The relationship of hypertension with obesity and obstructive sleep apnea in adolescents.

The relationship of hypertension with obesity and obstructive sleep apnea in adolescents.:

The relationship of hypertension with obesity and obstructive sleep apnea in adolescents.

Pediatr Pulmonol. 2020 Feb 18;:

Authors: Khan MA, Mathur K, Barraza G, Sin S, Yang CJ, Arens R, Sutton N, Mahgerefteh J

Abstract

OBJECTIVES: To assess the independent relationships of obesity and obstructive sleep apnea (OBA) with hypertension/elevated blood pressure (EBP) in adolescent patients.

STUDY DESIGN: A retrospective cohort analysis was performed on 501 patients (age 13-21 years) with three separate blood pressure measurements within 6 months of polysomnography. EBP was defined as average systolic blood pressure (SBP) ≤120 mm Hg; obesity as body mass index Z-score ≤1.65; and OBA as obstructive apnea-hypopnea index <1. Pearson correlations and multivariable analyses were performed to assess the independent effects of the apnea-hypopnea index and body mass index Z-score on SBP.

RESULTS: Of 501 patients (mean age 16 ± 2 years), 246 (49%) were male. OBA was present in 329 (66%) patients, obesity in 337 (67%), and EBP in 262 (52%). EBP was present in 70% of obese adolescents and 60% of adolescents with OBA. Univariable correlation showed a significant relationship between SBP, body mass index Z-score, and apnea-hypopnea index. Multivariable linear regression analysis showed blood pressure was significantly associated with body mass index Z-score (β = .46; P < .01), age (β = .25; P < .01), and height Z-score (β = .14; P < .01), but not apnea-hypopnea index (β = .01; P = .72).

CONCLUSIONS: The relationship between OBA and EBP in adolescents is most closely associated with the degree of obesity. Further studies are needed to assess the effect of the treatment of obesity and OBA on blood pressure in adolescents.

PMID: 32068974 [PubMed - as supplied by publisher]

Combination of head-up sleep and vertical recognition training may cure intractable motion-evoked dizziness with unknown origin.

Combination of head-up sleep and vertical recognition training may cure intractable motion-evoked dizziness with unknown origin.:

Combination of head-up sleep and vertical recognition training may cure intractable motion-evoked dizziness with unknown origin.

Acta Otolaryngol. 2020 Feb 18;:1-6

Authors: Kitahara T, Horinaka A, Shiozaki T, Ito T, Wada Y, Yamanaka T, Nario K

Abstract

Background: It has been reported that head-up sleep (HUS) prevents free-floating otoliths from entering canals and that vertical recognition training (VRT) promotes vestibular compensation.Aims/objectives: We would like to assess HUS and VRT for intractable motion-evoked dizziness, including possible benign paroxysmal positional vertigo (BPPV).Materials and methods: 162 patients diagnosed with intractable motion-evoked dizziness of unknown origin were enrolled and randomly divided into the following four groups: HUS-/VRT-, HUS+/VRT-, HUS-/VRT+, and HUS+/VRT+. The at-home interventions comprised HUS with an upper head position of 45° when lying down and VRT with a right down-left down 30° head inclination while watching the vertical index.Results: At the post-treatment 6th month, visual analogue scale (VAS) scores for vertiginous sensation were significantly lower in the HUS+/VRT + group than in the HUS+/VRT - and HUS-/VRT + groups, which were in turn significantly lower than those in the HUS-/VRT - group. VAS scores in the HUS-/VRT + group of patients with abnormal subjective visual vertical (SVV) were significantly lower than those in the HUS+/VRT - group, while those in the HUS+/VRT - group of patients with normal SVV were significantly lower than those in the HUS-/VRT + group.Conclusions: HUS and/or VRT is a good initial treatment for patients with intractable undiagnosed motion-evoked dizziness, including possible BPPV.

PMID: 32069120 [PubMed - as supplied by publisher]

Audiological outcome measures with the BONEBRIDGE transcutaneous bone conduction hearing implant: impact of noise, reverberation and signal processing features.

Audiological outcome measures with the BONEBRIDGE transcutaneous bone conduction hearing implant: impact of noise, reverberation and signal processing features.:

Audiological outcome measures with the BONEBRIDGE transcutaneous bone conduction hearing implant: impact of noise, reverberation and signal processing features.

Int J Audiol. 2020 Feb 18;:1-10

Authors: Curca IA, Parsa V, Macpherson EA, Scollie S, Vansevenant K, Zimmerman K, Lewis-Teeter J, Allen P, Parnes L, Agrawal S

Abstract

Objective: To assess the performance of an active transcutaneous implantable-bone conduction device (TI-BCD), and to evaluate the benefit of device digital signal processing (DSP) features in challenging listening environments.Design: Participants were tested at 1- and 3-month post-activation of the TI-BCD. At each session, aided and unaided phoneme perception was assessed using the Ling-6 test. Speech reception thresholds (SRTs) and quality ratings of speech and music samples were collected in noisy and reverberant environments, with and without the DSP features. Self-assessment of the device performance was obtained using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire.Study sample: Six adults with conductive or mixed hearing loss.Results: Average SRTs were 2.9 and 12.3 dB in low and high reverberation environments, respectively, which improved to -1.7 and 8.7 dB, respectively with the DSP features. In addition, speech quality ratings improved by 23 points with the DSP features when averaged across all environmental conditions. Improvement scores on APHAB scales revealed a statistically significant aided benefit.Conclusions: Noise and reverberation significantly impacted speech recognition performance and perceived sound quality. DSP features (directional microphone processing and adaptive noise reduction) significantly enhanced subjects' performance in these challenging listening environments.

PMID: 32069128 [PubMed - as supplied by publisher]

Assessing Free Flap Reconstruction Accuracy of the Midface and Orbit Using Computer-Aided Modeling Software.

Assessing Free Flap Reconstruction Accuracy of the Midface and Orbit Using Computer-Aided Modeling Software.:

Assessing Free Flap Reconstruction Accuracy of the Midface and Orbit Using Computer-Aided Modeling Software.

Facial Plast Surg Aesthet Med. 2020 Feb 18;:

Authors: Zhu B, Han M, Heaton C, Park AM, Seth R, Knott PD

Abstract

Importance: Aesthetically pleasing and functionally stable total maxillectomy reconstruction is among the greatest of challenges within head and neck surgery. Maintaining presurgical midface projection, contour, and cheek volume requires high-fidelity restorative control incorporating the provision of stable osseous support to prevent the relatively commonplace complications of lower lid and globe malposition. Objective: To determine the difference in position of the reconstructed infraorbital rim compared with the contralateral normal side, and its effect on globe position, lower eyelid position, orbital volume, and soft tissue contour. Design, Setting, and Participants: This was a case series from 2011 to 2018 in a tertiary academic center. Twelve adult patients underwent free flap reconstruction of the maxilla and inferior orbit by the senior surgeon. Patients with bilateral defects, intact orbital floors, or orbital exenterations were excluded, as were patients without high-resolution postoperative computed tomography (CT) scans. Exposures: Fibular free flaps with orbital floor plates were used in all but one patient, in whom an anterolateral thigh free flap with mesh was used instead. Digital three-dimensional models of the bone and soft tissue were generated from postoperative CT scans using open-source software. Main Outcomes and Measures: Differences in vertical height and anterior projection of the infraorbital rim on the reconstructed side were compared with the normal side. Differences in globe position and lower lid margin were obtained, as were orbital volumes. Differences in soft tissue contour were also examined in six patients who had CT scans at least 6 months after surgery and/or radiation therapy. Results: The absolute mean differences in infraorbital rim height, globe height, lower lid height, and orbital volume were 3.5 mm, 2.5 mm, 3.2 mm, and 2.4 cm3, respectively. The absolute mean difference in soft tissue contour was 10.3 mm for those patients with >6 months follow-up. Differences in infraorbital rim height and globe height were highly correlated (R = 0.77, p = 0.004), as were differences in infraorbital rim height and lower lid height (R = 0.76, p = 0.004). Conclusions and Relevance: Accurate orbitomaxillary free flap reconstruction is possible with precise positioning of the reconstructed infraorbital rim, as this likely affects the position of the lower lid and globe. This methodology of computer-aided modeling with free open-source software may lay the groundwork for future studies seeking to quantify results of facial reconstruction. Level of Evidence: 4.

PMID: 32069136 [PubMed - as supplied by publisher]

Implications of Tumor Size, Subsite, and Adjuvant Therapy on Outcomes in pT4aN0 Oral Cavity Carcinoma.

Implications of Tumor Size, Subsite, and Adjuvant Therapy on Outcomes in pT4aN0 Oral Cavity Carcinoma.:

Implications of Tumor Size, Subsite, and Adjuvant Therapy on Outcomes in pT4aN0 Oral Cavity Carcinoma.

Otolaryngol Head Neck Surg. 2020 Feb 18;:194599820904679

Authors: Namin AW, Bollig CA, Harding BC, Dooley LM

Abstract

OBJECTIVE: To determine if tumor size, subsite, and adjuvant radiation therapy (AXRT) are associated with overall survival (OS) in patients with pT4aN0 oral cavity squamous cell carcinoma (OSCC) who underwent mandibulectomy with negative surgical margins (NSMs).

STUDY DESIGN: Retrospective cohort study.

SETTING: National Cancer Database (NCDB).

SUBJECTS AND METHODS: Retrospective analysis of the NCDB that included patients diagnosed with pT4aN0 OSCC who underwent mandibulectomy with NSMs between 2004 and 2015. The association of age, Charlson-Deyo score (CDS), tumor size, subsite, and AXRT with OS was analyzed. The cases were divided into 3 subgroups based on maximal tumor dimension for subgroup analysis; tumors ≤2.0 cm, tumors 2.1 to 4.0 cm, and tumors >4.0 cm.

RESULTS: For the entire cohort; age (P < .001; hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02-1.03), CDS (P = .013; HR, 0.57; 95% CI, 0.37-0.89), tongue subsite (P = .003; HR, 2.01; 95% CI, 1.27-3.40), floor of mouth subsite (P = .001; HR, 1.76; 95% CI, 1.28-2.42), tumor size (P < .001; HR, 0.57; 95% CI, 0.45-0.72), and AXRT (P < .001; HR, 1.46; 95% CI, 1.24-1.72) were associated with OS on multivariate analysis. On subgroup analysis, AXRT not significantly associated with OS in patients with gingival, hard palate, retromolar trigone, and not specified tumors ≤2.0 cm (P = .323; HR, 1.29; 95% CI, 0.78-2.15).

