Unconventional use of fractional ablative CO2 laser in facial cutaneous sarcoïdosis

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Acknowledgment to Reviewers

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Adenoid cystic carcinoma of the breast – an aggressive presentation with pulmonary, kidney, and brain metastases: a case report

Adenoid cystic carcinoma of the breast is a rare malignant neoplasm associated with an excellent prognosis and a very rare occurrence of metastases.

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Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Publication date: Available online 29 October 2017
Source:American Journal of Otolaryngology
Author(s): Neha A. Patel, Kristen Carlin, Joseph M. Bernstein
SignificanceCurrent grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.ObjectiveTo propose and validate an easy-to-use flexible fiberoptic endoscopic grading system that provides physicians with a more accurate sense of the three-dimensional relationship of the tonsillar fossa to the upper-airway.Methods50 consecutive pediatric patients were prospectively recruited between February 2015 and February 2016 at a pediatric otolaryngology outpatient clinic. The patients had no major craniofacial abnormalities and were aged 1 to 16years. Each patient had data regarding BMI, Friedman palate position, OSA-18 survey results collected. For each child, digital video clips of fiberoptic nasopharyngeal, oropharyngeal and laryngeal exams were presented to 2 examiners. Examiners were asked to independently use the proposed Endoscopic tonsillar grading system, the Brodsky tonsillar grading scale, the Modified Brodsky tonsillar grading scale with a tongue depressor, and the Parikh adenoid grading system to rate adenotonsillar hypertrophy. Cohen's Kappa and weighted Kappa scores were used to assess interrater reliability for each of the four grading scales. The Spearman correlation was used to test the associations between each scale and OSA-18 scores, as well as Body Mass Index (BMI).Results50 pediatric patients were included in this study (mean age 6.1years, range of 1year to 16years). The average BMI was 20. The average OSA-18 score was 61.7. The average Friedman palate position score was 1.34. Twelve percent of the patients had a Friedman palate position score≥3, which made traditional Brodsky grading of their tonsils impossible without a tongue depressor. All four scales showed strong agreement between the two raters. The weighted Kappa was 0.83 for the Modified Brodsky scale, 0.89 for the Brodsky scale, 0.94 for the Parikh scale to 0.98 for the Endoscopic scale (almost perfect agreement). The Endoscopic scale showed the most consistent agreement between the raters during the study. There was a moderate association between the Parikh adenoid grading system with OSA-18 scores (Spearman's ρ=0.58, p<0.001) compared to a low association of the tonsillar grading systems with OSA- 18 scores. None of the scales correlated with patient BMI.ConclusionsThe proposed Endoscopic tonsillar grading system is as reliable of a method of grading tonsillar size as conventional grading systems. It offers the advantage of allowing for critical evaluation of the tonsils without any anatomic distortion which may occur with the use of a tongue blade. This new validated endoscopic grading system provides a tool for communicating the degree of airway obstruction at the level of the oropharynx regardless of Friedman palate position and may be used in future outcomes projects.



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Cat ownership, cat allergen exposure, and trajectories of sensitization and asthma throughout childhood

Publication date: Available online 28 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Healson Ihuoma, Danielle C. Belgrave, Clare S. Murray, Philip Foden, Angela Simpson, Adnan Custovic
Exposure to cat and/or cat allergens can confer either an increase in risk, or protection, or will have no effect, depending on the age of the assessment, study design and the choice of study population.



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Monitoring inflammatory heterogeneity with multiple biomarkers for multidimensional endotyping of asthma

Publication date: Available online 5 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Ioana Agache, Daniel S. Strasser, Gabin M. Pierlot, Hervé Farine, Kenji Izuhara, Cezmi A. Akdis




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Nitrogen dioxide exposure in school classrooms of inner-city children with asthma

Publication date: Available online 5 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jonathan M. Gaffin, Marissa Hauptman, Carter R. Petty, William J. Sheehan, Peggy S. Lai, Jack M. Wolfson, Diane R. Gold, Brent A. Coull, Petros Koutrakis, Wanda Phipatanakul
BackgroundAmbient and home exposure to nitrogen dioxide (NO2) causes asthma symptoms and decreased lung function in children with asthma. Little is known about the health effects of school classroom pollution exposure.ObjectiveWe aimed to determine the effect of indoor classroom NO2 on lung function and symptoms in inner-city school children with asthma.MethodsChildren enrolled in the School Inner-City Asthma Study were followed for 1 academic year. Subjects performed spirometry and had fraction of exhaled nitric oxide values measured twice during the school year at school. Classroom NO2 was collected by means of passive sampling for 1-week periods twice per year, coinciding with lung function testing. Generalized estimating equation models assessed lung function and symptom relationships with the temporally nearest classroom NO2 level.ResultsThe mean NO2 value was 11.1 ppb (range, 4.3-29.7 ppb). In total, exposure data were available for 296 subjects, 188 of whom had complete spirometric data. At greater than a threshold of 8 ppb of NO2 and after adjusting for race and season (spirometry standardized by age, height, and sex), NO2 levels were associated highly with airflow obstruction, such that each 10-ppb increase in NO2 level was associated with a 5% decrease in FEV1/forced vital capacity ratio (β = −0.05; 95% CI, −0.08 to −0.02; P = .01). Percent predicted forced expiratory flow between the 25th and 75th percentile of forced vital capacity was also inversely associated with higher NO2 exposure (β = −22.8; 95% CI, −36.0 to −9.7; P = .01). There was no significant association of NO2 levels with percent predicted FEV1, fraction of exhaled nitric oxide, or asthma symptoms. Additionally, there was no effect modification of atopy on lung function or symptom outcomes.ConclusionIn children with asthma, indoor classroom NO2 levels can be associated with increased airflow obstruction.



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