitalize on patient strengths and training providers in culturally-informed communication strategies hold promise as intervention approaches.ConclusionDisparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.



https://ift.tt/2pAPSkK

Climate Change and the Impact on Respiratory and Allergic Disease: 2018

Abstract

Purpose of Review

The purpose of this paper is to review allergic respiratory disease related to indoor and outdoor exposures and to examine the impact of known and projected changes in climate. The global burden of disease directly attributed to climate change is very difficult to measure and becomes more challenging when the capacity of humans to adapt to these changes is taken into consideration. Allergic respiratory disease, such as asthma, is quite heterogenous, though closely associated with environmental and consequently immunologic interaction. Where is the tipping point?

Recent Findings

Our climate has been measurably changing for the past 100 years. It may indeed be the most significant health threat of the twenty-first century, and consequently tackling climate change may be the greatest health opportunity. The impacts of climate change on human health are varied and coming more into focus. Direct effects, such as heatwaves, severe weather, drought, and flooding, are apparent and frequently in the news. Indirect or secondary effects, such as changes in ecosystems and the impact on health, are less obvious. It is these changes in ecosystems that may have the greatest impact on allergic and respiratory diseases.

Summary

This review will explore some ways that climate change, current and predicted, influences respiratory disease. Discussion will focus on changing pollen patterns, damp buildings with increased mold exposure, air pollution, and heat stress.

https://ift.tt/2HXuv3S

Treatment of Allergic Rhinitis as a Strategy for Preventing Asthma

Abstract

Purpose of Review

To evaluate the impact of allergic rhinitis (AR) on the development of asthma and to update readers on recent literature suggesting that early treatment of allergic subjects with immunotherapy may prevent asthma onset.

Recent Findings

AR is frequently associated with asthma, leading to the concept that these two conditions are different aspects of the same disease. There is increasing evidence that AR precedes the onset of asthmatic symptoms and current treatment strategies are beneficial in symptom control with no impact prevention. There is limited knowledge about the risk factors responsible for the progression of AR to asthma, though recent data supports the notion that it is possible to prevent asthma onset by allergen immunotherapy.

Summary

Despite significant advances in specific immunotherapy (SIT) therapy strengthening its efficacy in AR and possible prevention of progression to asthma, the adoption of this therapeutic strategy is still restricted in comparison to therapies directed towards treatment of AR symptoms. Unlike corticosteroids and other symptomatic therapies, the benefit of SIT treatment in allergic individuals has been shown to prevent the development of allergic conditions. Hence, large well-conducted randomized clinical trials with long-term efficacy of SIT are required to confirm or refute the concept that SIT may abrogate the progression of AR to asthma in patients.

https://ift.tt/2pynYpS

Immigrant Respiratory Health: a Diverse Perspective in Environmental Influences on Respiratory Health

Abstract

Purpose of Review

The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA.

Recent Findings

Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations.

Summary

Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person's respiratory health are needed to begin to tackle these disparities.

https://ift.tt/2pD257J

How Do Storms Affect Asthma?

Abstract

Purpose of Review

There are observations in various geographical areas that thunderstorms occurring during pollen seasons can induce severe asthma attacks in pollinosis patients.

Recent Findings

An accredited hypothesis explaining the association between thunderstorms and asthma suggests that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20–30 min of a thunderstorm, patients affected by pollen allergy may inhale a high quantity of the allergenic material that is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. A key message is that all subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe asthma exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events. Patients with respiratory allergy induced by pollens and molds need to be informed about a correct therapeutic approach of bronchial asthma by inhalation, including the use of bronchodilators and inhaled corticosteroids.

Summary

The purpose of this review is to focalize epidemiological, etiopathogenetic, and clinical aspects of thunderstorm-related asthma.

https://ift.tt/2pynU9C

Severe Cutaneous Adverse Drug Reactions: Presentation, Risk Factors, and Management

Abstract

Purpose of Study

Immune-mediated adverse drug reactions occur commonly in clinical practice and include mild, self-limited cutaneous eruptions, IgE-mediated hypersensitivity, and severe cutaneous adverse drug reactions (SCAR). SCARs represent an uncommon but potentially life-threatening form of delayed T cell-mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis (AGEP) to drug reaction with eosinophilia with systemic symptoms (DRESS), to the most severe form of illness, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Recent Findings

There is emerging literature on the efficacy of cyclosporine in decreasing mortality in SJS/TEN.