CONCLUSIONS: In patients with pT4aN0 OSCC who underwent mandibulectomy with NSMs, age, CDS, tongue subsite, floor of mouth subsite, tumor size, and AXRT are associated with OS. AXRT was not significantly associated with overall survival in patients with gingival, hard palate, retromolar trigone, and not specified tumors ≤2.0 cm.

PMID: 32069171 [PubMed - as supplied by publisher]

Risk Factors and Outcomes of Postoperative Recurrent Well-Differentiated Thyroid Cancer: A Single Institution's 15-Year Experience.

Risk Factors and Outcomes of Postoperative Recurrent Well-Differentiated Thyroid Cancer: A Single Institution's 15-Year Experience.:

Risk Factors and Outcomes of Postoperative Recurrent Well-Differentiated Thyroid Cancer: A Single Institution's 15-Year Experience.

Otolaryngol Head Neck Surg. 2020 Feb 18;:194599820904923

Authors: Amin SN, Shinn JR, Naguib MM, Netterville JL, Rohde SL

Abstract

OBJECTIVE: Identify risk factors and outcomes of recurrent well-differentiated thyroid cancer.

STUDY DESIGN: Retrospective case-control analysis.

SETTING: Tertiary care academic center in Nashville, Tennessee.

SUBJECTS AND METHODS: This single-center analysis reviews 478 patients who underwent initial surgical management of well-differentiated thyroid carcinoma between 2002 and 2017. Patients were dichotomized with or without recurrent well-differentiated thyroid cancer. Demographic and clinicopathologic risk factors were carefully reviewed. Univariate, multiple regression, and survival analyses were used to evaluate predictors of recurrence.

RESULTS: Thirty-eight patients (7.9%) who received initial surgical intervention for well-differentiated thyroid carcinoma at our institution recurred, with an average time to recurrence of 24 months. Male sex, tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, number of positive lymph nodes, and low lymph node yield were all significantly associated with locoregional recurrence (P < .05). Multiple regression analysis showed that extrathyroidal extension, number of positive lymph nodes, and low lymph node yield were independent factors predictive of posttreatment recurrence (P < .05). Metastatic lymph node ratio, the ratio of positive lymph nodes extracted to lymph node yield, of ≥0.3 is associated with increased risk of recurrence (P < .001) and decreased 5-year recurrence free survival (P < .001).

CONCLUSION: Extrathyroidal extension, number of positive lymph nodes, and low lymph node yield are independent clinicopathologic risk factors for postoperative recurrence of well-differentiated thyroid cancer. Metastatic lymph node ratio is uncommonly used but can be an important prognosticator of recurrence. Patients with metastatic lymph node ratio ≥0.3 should be counseled on their increased risk of recurrence and should undergo close surveillance following surgery.

PMID: 32069184 [PubMed - as supplied by publisher]

Novel EGFR ectodomain mutations associated with ligand-independent activation and cetuximab resistance in head and neck cancer.

Novel EGFR ectodomain mutations associated with ligand-independent activation and cetuximab resistance in head and neck cancer.:

Novel EGFR ectodomain mutations associated with ligand-independent activation and cetuximab resistance in head and neck cancer.

PLoS One. 2020;15(2):e0229077

Authors: Nair S, Trummell HQ, Rajbhandari R, Thudi NK, Nozell SE, Warram JM, Willey CD, Yang ES, Placzek WJ, Bonner JA, Bredel M

Abstract

Epidermal growth factor receptor (EGFR) is a pro-tumorigenic receptor tyrosine kinase that facilitates growth for cancer cells that overexpress the receptor. Monoclonal anti-EGFR antibody Cetuximab (CTX) provides significant clinical benefit in patients with head and neck squamous cell carcinoma (HNSCC). Missense mutations in the ectodomain (ECD) of EGFR can be acquired under CTX treatment and mimic the effect of large deletions on spontaneous untethering and activation of the receptor. Little is known about the contribution of EGFR ECD mutations to EGFR activation and CTX resistance in HNSCC. We identified two concurrent non-synonymous missense mutations (G33S and N56K) mapping to domain I in or near the EGF binding pocket of the EGFR ECD in patient-derived HNSCC cells that were selected for CTX resistance through repeated exposure to the agent in an effort to mimic what may occur clinically. Structural modeling predicted that the G33S and N56K mutants would restrict adoption of a fully closed (tethered) and inactive EGFR conformation while not permitting association of EGFR with the EGF ligand or CTX. Binding studies confirmed that the mutant, untethered receptor displayed reduced affinity for both EGF and CTX but demonstrated sustained activation and presence at the cell surface with diminished internalization and sorting for endosomal degradation, leading to persistent downstream AKT signaling. Our results demonstrate that HNSCC cells can select for EGFR ECD mutations under CTX exposure that converge to trap the receptor in an open, ligand-independent, constitutively activated state. These mutants impede the receptor's competence to bind CTX possibly explaining certain cases of CTX treatment-induced or de novo resistance to CTX.

PMID: 32069320 [PubMed - in process]

The Efficacy of Oral Celecoxib Following Surgical Rhinoplasty.

The Efficacy of Oral Celecoxib Following Surgical Rhinoplasty.:

The Efficacy of Oral Celecoxib Following Surgical Rhinoplasty.

Facial Plast Surg Aesthet Med. 2020 Feb 18;:

Authors: Newberry CI, McCrary HC, Cerrati EW

Abstract

Importance: Exploring potential methods of controlling postoperative rhinoplasty pain with non-narcotic medications. Objective: To examine the effects of celecoxib in reducing pain and possible opioid consumption after rhinoplasty surgery. Design, Setting, and Participants: This is a prospective cohort study of 51 consecutive patients who had undergone rhinoplasty surgery between July 2018 and May 2019 by a single facial plastic surgeon. A questionnaire regarding pain medication usage and complications was given to each patient at his or her initial 1-week postoperative visit. Patients were separated into groups based on whether celecoxib had been used perioperatively or not. Main Outcomes and Measures: In addition to demographic information, the following outcome measures were recorded for each group: type(s) of pain medications used, total opioid consumption, refills required, surgical complications, and related analgesic adverse effects. Results: Of the 51 patients included, 17 patients were provided celcoxib. Mean oxycodone-acetaminophen tablets taken in the celecoxib cohort was 4.2 (CI = 2.4-6.1), whereas mean tablets taken among controls was 14.8 (CI = 11.1-18.4) (p = 0.0006). Mean oxycodone-acetaminophen dose taken in the celecoxib cohort was 17.6 mg (CI = 9.0-26.3), whereas the mean among controls was 73.8 mg (CI = 55.5-92.0) (p = 0.0001). Mean total oral morphine equivalents (OMEs) were also reduced with an average of 26.5 OME (CI = 13.5-39.4) in the celecoxib cohort and 110.7 OMEs (CI = 83.3-138.0) in the control group (p = 0.001). Postoperative nausea and vomiting were significantly reduced in the celecoxib cohort versus the control group (p = 0.02). Overall, with the addition of celecoxib, there was a 76.2% decrease in milligrams of opioid use and an 83.4% decrease in incidence of nausea/vomiting. Conclusions and Relevance: Oral celecoxib appears to be effective in decreasing opioid consumption and nausea/vomiting rates after rhinoplasty without increasing surgical complications. Level of Evidence: 2.

PMID: 32069423 [PubMed - as supplied by publisher]

Enhanced Efficacy of Dust Mite Sublingual Immunotherapy in Low-Response Allergic Rhinitis Patients after Dose Increment at 6 Months: A Prospective Study.

Enhanced Efficacy of Dust Mite Sublingual Immunotherapy in Low-Response Allergic Rhinitis Patients after Dose Increment at 6 Months: A Prospective Study.:

Enhanced Efficacy of Dust Mite Sublingual Immunotherapy in Low-Response Allergic Rhinitis Patients after Dose Increment at 6 Months: A Prospective Study.

Int Arch Allergy Immunol. 2020 Feb 18;:1-9

Authors: Gao Y, Lin X, Ma J, Wei X, Wang Q, Wang M

Abstract

BACKGROUND: Several studies have suggested that sublingual immunotherapy (SLIT) involves a dose-response relationship and inadequate dosage might not achieve a favorable clinical effect.

OBJECTIVE: The aim of this prospective study was to investigate the efficacy and safety of increasing SLIT dosage at 6 months in patients with house dust mite-induced allergic rhinitis (AR) who had low response to treatment.

METHODS: A total of 157 AR participants aged 4-60 years were enrolled and received SLIT with Dermatophagoides farinae drops. After 6 months of SLIT, patients were interviewed and then classified into a high-response (HR) group and a low-response (LR) group based on the combined symptom and medication score (CSMS) reduction rate. Patients with a CSMS reduction rate over 50% were defined as HR and continued the original dose, while patients with a CSMS reduction rate ranging from 20 to 50% were defined as LR and received an increased dose (percentage of dosage increment, 33.33% for patients aged <14 years and 50% for patients aged ≥14 years). Patients with a CSMS reduction rate below 20% were considered nonresponse (NR) and recommended to withdraw from SLIT. CSMS, visual analog scale (VAS), and adverse events were assessed at 0.5, 1, 2, and 3 years during the 3-year treatment.

RESULTS: A total of 54 and 56 patients completed the treatment in the HR and LR groups, respectively. The CSMS and VAS of both groups decreased significantly at 6 months (p < 0.05). Significant differences between the two groups were found in CSMS and VAS at 6 months and 1 year (p < 0.05), but not in later follow-ups (p > 0.05). The improvement of adults in the LR group was significantly lower than that of children at 6 months (p < 0.05), but there was no difference in later follow-ups (p > 0.05). There was no difference in CSMS or VAS in patients with monosensitization and polysensitization in the same treatment group at 1 year and in subsequent visits (p> 0.05). Overall, 47 patients withdrew from this study due to NR (n = 22) and other reasons (n = 25).

CONCLUSIONS: Six months might be a critical time point for efficacy assessment and dosage adjustment for AR patients after SLIT. In patients with low response, dosage enhancement within a certain range may enhance the effectiveness of SLIT.

PMID: 32069460 [PubMed - as supplied by publisher]

Elucidation of the effect of plumbagin on the metastatic potential of B16F10 murine melanoma cells via MAPK signalling pathway

Elucidation of the effect of plumbagin on the metastatic potential of B16F10 murine melanoma cells via MAPK signalling pathway:

Abstract

Melanoma is the most dangerous form of skin cancer with a very poor prognosis. Melanoma develops when unrepaired DNA damage causes to skin cells to multiply and form malignant tumors. The current therapy is limited by the highly ability of this disease to metastasize rapidly. Plumbagin is a naphthoquinone (5‐hydroxy‐2‐methyl‐1, 4‐naphthoquinone), isolated from the roots of medicinal plant Plumbago zeylanica, and it is widely present in Lawsonia inermis L. It has been shown that plumbagin has an anti‐proliferative and anti‐invasive activities in various cancer cell lines; however, the anti‐cancer and anti‐metastatic effects of plumbagin are largely unknown against melanoma cells. In this study, we evaluated the effect of plumbagin on B16F10 murine melanoma cells . Plumbagin decreased B16F10 cell viability as well as the cell migration, adhesion, and invasion. The molecular mechanism was studied, and plumbagin downregulated genes relevant in MAPK pathway, matrix metalloproteinases (MMP's), and cell adhesion. Furthermore, plumbagin elevated the expression of apoptosis and tumors suppressor genes, and genes significant in reactive oxygen species (ROS) response. Taken together, our findings suggest that plumbagin has an anti‐invasion and anti‐metastasis effect on melanoma cancer cells by acting on MAPK pathway and its related genes.

Keratinocyte aquaporin‐3 expression induced by histone deacetylase inhibitors is mediated in part by peroxisome proliferator‐activated receptors (PPARs)

Keratinocyte aquaporin‐3 expression induced by histone deacetylase inhibitors is mediated in part by peroxisome proliferator‐activated receptors (PPARs):

Abstract

The water and glycerol channel, aquaporin‐3 (AQP3), plays an important role in the skin epidermis, with effects on hydration, permeability barrier repair and wound healing; therefore, information about the mechanisms regulating its expression is important for a complete understanding of skin function physiologically and in disease conditions. We previously demonstrated that histone deacetylase inhibitors (HDACi) induce the mRNA and protein expression of AQP3, in part through the p53 family, transcription factors for which acetylation is known to affect their regulatory activity. Another set of transcription factors previously shown to induce AQP3 expression and/or regulate skin function are the peroxisome proliferator‐activated receptors (PPARs). Since there are reports that PPARs are also acetylated, we examined the involvement of these nuclear hormone receptors in HDACi‐induced AQP3 expression. We first verified that a PPARγ agonist upregulated AQP3 mRNA and protein levels and that this increase was blocked by a PPARγ antagonist. We then showed that the PPARγ antagonist also inhibited AQP3 expression induced both by a broad‐spectrum HDACi and an HDAC3‐selective inhibitor. Interestingly, a PPARα antagonist also inhibited HDACi‐induced AQP3 expression. These antagonist effects were observed in both primary mouse and normal human keratinocytes. Furthermore, PPARγ overexpression enhanced HDACi‐stimulated AQP3 mRNA levels. Thus, our results suggest that PPARγ and/or PPARα may play a role in regulating AQP3 levels in the skin; based on the ability of PPAR agonists to promote epidermal differentiation and/or inhibit proliferation, topical PPAR agonists might be considered as a therapy for hyperproliferative skin disorders, such as psoriasis.

Heliovaccination: Solar mediated immunity against cancer

Heliovaccination: Solar mediated immunity against cancer:

Abstract

The protective effect of ultraviolet (UV) light against a host of malignancies is well characterised. It was recognised by WHO in their 2006 publication on the global burden of UV‐mediated disease. The mechanism by which this oncoprotective effect occurs remains unclear. Vitamin D has been mooted as a potential mediator. However, the evidence does not support this. I suggest that UV irradiation of the skin produces nascent malignant and pre‐malignant cells with associated generic tumour specific antigens. These are eliminated by immunosurveillance resulting in adaptive immunity. The clonal expansion of these immune cells protects against tumours in other viscera, effectively immunising the host. The evidence for this "heliovaccination" is very strong. Childhood UV exposure protects against cancer in adulthood. Tumour naïve individuals possess anti‐tumour antibodies. Antigen presenting cells mobilise to the skin following specifically UVB skin irradiation. It is time to rethink the link between UV light and cancer.

Different results of tracheoplasty for various tracheal diseases

Different results of tracheoplasty for various tracheal diseases: Ming-Ho Wu



Formosan Journal of Surgery 2020 53(1):14-19



Background: Tracheoplasty is a challenging surgical procedure for treating tracheal diseases. Preserving the voice and achieving normal breaths are considered favorable results. This article reports the mid-term results of tracheoplasty.

Materials and Methods: From July 1988 to June 2018, a total of 91 adults with various tracheal diseases who underwent tracheoplasty were enrolled in this study. Tracheal diseases were divided into two categories. Category 1 was not related to neoplasm and included posttracheostomy or postintubation tracheal stenosis, caustic tracheal stricture, tuberculous tracheal stenosis, and congenital tracheal stenosis. Category 2 was related to neoplasm and included tracheal neoplasm and tracheal invasion by thyroid cancer or esophageal cancer. The surgical procedures mainly involved segmental resection of the trachea, telescopic anastomosis following a middle split of thyroid-cricoid cartilage, spiral tracheoplasty, and slide tracheoplasty.

Results: One hospital death (1.1%) occurred. Favorable results of tracheoplasty were 81.3% (74/91). The failure rate of tracheoplasty was higher in Category 1 (24.2%, 15/62) than Category 2 (3.6%, 1/28). The subglottic involvement also induced a higher failure rate of tracheoplasty (35.3%, 6/17 vs. 13.7%, 10/73). However, the multivariate logistic regression model demonstrated that the category of tracheal disease and subglottis involvement did not statistically significant induce surgical failure of tracheoplasty. Sixteen (17.6%) patients had surgical failure resulted from anastomotic leaks, regrowth of granulation, or subglottic involvement.

Conclusions: Carefully evaluating the tracheal lesions and selecting the appropriate surgical procedure can yield favorable results of tracheoplasty.

The impact of alcohol intoxication on injury severity and outcomes of adult patients with different trauma type

The impact of alcohol intoxication on injury severity and outcomes of adult patients with different trauma type: Yee-San Lee, Chih-Fang Huang, Pei-Ming Wang, Shu-Hui Peng, Hang-Tsung Liu, Ching-Hua Hsieh



Formosan Journal of Surgery 2020 53(1):8-13



Background: This study was designed to investigate the impact of alcohol intoxication on injury severity and outcomes of adult patients who experienced different modes of trauma.

Materials and Methods: This retrospective study collected data of hospitalized patients who experienced trauma at age ≥20 years between January 1, 2009 and December 21, 2015, from the Trauma Registry System of a Level I trauma center. Patients were categorized into two groups according to their blood alcohol concentrations (BACs): alcohol intoxication (BAC of ≥50 mg/dL at the time of arrival to the emergency room) and nonalcohol intoxication (BAC of <50 mg/dL). The Abbreviated Injury Scale (AIS) score of each injured body region, Injury Severity Score, length of stay (LOS) in the hospital, and in-hospital mortality of these trauma patients according to different modes of trauma were compared between patients with or without alcohol intoxication.

Results: Among 20,513 patients included in this study, 1206 had alcohol intoxication and 19,307 did not. Patients with alcohol intoxication were predominantly males and younger than those without alcohol intoxication. Among patients who had a motorcycle accident, bicycle accident, fall accident, and hit by/against an object, AIS of ≥3 head/neck injuries more commonly occurred in patients with alcohol intoxication than in those without. In addition, compared to those without alcohol intoxication, patients with alcohol intoxication who experienced motorcycle accidents and hit by/against an object had longer hospital LOS, whereas those who experienced motor vehicle and motorcycle accidents had significantly higher mortality rates.

Conclusions: This study revealed that alcohol intoxication had impacted the injury severity and outcomes in adult patients who experienced different modes of trauma.

Dilemma in primary hyperparathyroidism with multiple brown tumors

Dilemma in primary hyperparathyroidism with multiple brown tumors: Girish Mysore Suresh, Ravi Arjunan, S Altaf, Veerendra Kumar



Formosan Journal of Surgery 2020 53(1):35-38



Primary hyperparathyroidism (PHPT) is a disease characterized by excessive secretion of parathormone. During the disease, bone loss occurs, particularly depending on the resorption of the skeletal system. One of the complications of PHPT is fibrotic, cystic bony changes which are called a brown tumor (BT). Skeletal manifestations in the form of BTs are rare, and according to literature studies, it occurs in <2% of patients suffering from any form of HPT. As it is a rare disease and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present the case of a 35-year-old man who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of PHPT.

Accessory tragus: Report of a case in a rare location on the nasal vestibule

Accessory tragus: Report of a case in a rare location on the nasal vestibule:

Abstract

A case of an accessory tragus located on the nasal vestibule is reported. This represents the third case of this entity located outside of a derivative of a branchial arch. All three of these cases were located in the nose/glabella region.

Good response to pulsed dye laser in patients with capillary malformation‐arteriovenous malformation syndrome (CM‐AVM)

Good response to pulsed dye laser in patients with capillary malformation‐arteriovenous malformation syndrome (CM‐AVM):

Abstract

Capillary malformation‐arteriovenous malformation syndrome (CM‐AVM) is an autosomal dominant disorder caused by heterozygous mutations in RASA1 and EPHB4. Capillary stains in CM‐AVM are compatible with Schöbinger's phase I AVMs. Vascular laser has been classically contraindicated for the treatment of AVMs, as there is a fear of accelerating their progression. In this study, we have treated capillary stains in five CM‐AVM patients with pulsed dye laser, with improvement and without worsening or recurrence of the lesions after 1 year of clinical and ultrasound follow‐up.