Summary

The purpose of our review is to discuss the typical presentations of these conditions, with a special focus on identifying the culprit medication. We review risk factors for developing SCAR, including HLA alleles strongly associated with drug hypersensitivity. We conclude by discussing current strategies for the management of these conditions.

https://ift.tt/2I37i0p

Precision Medicine in Chronic Rhinosinusitis with Nasal Polyps

Abstract

Purpose of Review

Chronic rhinosinusitis is a disease with high prevalence, significant impact on health-related quality of life (HRQoL) and it is associated with substantial healthcare and productivity costs. We face an urgent need to improve the level of disease control and achieve higher patient satisfaction and disease prevention. Precision medicine is increasingly recognized as the way forward in optimal patient care. The combination of personalized care, prevention of disease, prediction of success of treatment, and participation of the patient in the elaboration of the treatment plan is expected to guarantee the best possible therapeutic approach for individuals suffering from a chronic disabling condition.

Recent Findings

This is a narrative review on the current state of endotypes, biomarkers, and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses. Different phenotypes of rhinitis and chronic rhinosinusitis (CRS) have been described based on symptom severity and duration, atopy status, level of control, comorbidities, and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different endotypes being recognized. Novel emerging therapies are targeting specific pathophysiological pathways or endotypes. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment.

Summary

This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.

https://ift.tt/2pBHHEZ

Erythroderma and extensive poikiloderma – a rare initial presentation of dermatomyositis: a case report

Dermatomyositis is a humoral-mediated inflammatory myopathy with symmetrical proximal muscle weakness and dermatological manifestations such as Gottron's papules, heliotrope rash, periungual abnormalities, and...

https://ift.tt/2IR9bP6

Climate Change and the Impact on Respiratory and Allergic Disease: 2018

Abstract

Purpose of Review

The purpose of this paper is to review allergic respiratory disease related to indoor and outdoor exposures and to examine the impact of known and projected changes in climate. The global burden of disease directly attributed to climate change is very difficult to measure and becomes more challenging when the capacity of humans to adapt to these changes is taken into consideration. Allergic respiratory disease, such as asthma, is quite heterogenous, though closely associated with environmental and consequently immunologic interaction. Where is the tipping point?

Recent Findings

Our climate has been measurably changing for the past 100 years. It may indeed be the most significant health threat of the twenty-first century, and consequently tackling climate change may be the greatest health opportunity. The impacts of climate change on human health are varied and coming more into focus. Direct effects, such as heatwaves, severe weather, drought, and flooding, are apparent and frequently in the news. Indirect or secondary effects, such as changes in ecosystems and the impact on health, are less obvious. It is these changes in ecosystems that may have the greatest impact on allergic and respiratory diseases.

Summary

This review will explore some ways that climate change, current and predicted, influences respiratory disease. Discussion will focus on changing pollen patterns, damp buildings with increased mold exposure, air pollution, and heat stress.

https://ift.tt/2HXuv3S

Treatment of Allergic Rhinitis as a Strategy for Preventing Asthma

Abstract

Purpose of Review

To evaluate the impact of allergic rhinitis (AR) on the development of asthma and to update readers on recent literature suggesting that early treatment of allergic subjects with immunotherapy may prevent asthma onset.

Recent Findings

AR is frequently associated with asthma, leading to the concept that these two conditions are different aspects of the same disease. There is increasing evidence that AR precedes the onset of asthmatic symptoms and current treatment strategies are beneficial in symptom control with no impact prevention. There is limited knowledge about the risk factors responsible for the progression of AR to asthma, though recent data supports the notion that it is possible to prevent asthma onset by allergen immunotherapy.

Summary

Despite significant advances in specific immunotherapy (SIT) therapy strengthening its efficacy in AR and possible prevention of progression to asthma, the adoption of this therapeutic strategy is still restricted in comparison to therapies directed towards treatment of AR symptoms. Unlike corticosteroids and other symptomatic therapies, the benefit of SIT treatment in allergic individuals has been shown to prevent the development of allergic conditions. Hence, large well-conducted randomized clinical trials with long-term efficacy of SIT are required to confirm or refute the concept that SIT may abrogate the progression of AR to asthma in patients.

https://ift.tt/2pynYpS

Immigrant Respiratory Health: a Diverse Perspective in Environmental Influences on Respiratory Health

Abstract

Purpose of Review

The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA.

Recent Findings

Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations.