Basosquamous carcinoma and melanoma collision tumor in a child with xeroderma pigmentosum

Basosquamous carcinoma and melanoma collision tumor in a child with xeroderma pigmentosum:

Abstract

Xeroderma pigmentosum (XP) is a rare autosomal recessive genodermatosis associated with hypersensitivity to ultraviolet radiation (UVR), being due to defects involving the nucleotide excision repair pathway. Patients with XP are prone to develop multiple cutaneous neoplasms including non‐melanoma skin cancers and melanoma. Collision tumors in patients with XP have been reported in the literature including the following lesions, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, and in situ melanoma. Herein, we present a rare collision tumor composed of melanoma and basosquamous carcinoma in a 13‐year‐old XP patient and describe the dermoscopic features.

Treatment of superficial vascular anomalies with topical sirolimus: A multicenter case series

Treatment of superficial vascular anomalies with topical sirolimus: A multicenter case series:

Abstract

Background

Systemic sirolimus (rapamycin) has recently been found effective in treating complex vascular anomalies by reducing the size and associated complications. Many vascular anomalies have a cutaneous component, and thus, we sought to determine whether topical administration of sirolimus may be an effective therapy, as data on the use of topical sirolimus are limited.

Objective

We reviewed the efficacy and tolerability of topical formulations of sirolimus in the treatment of various simple and combined vascular malformations and tumors.

Methods

Eighteen patients with any vascular anomaly treated exclusively with topical sirolimus were retrospectively reviewed.

Results

Eleven patients had combined venous lymphatic malformations, three had tufted angiomas, two had a lymphatic malformation, one had a venous malformation, and one had a verrucous venous malformation. All (100%) patients reported some degree of improvement and 50% of patients reported marked improvement in one or more symptoms, most commonly blebs and lymphatic drainage, and bleeding.

Limitations

The retrospective nature, small number of patients, and differences in topical preparations limit the broad application of the results.

Conclusion

Topical sirolimus appears to be a safe and useful non‐invasive therapy that is well‐tolerated in the treatment of the cutaneous portion of a variety of vascular anomalies.

Hoarse cry in a newborn with epidermolysis bullosa simplex, generalized severe

Hoarse cry in a newborn with epidermolysis bullosa simplex, generalized severe:

Abstract

Hoarse cry and respiratory stridor are the signs of potentially life‐threatening laryngeal involvement in selected severe and frequently early lethal subtypes of inherited epidermolysis bullosa (EB). We present a newborn with generalized skin blistering and onychodystrophy who developed a hoarse cry and inspiratory stridor. Ultrastructural skin examination revealed tonofilament clumping in basal keratinocytes and genetic testing identified the de novo missense mutation p.Arg125Cys in the KRT14 gene, consistent with EB simplex generalized severe, which is characterized by major morbidity in infancy but a favorable long‐term prognosis. The present case underlines the importance to consider EB simplex generalized severe in the differential diagnosis of EB infants presenting hoarseness and stridor.

Oral erosions associated with surreptitious marijuana vaping in an adolescent boy

Oral erosions associated with surreptitious marijuana vaping in an adolescent boy:

Abstract

A 15‐year‐old boy presented with painful ulcerations affecting the oral mucosa that were eventually attributed to marijuana vaping. In this case report, we highlight cannabis vaping as a potential cause of oral erosions due to injury and chronic inflammation of the oral mucosa.

Allergic contact dermatitis caused by wound closure tape in a pediatric patient

Allergic contact dermatitis caused by wound closure tape in a pediatric patient:

Abstract

Wound care products are emerging as causes of allergic contact dermatitis (ACD). There are increasing reports of ACD to certain medical adhesives; however, there are no published reports of contact sensitization solely due to wound closure tape such as Steri‐Strips™. Herein, we present the first confirmed case of ACD in a child caused by wound closure tape.

Stüve‐Wiedemann syndrome with multiple eruptive vellus hair cysts and clefted tongue

Stüve‐Wiedemann syndrome with multiple eruptive vellus hair cysts and clefted tongue:

Abstract

Stüve‐Wiedemann syndrome is a rare autosomal recessive congenital primary skeletal dysplasia, characterized by small stature, bowed long bones, joint restrictions, hyperthermic episodes, dysautonomia, and respiratory and feeding difficulties, that usually leads to early mortality. Cutaneous manifestations have rarely been reported. We report the case of a girl with Stüve‐Wiedemann syndrome presenting with progressive development of multiple eruptive vellus hair cysts.

Characterizing calcinosis cutis in a pediatric population

Characterizing calcinosis cutis in a pediatric population:

Abstract

Background/Objectives

Calcinosis cutis is the abnormal deposition of calcium in the skin and subcutis. There is currently a paucity of data surrounding pediatric calcinosis cutis. The objective of this study is to characterize calcinosis cutis in a pediatric cohort.

Methods

A single‐institution retrospective cohort study was performed over a 5.5‐year period.

Results

Thirty cases were identified. Calcinosis cutis was found to be more common in men (63%), with a younger median age of onset (5 years) compared to women (10 years). Dystrophic calcinosis cutis (43%) was the most common type in the study population, though idiopathic calcinosis cutis (37%) was nearly as common. No cases of metastatic calcinosis cutis were found.

Conclusions

The etiology of calcinosis cutis in the study population was found to be similar to that identified in adults with the exception of metastatic calcinosis cutis, which was not seen in our cohort. Previous recommendations using laboratory testing to diagnose this disease process might not be as critical as previously thought.

Dermoscopic findings of a congenital smooth muscle hamartoma in an infant

Dermoscopic findings of a congenital smooth muscle hamartoma in an infant:

Abstract

Cutaneous smooth muscle hamartoma is an uncommon, benign tumor developing in the dermis as a result of disorganized hyperproliferation of arrector pili muscle fibers. We present a 1‐month‐old infant with a congenital smooth muscle hamartoma together with the dermoscopic findings of the case. Dermoscopy can be a helpful non‐invasive tool in diagnosing congenital smooth muscle hamartoma due to its distinct findings that help to differentiate it from close mimickers like solitary mastocytoma.

Microphthalmia and linear skin defects syndrome: Precise diagnosis guides prognosis

Microphthalmia and linear skin defects syndrome: Precise diagnosis guides prognosis:

Abstract

Microphthalmia and linear skin defects syndrome (MLS) is a rare X‐linked dominant disorder characterized by microphthalmia and linear atrophic plaques of the face and neck. The diagnosis of MLS can be challenging secondary to both its rarity and to clinical overlap with Goltz syndrome. Whereas the skin lesions of MLS are more likely to improve in appearance with age, the lesions of Goltz are typically persistent.

A PIK3CA mutation in an acquired capillary malformation

A PIK3CA mutation in an acquired capillary malformation:

Abstract

Acquired capillary malformations are rare vascular anomalies composed of dilated capillaries in the skin. We present a pediatric case of an acquired capillary malformation as a novel presentation of the PIK3CA‐related overgrowth syndromes. Using next‐generation sequencing, we identified a PIK3CA p.Val344Met mutation within the acquired capillary malformation with possible prognostic and therapeutic significance.

The association between atopic dermatitis and serum 25‐hydroxyvitamin D in children: Influence of sun exposure, diet, and atopy features—A cross‐sectional study

The association between atopic dermatitis and serum 25‐hydroxyvitamin D in children: Influence of sun exposure, diet, and atopy features—A cross‐sectional study:

Abstract

Background

Previous studies have linked low serum vitamin D (VD) or 25‐hydroxyvitamin D (25(OH)D) levels with increased severity of atopic dermatitis (AD) in children.

Objective

To investigate the association between serum VD (25(OH)D) levels and AD and AD severity, considering the influence of diet and sun exposure.

Methods

We performed a prospective cross‐sectional study of healthy controls and children diagnosed with AD. Participants were recruited between January 2011 and December 2012, and the following parameters were assessed: age, sex, body mass index (BMI), AD severity, Fitzpatrick skin type, asthma and rhinitis history, dietary VD intake, daily potential sun‐induced VD production, sunscreen use, 25(OH)D and IgE serum levels, and results of the ImmunoCAP Phadiatop Infant test.

Results

The study population consisted of 105 healthy controls and 134 AD patients. Serum 25(OH)D levels were significantly lower in moderate and severe AD than in mild AD, although this association was only significant for patients with light Fitzpatrick skin type (mean(SD) 36.7 (11.9) ng/mL; moderate 28.8 [11.5] ng/mL; and severe 27.6 [12.1] ng/mL, P = .045). Logistic regression analysis revealed a positive association between severe AD and both positive ImmunoCAP Phadiatop test and BMI.

Conclusion

Our data support an association between VD deficiency and AD severity only in patients with light complexion.

Pemphigus‐like eruption as a complication of molluscum contagiosum treatment with imiquimod in a 5‐year‐old girl

Pemphigus‐like eruption as a complication of molluscum contagiosum treatment with imiquimod in a 5‐year‐old girl:

Abstract

Pemphigus and pemphigus‐like reactions can be triggered by a variety of medications including topical therapies, such as imiquimod. While the association between imiquimod and pemphigus‐like reactions has been reported in adults, this is the first report of a generalized reaction beyond the site of imiquimod application in a child. The mechanism by which this occurs may be through a unique pathway, separate from the classic antibody‐mediated pathway. Our patient had a full recovery without recurrence after cessation of the inciting drug.

Skin and nails abnormalities in a patient with ZTTK syndrome and a de novo mutation in SON

Skin and nails abnormalities in a patient with ZTTK syndrome and a de novo mutation in SON:

Abstract

Zhu‐Tokita‐Takenouchi‐Kim (ZTTK) syndrome is a rare, severe, and recently described multisystem developmental disorder characterized by delayed psychomotor development and intellectual disability, characteristic facial features, hypotonia, poor overall growth, and visual abnormalities. Mucocutaneous manifestations have not been reported so far among individuals with ZTTK syndrome. Herein, we present a patient with ZTTK syndrome due to a de novo mutation in SON gene, who has dental abnormalities and retronychia of the toenails. We suggest that mucocutaneous features may be a part of the phenotype.

Low risk of clinically important central nervous system dysraphism

Low risk of clinically important central nervous system dysraphism in a cohort study of 69 patients with isolated aplasia cutis congenita of the head:

Abstract

Background

Aplasia cutis congenita of the head may be associated with underlying fusion defects in the skin, soft tissues, muscle, or bone. The risk of central nervous system dysraphism in patients with aplasia cutis congenita is not known; however, knowledge of underlying structural defects can inform management considerations.

Methods

This retrospective review investigated the risk of cranial central nervous system dysraphism in children presenting with aplasia cutis congenita of the head, who presented between 1/1/2000 and 6/15/2016. Inclusion criteria were subjects with aplasia cutis congenita of the head who received CT or MR imaging of the head.

Results

We identified a total of 69 subjects with aplasia cutis congenita affecting the head and who received imaging. The most common location of the aplasia cutis congenita lesion was the vertex scalp (49.3%). The hair collar sign was present in 27.5% of patients. Twelve of 69 patients (17.4%) demonstrated abnormalities of the bone, vasculature, or brain on head imaging. Only one patient had a diagnosis of encephalocele that required neurosurgical intervention. There was a statistical association between the hair collar sign and the presence of abnormal imaging findings (P = .029), with a negative predictive value of 89.4%.

Conclusions

The incidence of central nervous system dysraphism in patients with aplasia cutis congenita of the head appears to be low, and it may not be necessary to image the head of each child presenting with this skin lesion. The hair collar sign may be a marker of underlying defects.

Retrospective review of drug‐induced Stevens‐Johnson syndrome and toxic epidermal necrolysis cases at a pediatric tertiary care institution

Retrospective review of drug‐induced Stevens‐Johnson syndrome and toxic epidermal necrolysis cases at a pediatric tertiary care institution:

Abstract

Background/Objectives

Stevens‐Johnson syndrome and toxic epidermal necrolysis represent important sources of potential mortality and morbidity in children. There is a need for more clinical data in this population to determine whether specific treatments preferentially improve outcomes.

Methods

This was a single‐center retrospective review of children admitted with drug‐induced Stevens‐Johnson syndrome, toxic epidermal necrolysis or Stevens‐Johnson syndrome/toxic epidermal necrolysis overlap at a tertiary care pediatric institution in North America from 2008 to 2018. Patients without a dermatology assessment and diagnosis were excluded. Demographic, clinical, and treatment information were abstracted and reviewed for all included patients.

Results

Sixteen patients were identified, 43% female (7/16), with a mean age at presentation of 10.4 ± 5.2 years. Antibiotics were implicated in 56.3% of patients (9/16) and anticonvulsants in 31.3% (5/16). Sulfamethoxazole‐trimethoprim was the triggering antibiotic in 31.3% of patients. The majority of patients were treated with intravenous immunoglobulin alone (50%, 8/16) or intravenous immunoglobulin with steroids (25%, 4/16). Etanercept was added to intravenous immunoglobulin and corticosteroid in a 2‐year‐old patient, resulting in clinical stabilization and halting of epidermolysis. No patients died. Clinical sequelae were noted in five patients, including ocular complications (n = 4), labial adhesions (n = 1), and persistent skin dyspigmentation (n = 3).

Conclusions

Our results highlight that sulfamethoxazole‐trimethoprim is an important cause of Stevens‐Johnson syndrome‐toxic epidermal necrolysis in children. Mortality was reassuringly low, but ocular sequelae were an important cause of morbidity. More data are needed to help determine whether specific treatments including etanercept may provide mortality or morbidity benefit in pediatric populations.

A pediatric approach to management of skin growths in basal cell nevus syndrome

A pediatric approach to management of skin growths in basal cell nevus syndrome:

Abstract

Little guidance on management of basal cell nevus syndrome in children exists. We report a case series of four patients diagnosed with BCNS in early childhood, in whom several highly suspicious lesions were biopsied, but several smaller and questionably concerning lesions were treated with therapies that are more tolerable for children, including topical imiquimod, 5‐fluorouracil, cryotherapy, or touch electrodessication following topical anesthetic cream. These therapies were well tolerated, and all residual or persistent lesions were subsequently biopsied and found to be benign. This approach is often preferable for pediatric BCNS patients, in whom concerning lesions can be identified clinically and managed compassionately. However, any lesion that exhibits growth, bleeding, or symptoms should be biopsied for definitive diagnosis.

Comprehensive prosthetic rehabilitation of a case of the orofacial digital syndrome

Comprehensive prosthetic rehabilitation of a case of the orofacial digital syndrome: Rajat Lanzara, M Viswambaran, Anup Gopi



The Journal of Indian Prosthodontic Society 2020 20(1):110-114



Maxillofacial defects can result from trauma, treatment of neoplasm, or congenital malformations. Many a time due to the size, location of the defect, or because of the patient's medical condition, surgical reconstruction may not be possible. In these cases, rehabilitation is indicated with the help of a maxillofacial prosthesis. Orofacial digital syndrome (OFDS) is a congenital anomaly that affects the development of the mouth, face, and digits. Such abnormalities or defects compromise form, function, esthetics, and social acceptance and deeply affect the psychological status of an individual. This report describes the comprehensive prosthetic rehabilitation of a case of OFDS with bilateral cleft lip and palate as well as syndactyly and brachydactyly of the foot. The individual was rehabilitated with a definitive obturator and a custom-made foot prosthesis using room-temperature-vulcanizing silicone. The prosthetic rehabilitation significantly improved esthetics, phonetics, and function as well as social and psychological status of the patient.

Classification of anatomical variants of maxillary sinus shapes and symmetry using computerized tomographic imaging

Classification of anatomical variants of maxillary sinus shapes and symmetry using computerized tomographic imaging: Abdulhameed Aliu, Ma’aji S Mohammad, Bello S Sirajo, Ahmad M Ibrahim, Zagga D Abdullahi



Sub-Saharan African Journal of Medicine 2019 6(3):143-147



Background: The maxillary sinus is characterized by a considerable variation in sizes and shapes and between the right and left sides. Due to easy access to all its walls and surfaces, imaging via computerized tomography (CT) has enhanced the quality and quantity of information obtainable from the assessment of the maxillary sinus. Aim: To determine normal variations in shapes and symmetry of the maxillary sinus using CT. Methods: A total of 130 subjects comprising 79 males and 51 females, between the ages of 20 and 80 years, with normal maxillary sinus CT anatomy, who had head CT scans carried out at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, over a period of five years, were used for this study. Images were taken with a GE Bright Speed Multidetector Helical CT (GE Healthcare, USA, 2005) Scanner, while films were viewed on the computer monitor. Variations in shapes of the maxillary sinus were identified on axial images and classified based on their resemblance to known shapes of solids. Data were analyzed using Minitab 16.0 statistical package (Minitab inc. USA). Results: Five distinct shapes of the maxillary sinus were identified. These were: irregular in two subjects (0.77%) (right = 1 and left = 1); oval in three subjects (1.15%) (right = 2 and left = 1); quadrangular in three subjects (1.15%) (right = 2 and left = 1); spherical in 61 subjects (23.46%) (right = 30 and left = 31); and triangular 191 (73.46%) (right = 95 and left = 96). Shapes were symmetrical in 85.38% and asymmetrical in 14.62% of subjects. Conclusion: Five normal but distinct shapes of the maxillary sinus were identified, with the predominant shape, being the triangular type, and sinuses of individuals were frequently symmetrical in shape.

Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals.

Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals.:

Related Articles

Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals.

Curr Med Imaging Rev. 2019;15(10):990-993

Authors: Gündoğdu E, Toprak U

Abstract

BACKGROUND: The middle ear cavity is ventilated through the aditus ad antrum. Aditus blockage contributes to the pathology of otitis media.

OBJECTIVE: To determine the normal values of the aditus ad antrum diameter on computed tomography and to investigate its relationship with chronic otitis media and related pathologies (tympanosclerosis and myringosclerosis).

METHODS: The temporal CT images of 162 individuals were evaluated retrospectively. In the axial sections, the inner diameter of the aditus was measured at the narrowest point at the cortex. The differences in diameter were compared between diseased and healthy ears.

RESULTS: In healthy individuals, the diameter was narrower in women. There was no difference between the right and left ears in healthy subjects. No correlation was found between age and diameter. In male patients with myringosclerosis, the diameter was slightly narrower on both sides but more marked on the left. In female patients with myringosclerosis, the diameter in both ears was slightly narrower. In cases of otitis media and tympanosclerosis, the diameter was less than that of healthy individuals, despite the lack of statistically significant result in all cases.

CONCLUSION: The aditus ad antrum was narrower in diseased ears, indicating that a blocked aditus may contribute to the development of otitis media, as well as mucosal diseases.

PMID: 32008526 [PubMed - in process]

Environmental radioactivity levels in agricultural soil and wheat grains collected from wheat-farming lands

Environmental radioactivity levels in agricultural soil and wheat grains collected from wheat-farming lands of Koya district, Kurdistan region-Iraq: Najeba Farhad Salih, Zakariya Adel Hussein, Shalaw Zrar Sedeeq



Radiation Protection and Environment 2019 42(4):128-137



The purpose of this study is to determine the activity concentration levels of radionuclides of226Ra,232Th,40K, and137Cs in soil and wheat grain samples. A total of 72 samples of soil and wheat grains were collected in the study area. Measurements were performed using a gamma-ray spectroscopic system based on high purity germanium detector. The average activity concentrations of226Ra,232Th, and40K in soil samples were found to be 14.7 ± 0.2 Bq/kg, 19.9 ± 0.5 Bq/kg, and 329 ± 5.4 Bq/kg, respectively, and for the measured wheat grain samples their values were found to be 0.4 ± 0.09 Bq/kg for226Ra, 0.36 ± 0.1 Bq/kg for228Ra, and 109.2 ± 2.2 Bq/kg for40K. The calculated mean values of radium equivalent activity Raeq, outdoor absorbed dose rate Dout, and outdoor annual effective dose rate of the soil samples were found to be 68.55 Bq/kg, 32.5 nGy/h, and 0.039 mSv/year, respectively. Moreover, the radionuclide transfer factor from soil-to-wheat grains of naturally occurring radionuclides were found in this order40K > 226Ra > 228Ra.