Summary

Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person's respiratory health are needed to begin to tackle these disparities.

https://ift.tt/2pD257J

How Do Storms Affect Asthma?

Abstract

Purpose of Review

There are observations in various geographical areas that thunderstorms occurring during pollen seasons can induce severe asthma attacks in pollinosis patients.

Recent Findings

An accredited hypothesis explaining the association between thunderstorms and asthma suggests that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20–30 min of a thunderstorm, patients affected by pollen allergy may inhale a high quantity of the allergenic material that is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. A key message is that all subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe asthma exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events. Patients with respiratory allergy induced by pollens and molds need to be informed about a correct therapeutic approach of bronchial asthma by inhalation, including the use of bronchodilators and inhaled corticosteroids.

Summary

The purpose of this review is to focalize epidemiological, etiopathogenetic, and clinical aspects of thunderstorm-related asthma.

https://ift.tt/2pynU9C

Severe Cutaneous Adverse Drug Reactions: Presentation, Risk Factors, and Management

Abstract

Purpose of Study

Immune-mediated adverse drug reactions occur commonly in clinical practice and include mild, self-limited cutaneous eruptions, IgE-mediated hypersensitivity, and severe cutaneous adverse drug reactions (SCAR). SCARs represent an uncommon but potentially life-threatening form of delayed T cell-mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis (AGEP) to drug reaction with eosinophilia with systemic symptoms (DRESS), to the most severe form of illness, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Recent Findings

There is emerging literature on the efficacy of cyclosporine in decreasing mortality in SJS/TEN.

Summary

The purpose of our review is to discuss the typical presentations of these conditions, with a special focus on identifying the culprit medication. We review risk factors for developing SCAR, including HLA alleles strongly associated with drug hypersensitivity. We conclude by discussing current strategies for the management of these conditions.

https://ift.tt/2I37i0p

Precision Medicine in Chronic Rhinosinusitis with Nasal Polyps

Abstract

Purpose of Review

Chronic rhinosinusitis is a disease with high prevalence, significant impact on health-related quality of life (HRQoL) and it is associated with substantial healthcare and productivity costs. We face an urgent need to improve the level of disease control and achieve higher patient satisfaction and disease prevention. Precision medicine is increasingly recognized as the way forward in optimal patient care. The combination of personalized care, prevention of disease, prediction of success of treatment, and participation of the patient in the elaboration of the treatment plan is expected to guarantee the best possible therapeutic approach for individuals suffering from a chronic disabling condition.

Recent Findings

This is a narrative review on the current state of endotypes, biomarkers, and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses. Different phenotypes of rhinitis and chronic rhinosinusitis (CRS) have been described based on symptom severity and duration, atopy status, level of control, comorbidities, and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different endotypes being recognized. Novel emerging therapies are targeting specific pathophysiological pathways or endotypes. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment.

Summary

This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.

https://ift.tt/2pBHHEZ

Letter to the Editor referring to the retracted publication entitled “Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment” by Hwang et al.

Publication date: Available online 23 March 2018
Source:Oral Oncology
Author(s): Jason T.K. Hwang, Ying R. Gu, Benjamin J. Dickson, Mi Shen, Ranju Ralhan, Paul G. Walfish, David Mock, Kenneth P.H. Pritzker




https://ift.tt/2IKW2H8

Patrón olfativo en lesiones cerebrales no psiquiátricas ni traumáticas

Publication date: Available online 23 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Josep de Haro-Licer, Adela González-Fernández, Albert Planas-Comes, Josep Antón González-Ares
IntroducciónLas etiologías más frecuente de las patologías olfativas dentro de la otorrinolaringología suelen ser las producidas por resfriados, inflamaciones nasosinusales, alergias y traumatismos craneo-faciales, fuera de estas etiologías tenemos, con menor frecuencia, las enfermedades neurológicas, psiquiátricas, metabólicas. Nuestro servicio ha podido atender a pacientes con alteraciones neurológicas que presentan patologías olfativas.ObjetivoEste trabajo tiene por finalidad verificar qué tipo de alteraciones olfativas se hallan en las personas que padecen lesiones del sistema nervioso central excluidos los traumatismos craneales, las enfermedades psiquiátricas, las epilepsias, las enfermedades de Parkinson y Alzheimer y las sinestesias.Material metodosSe trata de un estudio descriptivo basado en un grupo de 61 pacientes diagnosticados de diversas lesiones neurológicas y de un grupo control. Ambos grupos fueron valorados por medio del olfatómetro BAST-24. Se comparan los resultados con un grupo control de 120 personas.ResultadosLos resultados muestran que las personas con estos tipos de lesiones neurológicas tienen una capacidad de percibir olores que oscila entre el 60 y el 77% mientras que el grupo control se sitúa entre el 98 y el 100%. Respecto a la capacidad de reconocer correctamente los olores, los paciente neurológicos no superan el 32% de aciertos, mientras que el grupo control se sitúa entre el 59 y el 75% de aciertos, siendo las diferencias olor a olor presentado estadísticamente significativas (p<0,05) tanto para la detección como para el acierto.Conclusionesa) Las alteraciones neurológicas no causadas por traumatismos craneales ni por alteraciones psiquiátricas pueden presentar una pérdida olfativa que oscila entre el 68 y el 89%. b) En este tipo de lesiones debe tenerse en cuenta la presencia de alteraciones olfativas. c) Hay alteraciones olfativas por afectación de otras áreas cerebrales distintas a las clásicas olfativas. d) Debe establecerse una colaboración entre los servicios de ORL y Neurología para poder atender dichas alteraciones.IntroductionThe most common cause of olfactory ENT disorders are colds and flu, chronic sinusitis, allergies and traumatic brain injury. Rarer aetiologies include certain neurological, psychiatric and metabolic injuries.TargetThe aim of this paper was to check the sort of olfactory disorders found in people who have suffered a brain injury, excluding: cranial traumas, psychiatric diseases, epilepsy, Parkinson's and Alzheimer's disease, and synaesthesia.Material and methodsA descriptive study based on 61 patients with diagnoses of various neurological injuries, which were tested by BAST-24 olfactometer. The results were compared with those of a control group (n= 120).ResultsThe results show major impairment in these patients' olfactory sense. The neurological injury patients were able to detect from 60-77% of the odours, while the control group were able to detect between 98-100%. The neurological patients were able, at best, to identify, 11-32% of the odours correctly, while the control group were able to correctly detect between 59 -75%. The differences between odour detection and correct identification were statistically significant (p<.05).ConclusionsWe concluded: a) Neurological injury, not caused by traumatic brain injury, psychiatric disorders or ENT diseases, ranged from 68-89% of the olfactory failures. b) We must bear in mind that these sorts of injuries can cause olfactory disorders. c) ENT and Neurologists should collaborate in the treatment of these disorders.



https://ift.tt/2pAVPxu

Parálisis bilateral de cuerdas vocales en pediatría: nuestra experiencia

Publication date: Available online 23 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): María Laura Scatolini, Hugo A. Rodriguez, Cinthia G. Pérez, Alejandro Cocciaglia, Hugo A. Botto, Mary Nieto, Lucas Bordino
La parálisis bilateral de cuerdas vocales (PBCV) es la segunda causa más frecuente de estridor neonatal. Nuestro objetivo es describir la demografía, etiología, comorbilidades y tratamientos instaurados.Materiales y métodosRevisión retrospectiva de las historias clínicas de pacientes con diagnóstico de PBCV de 2011 a 2015.ResultadosSe incluyeron 47 pacientes. La edad media de diagnóstico fue un mes de vida, con predominio de sexo masculino (63%). El 59% fue por causa congénita y el 41% adquirida, por lo general idiopática y postoperatoria, respectivamente. Se realizó traqueostomía (TQT) en 42 pacientes (89%), sin diferencias significativas en relación con la causa. La recuperación de la movilidad cordal fue del 39% en toda la muestra, 44% en la congénita, 31% en la adquirida y 62,5% en la idiopática. A 5 pacientes se les realizó laringotraqueoplastia con injerto costal posterior y a un paciente cordectomía posterior. Todos fueron decanulados. A un paciente se le realizó lateralización cordal, evitando la TQT.ConclusiónLas causas congénitas fueron las más frecuentes, en su mayoría idiopáticas. Se registró una leve predilección por el sexo masculino. Un alto porcentaje de pacientes requirieron de TQT. La tasa de recuperación de la movilidad es mayor en causas idiopáticas. Se decanularon todos los pacientes operados, pero se requieren trabajos con mayor número de participantes, comparación de técnicas y evaluación de la deglución y la fonación de forma objetiva.Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP.Material and methodsWe conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015.Results47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralization was performed, avoiding tracheostomy.ConclusionBVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary.



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Inhaltsverzeichnis

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