Evaluation of the radiation dose from radon ingestion from different types of drinking water samples

Evaluation of the radiation dose from radon ingestion from different types of drinking water samples in Egypt using nuclear track detectors (LR-115 Type II): Ahmed Saad Hussein



Radiation Protection and Environment 2019 42(4):168-172



Radon concentrations in different sources of water samples collected from five different regions of Egypt by alpha track dosimetry using LR-115 detectors were determined. The values of radon concentration in water samples did not exceed the maximum level of contamination of 11 BqL−1 reported by the US Environmental Protection Agency and the recommended level of 10 BqL−1 by UNSCEAR 2000. The calculated values of annual effective dose for adults, children, and infants from radon ingested are less than the reference level of 100 μSvy−1 as recommended by the International Atomic Energy Agency, 2002 and WHO, 2009. From these results, it is concluded that there is no radiological risk related to radon ingested from the water samples analyzed in the study area of five different regions of Egypt.

Dilated cardiomyopathy following H1N1 infection

Dilated cardiomyopathy following H1N1 infection: Sweta Shanbhag, Rashmi Alva, K Shreedhara Avabratha



Muller Journal of Medical Sciences and Research 2019 10(2):86-88



Acute myocarditis and dilated cardiomyopathy are known to be common manifestations of several viral infections, presenting with a wide spectrum of symptoms. The exact pathogenesis of influenza virus-induced myocarditis is still unclear. Management involves early detection using echocardiography and cardiac support to tide over acute phase. Following recovery, prognosis is known to be quite good; however, fulminant cases have poor prognosis. A 2-year-old female infant previously diagnosed to have H1N1 bronchopneumonia a year back, who was found to have compromised cardiac function suggestive of dilated cardiomyopathy on follow-up and was started on oral antifailure medications and kept on regular follow-up, presented to the emergency department with symptoms suggestive of severe form of dilated cardiomyopathy and succumbed to illness. The association between influenza viral infection and myocarditis is being linked with host immune response as well as direct cellular damage. Vaccination is being said to be the most cost-effective strategy to prevent this potentially fatal complication. Recent-onset cardiac symptomatology with a preceding history suggestive of influenza infection warrants a high index of suspicion for myocarditis and dilated cardiomyopathy. Early detection and prompt cardiac supportive care and management are paramount and help to reduce morbidity and mortality.

Hypohidrotic ectodermal dysplasia with autosomal inheritance: A rare entity

Hypohidrotic ectodermal dysplasia with autosomal inheritance: A rare entity: Ayushi Lodha, Shylaja Someshwar



Muller Journal of Medical Sciences and Research 2019 10(2):82-85



Hypohidrotic ectodermal dysplasia (HED) is a rare disorder which is characterized by the involvement of all ectodermal derivatives and marked deficiency of sweating. It has a prevalence of 1: 100,000. X-linked recessive fashion is the most common pattern of inheritance, and 90% of the individuals affected are males. Autosomal dominant and recessive forms of this disease are very rare. Here, a 24-year-old female presented with classical features of HED: sparse lusterless hair, everted lips, and artificial dentures with a history of hypodontia in childhood. Patient's niece had complaints of decreased hair growth and sweating since birth. The patient also gave a history of similar complaints in great grandmother. Hence, we present an uncommon scenario where three females of an extended family were affected with HED and had symptoms of varying severity.

Exploring the anti-allergic property of potentized sodium chloride using nasal eosinophil count as a criterion

Exploring the anti-allergic property of potentized sodium chloride using nasal eosinophil count as a criterion: Dania P Johnson, K John Paul



Muller Journal of Medical Sciences and Research 2019 10(2):47-50



Background: Nasal eosinophilia is a specific and valuable means for diagnosing and predicting the prognosis of allergic rhinitis (AR). Evidence-based recommendation for treating AR with homeopathic medicines is lacking. Symptomatology of Natrum Muriaticum (NM) derived from homeopathic pathogenetic trials and clinical proving aids its wide use in practice. Objective: The study aided in ascertaining the anti-allergic property of NM in lowering the nasal eosinophil count in patients with AR. Methods: This prospective, observational study included patients diagnosed with AR along with nasal eosinophilia, provided they received NM 30C homeopathic remedy. Written consent was obtained from 15 patients and then included in the study. Nasal smear was collected on the first visit before the treatment and at the end of 2 weeks after the treatment. Statistical Analysis and Results: Pre- and post-treatment nasal eosinophil counts were statistically analyzed using the paired t-test. The difference in mean eosinophil count (0.06333) was statistically significant, where P < 0.00000085. Results: From the study conducted, the eosinophil count was recorded before and after treatment [Figure 1]. Out of 15 participants, two had moderate eosinophilia and 13 had mild eosinophilia before treatment. There was no eosinophilia in any of the patients in the 2nd week after NM intake. Conclusions: It was evident that NM lowers the nasal eosinophil count when administered according to homeopathic principles. Nevertheless, it has opened new avenues to investigate the underlying mechanisms of the anti-allergic property possessed by NM through in vitro studies.

Pulmonary actinomycosis presenting as a pleural tumour

Pulmonary actinomycosis presenting as a pleural tumour: Neeraj Kumar Keyal, Raju Shrestha, Niru Nepal, Manish Nakarmi



The Journal of Association of Chest Physicians 2020 8(1):23-25



Pulmonary actinomycosis is a rare gram positive higher prokaryotic bacterial infection. We hereby present a case of 78-year old male presented with non-specific symptoms like cough, shortness of breath (SOB) and chest pain mimicking as pulmonary tuberculosis, fungal infection and lung cancer but was diagnosed to have pulmonary actinomycosis. From this, we want to emphasize that pulmonary actinomycosis should be evaluated in all patients that are not responding to anti-tubercular and lung cancer treatment.

A rare case of granulomatosis with polyangiitis (Wegener’s) presenting with tracheo-bronchial involvement

A rare case of granulomatosis with polyangiitis (Wegener’s) presenting with tracheo-bronchial involvement: Pragyan Rout, Bijay Meher, Garima Markam, Kiran Sabat



The Journal of Association of Chest Physicians 2020 8(1):30-32



Granulomatosis with polyangiitis (Wegener’s) (GPA) is a form of systemic vasculitis that involves primarily the upper and lower airways and the kidneys. Although the pulmonary involvement of GPA is well described, the lower airway findings are rarely involved, and only various descriptions have been reported. The most frequent airway manifestations include subglottic stenosis and inflammation, and tracheal and bronchial stenoses. We, hereby, report a case of GPA presenting with fever, cough and haemoptysis with bronchoscopy showing markedly inflamed bronchial mucosa.

Erasmus Syndrome: Co-existence of silicosis and progressive systemic sclerosis in a 55 year old male

Erasmus Syndrome: Co-existence of silicosis and progressive systemic sclerosis in a 55 year old male: Jitendra Jalutharia, Ramakant Dixit



The Journal of Association of Chest Physicians 2020 8(1):19-22



The Erasmus syndrome describes the association of generalised progressive scleroderma following exposure to silica with or without silicosis. We report a case of Erasmus Syndrome in a 55-year old labourer presenting with shortness of breath, arthralgia, Raynaud’s phenomenon, skin tightening and microstomia along with pulmonary arterial hypertension. Among investigations, serological markers were strongly positive, high-resolution computed tomography chest showed evidence of interstitial lung disease (ILD) with mediastinal lymphadenopathy and histopathology of skin biopsy were suggestive of systemic sclerosis. Correlating the occupational history, clinical features, haematological investigations and histological findings, a diagnosis of Erasmus syndrome was safely made.

Impact of obstructive sleep apnea and sleep parameters on level of asthma control

Impact of obstructive sleep apnea and sleep parameters on level of asthma control: Ramakant Dixit, Satyadeep Verma, Mukesh Goyal



The Journal of Association of Chest Physicians 2020 8(1):1-5



Background and Objective: Several studies support high prevalence of obstructive sleep apnea (OSA) symptoms in patients with asthma. Our objective was to evaluate the relationship between OSA severity and level of asthma control if any and analyze sleep parameters in patients having different levels of asthma control. Methods: A cross-sectional study among asthma patients having symptoms of sleep-related breathing disorders. Eligible patients were assessed clinically and with sleep questionnaire including asthma control followed by level 1 Polysomnography. Results: Among 53 patients of asthma (mean age 48.16 years), OSA was present in 84.21% of uncontrolled asthma, 35% in partially controlled asthma, and 7.14% in well-controlled asthma. Uncontrolled asthma patients were associated with higher apnea/hypopnea index (AHI) (30.8±17.6 vs. 3.7±1.2; p-value < 0.0001), more time spent in non rapid eye movement (NREM) 1 stage (18.5±11.9% vs. 13.0±11.2% of total sleep time), higher nocturnal desaturation episodes (152.5±13 vs. 22.1±16.7; p-value < 0.001), and severe OSA in supine position (AHI 33.1±17.7 vs. 9.2±9.7; p-value < 0.001) compared with well-controlled asthma. Conclusion: There seems a strong relationship between desaturation events and higher AHI with poor level of asthma control, especially during supine position. OSA must be suspected in patients with uncontrolled asthma. An early detection and treatment of OSA may improve the level of asthma control as well as quality of life in such patients.

Disseminated Multidrug-Resistant Tuberculosis in a Young Patient: A Rare Case Report

Disseminated Multidrug-Resistant Tuberculosis in a Young Patient: A Rare Case Report: Ritu Dadra, Nirmal Chand Kajal, Balbir Malhotra, Prasanth Pandiyaraj, Lakhvir Kaur, Gurleen kaur



The Journal of Association of Chest Physicians 2020 8(1):26-29



Drug resistance is a persistent threat to tuberculosis (TB) control program worldwide. Patients infected with multiple drug-resistant strains are less likely to become cured. Management of resistant cases is complex and presents therapeutic limitations. Patients with multidrug-resistant strains are more prone to treatment failure and progress to more chronic forms of the disease and death. According to the Global Tuberculosis Report 2018, about 3.5% of newly diagnosed patients had multidrug-resistant tuberculosis (MDR-TB) and 18% of previously treated TB cases were estimated to have MDR-TB. This case presented a rare occurrence of disseminated MDR-TB in a diabetic patient. A case of a 14-year-old female, who was an old-treated case of abdominal TB, presented with 5 months of history of fever, breathlessness, and pain in the abdomen with diabetes mellitus, in whom disseminated MDR-TB was documented with fine-needle aspiration cytology of abdominal lymph nodes and bronchoalveolar lavage fluid that showed drug-resistant TB. So this case emphasizes the importance of screening all extrapulmonary TB patients for drug resistance especially if the patient also has associated comorbid conditions.

An unusual case of Salmonella enterica subtype Typhi causing pneumonia, synpneumonic effusion, and septic shock in an immunocompetent pregnant patient

An unusual case of Salmonella enterica subtype Typhi causing pneumonia, synpneumonic effusion, and septic shock in an immunocompetent pregnant patient: Arun Agarwal, Pooja Parab, Madan Mohan Sharma



The Journal of Association of Chest Physicians 2020 8(1):33-36



Salmonellosis may present with varying clinical manifestations ranging from fever, malaise, abdominal discomfort, and gastroenteritis to nonspecific symptoms related to febrile syndromes. Pneumonia, however, is an atypical site for Salmonellosis. More severe infections can invade into the blood stream and cause bacteremia with the possibility of disseminated focal infection. We report a case of a 29-year old pregnant immunocompetent patient with atypical extraintestinal symptoms in the first week of typhoid illness. She presented with high-grade fever with chills, dry cough, and breathlessness developing extensive lobar pneumonia along with synpneumonic effusion and shock. Her blood culture was positive for Salmonella enterica serotype Typhi. She was diagnosed with community-acquired pneumonia with pleural effusion due to Salmonella enterica serotype Typhi without any gastrointestinal symptoms.

Endoscopic spine surgery in cervical spine: Anterior and posterior approach

Current status of full-endoscopic spine surgery in cervical spine: Anterior and posterior approach: Sagar B Sharma, Jin-Sung Luke Kim, Naveen D Siddappa, Hussam E Jabri



Indian Spine Journal 2020 3(1):41-53



The techniques for the treatment of cervical disc herniation and cervical myelopathy have evolved over the last two decades. Anterior cervical decompression and fusion has been considered to be the gold standard technique to date. Recently, it has been shown that full-endoscopic spine surgery with upgraded technology and instrumentation has the capability to decompress the exiting nerve root and thecal sac effectively in the cervical spine. Good clinical outcomes have been reported in the literature with endoscopic procedures. The full-endoscopic spine technique can be an alternative to avoid interbody fusion surgeries. Successful decompression under constant visualization with a small incision and minimal surgical trauma can be achieved. There are two percutaneous endoscopic cervical spine approaches: anterior and posterior. Decision-making depends on anatomical and pathological considerations. Attaining full-endoscopic cervical spine technique requires a steep learning curve, practical training under the experts, and proper selection of patients. The recent developments related to endoscopic equipment with the availability of better optics, three-dimensional monitors, lighting systems, and newer generation endoscopes have made these techniques applicable in complex surgeries as well. The objective of this review was to provide a technical description of full-endoscopic anterior and posterior cervical spine surgeries and their current status in management of various cervical spine pathologies.

Traumatic thoracic spine intramedullary hemorrhage: Rare spinal cord injury

Traumatic thoracic spine intramedullary hemorrhage: Rare spinal cord injury: Nitesh Gahlot, Abhay Elhence



Indian Spine Journal 2020 3(1):123-126



The aim of this study was to report a rare case of post-traumatic thoracic spine intramedullary bleeding associated with spine fracture in the absence of compression due to fracture fragments on spinal cord. Magnetic resonance imaging scan showed thrombus formation inside the spinal cord with obliteration of neural elements. The patient was managed non-operatively and improved. Intramedullary hemorrhage in spinal cord is a rare cause of neurological deficit in post-traumatic cases and only a handful cases have been reported in the literature, giving no guidance regarding treatment of the condition. Conservative management can be considered a viable treatment option for intramedullary bleeds, especially in cases where there is no bony cord compression.

Single-level lumbar pyogenic discitis treated with combined minimally invasive posterior and mini-open anterior approach: Functional outcome analysis

Single-level lumbar pyogenic discitis treated with combined minimally invasive posterior and mini-open anterior approach: Functional outcome analysis: Charanjit Singh Dhillon, Narendra R Medagam, Shrikant Ega, Raviraj Tantry, Nilay P Chhasatia



Indian Spine Journal 2020 3(1):102-109



Study Design: This was a retrospective study. Objective: The objective of this study was to evaluate the clinico-radiological outcome in single-level lumbar pyogenic discitis treated with single-stage combined percutaneous posterior stabilization with mini-open anterior debridement and fusion under single anesthesia. Materials and Methods: We retrospectively reviewed 27 patients with single-level lumbar pyogenic discitis who presented to our institute from January 2010 to August 2015. All the patients underwent preoperative evaluation with blood parameters including complete blood count, erythrocyte sedimentation rate, C-reactive protein, blood and urine cultures, and imaging studies. They underwent single-stage combined posterior percutaneous stabilization with mini-open anterior debridement and fusion with tricortical iliac crest graft under the same anesthesia. They were followed up at regular intervals with clinical and radiological assessment with minimum follow-up of 24 months. Preoperative and postoperative final follow-up assessments of neurological status, pain, and disability were conducted using the Frankel Grade scoring, visual analog scale (VAS) score, and Oswestry Disability Index (ODI), respectively. Results: This study included 10 women and 17 men (n = 27) with average age of 57 years (range: 45–73 years). The mean operative time was 194min (range: 150–230min). The mean intraoperative blood loss was 212mL (range: 100–350mL). The mean VAS score (0.56) at final follow-up was significantly lower than the mean preoperative VAS score (7.30) with P < 0.001. The ODI scores at final follow-up (mean, 13.48) were significantly lower than preoperative ODI scores (mean, 83.70) with P < 0.001. Conclusion: Single-stage combined posterior percutaneous stabilization with mini-open anterior debridement and fusion under one anesthesia is an effective alternative to conventional open technique as it allows thorough debridement and rigid fixation, and results in minimal blood loss and lesser postoperative complications.

Expanding the horizons of minimally invasive spine surgery

Expanding the horizons of minimally invasive spine surgery: Arvind G Kulkarni, Tushar S Kunder, Swaroop Das, Sandeep Tapashetti



Indian Spine Journal 2020 3(1):11-25



The trend of using smaller operative corridors is observed in various surgical specialties. The development of smart technologies with the overall aim of reducing surgical trauma has resulted in the concept of minimally invasive surgical techniques. Enhancements in microsurgery, tubes, endoscopy, and various percutaneous techniques, as well as improvement of implant materials, have proven to be milestones. The ease of performing surgery through tubes has recently evolved into percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, and pedicle screws. The advancement of training of spine surgeons and the integration of image guidance with precise intraoperative imaging, computer-, and navigation-assisted treatment modalities constitute the era of reducing treatment morbidity in spinal surgery. This progress has led to the present era of preserving spinal function. In this report, we present a chronological perspective of the use of tubular retractors, the learning curve of tubular retractor in dealing complex cases and its wide applications, and expanding the horizon using tubular retractors.

Grade III Spondylolisthesis L5-S1 Treated by Minimally Invasive Spine Transforaminal Lumbar Interbody Fusion (MIS-TLIF) in a Patient of Rheumatoid Arthritis

Grade III Spondylolisthesis L5-S1 Treated by Minimally Invasive Spine Transforaminal Lumbar Interbody Fusion (MIS-TLIF) in a Patient of Rheumatoid Arthritis: Vinay H Patel, Vishal B Peshwattiwar



Indian Spine Journal 2020 3(1):91-96



We present a case of a 76-year-old woman on treatment for rheumatoid arthritis, who was bedridden for the past 3 months due to severe neurological claudication. The patient’s radiologic evaluation showed Grade III spondylolisthesis. Spondylolisthesis was treated with minimally invasive transforaminal lumbar interbody fusion (TLIF) in which the reduction was achieved with distraction and restoring height at the disc space. She had no claudication on day 0 postoperative, and she was able to walk for 10min and climb a floor of stairs at discharge. At 6 weeks, she was able to carry out her activities of daily living independently. Computed tomography scan carried out at 1-year follow-up showed bony union at L5-S1 interspace. Thus, minimally invasive TLIF carried out for Grade III spondylolisthesis achieved good reduction with the described technique and had excellent functional results at 2-year follow-up.

Larger screw on the concave side of apex pedicle: Friend or foe? Report on a rare cause of neurological deficit in scoliosis surgery

Larger screw on the concave side of apex pedicle: Friend or foe? Report on a rare cause of neurological deficit in scoliosis surgery: Bhavuk Garg, Nishank Mehta, Ashok Jaryal



Indian Spine Journal 2020 3(1):114-117



Pedicle screw instrumentation is currently the “gold standard” in scoliosis surgery. However, placement of pedicle screws in thoracic spine is considered challenging. Previous studies have described morphometric changes in the pedicle when a larger screw is inserted, with pedicle expansion preceding screw cutout and pedicle fracture. We report an unusual case of neurological deficit due to cord compression by an expanded pedicle following pedicle screw insertion on the concave side of the apical vertebra in a 14-year-old patient with Lenke Type 3C(-) adolescent idiopathic scoliosis. Identification of the expanded pedicle as the cause of neurological symptoms, prompt action, and deferring the corrective surgery while accepting less correction helped us in negotiating the problem without causing permanent neurological deficit. Pedicle expansion in an immature spine can cause neurological complications. The screw diameter at the apical vertebrae on the concave side should be carefully selected.

A case of gingival stem cell administration using adipose tissue-derived stem cells

A case of gingival stem cell administration using adipose tissue-derived stem cells: Yukako Suzuki



Journal of Oral Research and Review 2020 12(1):42-46



Adipose tissue-derived stem cells (ASCs) are reported to be capable of differentiating into all of mature cells, including bones and cartilage as same as bone marrow mesenchymal stem cells. In this study, we examined to treat periodontal disease using autologous ASCs to avoid rejection by transplantation. After autologous ASCs were injected into the gingiva, X-ray examination, periodontal pocket examination, and bleeding on probing were good results, and we obtained regeneration of periodontal tissue. Autologous ASCs are also easy to collect. Compared with other periodontal regeneration treatments, the burden on patients with less risk of postoperative infection is also less. In future, we hope to consider combined use with growth factors to aim at the alveolar bone and periodontal tissues regeneration. Moreover, we hope to conduct further investigations with a large number of cases over a long period of time.

Comparison of temporomandibular changes in edentulous and dentulous patients using digital panoramic imaging

Comparison of temporomandibular changes in edentulous and dentulous patients using digital panoramic imaging: Nikhil Rajesh Gharge, SR Ashwinirani, Abhijeet Sande



Journal of Oral Research and Review 2020 12(1):17-22



Introduction: Prevalence of TMJ disorder in general population is approximately 50% out of which 3-7% are reported to seek treatment. Various modalities are used to diagnosis TMJ like Panoramic Imaging, Computed Tomography, Magnetic Resonance Imaging, Cone Beam Computed Tomography. The Present study is to design and analyse TMJ changes in Edentulous and Dentulous using Digital Panoramic Imaging.

Methodology: Retrospective study was carried out using 208 Panoramic Radiographs retrieved from Department of Oral Medicine and Radiology TMJ changes have assessed and Compared between the Dentulous and Edentulous patients.

Results: Out of 208 patients,103 individual were Dentulous and 105 were edentulous (94-Partially, 11-Complete). So in Dentulous patients female were predominately affected by TMJ changes, whereas in edentulous patients males were affected by TMJ changes. In dentulous patients flattening was most common followed by resorption whereas in edentulous resorption was most common followed by osteophyte in tmj region.

Conclusion: In our study in comparison of TMJ changes in edentulous and Dentulous patients showed flattening as most common changes in dentulous patients with female predominately and resorption as most common changes in edentulous patients with male predomiently.

Bone one session treatment: A new concept of treating periodontal diseases

Bone one session treatment: A new concept of treating periodontal diseases: Jilkapally Sai Priya, Kanakagiri Phani Yasaswini, Jammula Surya Prasanna



Journal of Oral Research and Review 2020 12(1):47-51



Periodontitis is an inflammatory disease of multifactorial origin that represents the destruction of periodontium due to the upregulation of immune response and in the presence of disease-causing pathogens, resulting in loss of attachment and bone loss. Advances in periodontal disease control cracked wide open various therapies that will successfully arrest periodontal infections. One such new technique is bone one session treatment (BOST) for the treatment of periodontal disease without an invasive procedure. BOST is an aerobic treatment that eliminates the periodontal disease in the deepest pockets and supporting alveolar bone. This technique predicts the same phenomenon in periodontal diseases healing and repair, works by influencing the disease etiological factors and aiding healing by three immune phases. This plays a role in altering the pathogenesis and disease progression by changing the defensive phase against bacteria and other microorganisms into a regeneration phase to achieve a new attachment. We conclude that a noninvasive technique (BOST) can alter the pathogenesis by removing the etiological factors as well as guide the tissue for regeneration and new attachment.

Comparative clinical evaluation of supplementation with omega-3 fatty acids, given for different time period, in chronic periodontitis patients

Comparative clinical evaluation of supplementation with omega-3 fatty acids, given for different time period, in chronic periodontitis patients: Govind Bhartiya, Triveni Kale, Swapna Mahale, Shruti Shankarrao Lendhey



Journal of Oral Research and Review 2020 12(1):11-16



Aim: The aim of the study was to evaluate the effects of supplementation with omega-3 (ω-3) polyunsaturated fatty acids (FAs) as host modulating agent, given at varying interval, in patients with chronic periodontitis.Materials and Methods: This study was carried out in the Department of Periodontology and Implantology of Mahatma Gandhi Vidyamandir's K.B.H. Dental College and Hospital, Nashik, Maharashtra, India. Forty-five patients with chronic periodontitis were selected. The patients were randomly allotted into one of the following groups: Group A (15 patients): Scaling and root planning (SRP) + ω-3 FAs for 1 month, Group B (15 patients): SRP + ω-3 FAs for 2 months, Group C (15 patients): SRP + ω-3 FAs for 3 months. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed pre-SRP (baseline), 1 month, and 3 months, respectively, after the treatment. Results: In the present study, in the intra-group comparison; PI, GI, PPD, and CAL were significantly reduced in all three groups (P < 0.001). There was no statistically significant difference in PI, GI, PPD, and CAL in Group A, B, and C (P > 0.05) after 1 month, 2 months, and after 3 months, respectively. Conclusion:ω-3 FAs are equally effective as far as periodontal therapy is concerned when given for short duration of 1 month.

Peripheral ossifying fibroma of the anterior maxilla: A case report and brief review

Peripheral ossifying fibroma of the anterior maxilla: A case report and brief review: Aishwarya Madhukar Kale, Kunal Sundar Sethi, Prerna Ashok Karde



Journal of Oral Research and Review 2020 12(1):38-41



Peripheral ossifying fibroma (POF) presents as a tumor-like growth of the soft tissue and is often associated with sharp teeth, rough restoration, and ill-fitting denture. POF is fibro-osseous in origin and is commonly found in the maxillary region. It is a slow-growing benign tumor and usually asymptomatic. However, it may induce facial asymmetry. A 29-year-old male patient who reported to the Department of Periodontology with the chief complaint of slow-growing painless mass over the anterior palatal region underwent surgical excision of the mass using electrocautery. Fifteen days follow-up showed uneventful and satisfactory healing of the excised region.

Accuracy and Reliability of Smartphone Self-Test Audiometry in Community Clinics in Low Income Settings: A Comparative Study

Accuracy and Reliability of Smartphone Self-Test Audiometry in Community Clinics in Low Income Settings: A Comparative Study: Annals of Otology, Rhinology &Laryngology, Ahead of Print.

Background:There is a lack of hearing health care globally, and tele-audiology and mobile technologies have been proposed as important strategies to reduce the shortfall.Objectives:To investigate the accuracy and reliability of smartphone self-test audiometry in adults, in community clinics in low-income settings.Methods:A prospective, intra-individual, repeated measurements design was used. Sixty-three adult participants (mean age 52 years, range 20-88 years) were recruited from ENT and primary health care clinics in a low-income community in Tshwane, South Africa. Air conduction hearing thresholds for octave frequencies 0.5 to 8 kHz collected with the smartphone self-test in non-sound treated environments were compared to those obtained by reference audiometry.Results:The overall mean difference between threshold seeking methods (ie, smartphone thresholds subtracted from reference) was −2.2 dB HL (n = 467 thresholds, P = 0.00). Agreement was within 10 dB HL for 80.1% (n = 467 thresholds) of all threshold comparisons. Sensitivity for detection hearing loss >40 dB HL in one ear was 90.6% (n = 84 ears), and specificity 94.2% (n = 84 ears).Conclusion:Smartphone self-test audiometry can provide accurate and reliable air conduction hearing thresholds for adults in community clinics in low-income settings.

Thyroglossal Duct Cyst Occupying Posterior Hyoid Space with Endolaryngeal Extension Presenting After Neck Trauma

Thyroglossal Duct Cyst Occupying Posterior Hyoid Space with Endolaryngeal Extension Presenting After Neck Trauma: Annals of Otology, Rhinology &Laryngology, Ahead of Print.

Objective:Thyroglossal duct cysts are the most common congenital neck mass. They typically present as a painless midline neck mass in a child or young adult, but may also present later in adulthood when the cyst becomes symptomatic. Thyroglossal duct cysts are most commonly located inferior to the hyoid bone in close relation with the thyrohyoid membrane. Very rarely, they may extend intralaryngeal, occupy the posterior hyoid space, and present with dysphonia and/or dysphagia. To our knowledge, this is the 24th reported case in the literature.Methods:Case report with a comprehensive review of the literature.Results:The patient was a 43-year-old male experiencing dysphonia and dysphagia following a motor vehicle accident. He was subsequently found to have a large thyroglossal duct cyst with endolaryngeal extension that was previously asymptomatic and undiagnosed. He underwent successful surgical excision which resulted in resolution of symptoms.Conclusion:This is the first reported case of a thyroglossal duct cyst in the posterior hyoid space with endolaryngeal extension being diagnosed following a traumatic event. This case illustrates the need to consider thyroglossal duct cyst in the differential diagnosis when working up a post-traumatic intralaryngeal neck mass. A secondary educational objective in this case is to be diligent to consider and rule out laryngeal fracture in the case of a neck mass presenting after trauma as they can easily be missed and present with many overlapping symptoms.

Chemical, Electrical and Tactile Sensitivity Changes After Middle Ear Surgery

Chemical, Electrical and Tactile Sensitivity Changes After Middle Ear Surgery: Annals of Otology, Rhinology &Laryngology, Ahead of Print.

Objective/Hypothesis:Taste disturbances are often seen in patients after middle ear surgery due to the stress received by an unprotected chorda tympani. It has also been reported that loss in tactile sensitivity may accompany this issue. The current study was designed to measure electrical, chemical, and tactile sensitives of several senses involved in oral processing, smell, taste and touch, over time.Study Design:Prospective cohort study.Methods:For three time points, one before middle ear surgery and two after operation (about 5 and 23 days), sensitivity thresholds were obtained using electrogustometry (electrical taste), taste strips (chemical taste), Sniffin’ Sticks (smell) and Von Frey Hairs (point-pressure tactile sensitivity).Results:The results show a decline in both chemical and electrical taste responses. Additionally, the electrical taste response showed more sensitivity to deviations and no sign of recovery unlike the chemical taste response. Mechanosensory function of the anterior tongue and olfactory function was not strongly affected by middle ear surgery.Conclusion:Taste responses, but not mechanosensory or olfaction function, are altered after middle ear surgery. Due to the effects that taste loss has on quality of life, gustometry is recommended for this group of patients.Levels of Evidence:4

Nasal Septal Abscess Caused by Protrusion of a Dental Implant Into the Nasopalatine Duct: A Case Report

Nasal Septal Abscess Caused by Protrusion of a Dental Implant Into the Nasopalatine Duct: A Case Report: Annals of Otology, Rhinology &Laryngology, Ahead of Print.

Objective:A nasal septal abscess after placement of a dental implant is seldom seen and is usually caused by an infection around the implant. A septal haematoma following dental implantation leading to septal abscess formation has never been reported.Methods and results:We present a case of a patient who developed a septal abscess after dental implantation without accompanying signs of infection around the implant. On the computed tomography scan we found the implant protruding the nasopalatine duct which led to bilateral septal hemorrhage, resulting in abscess formation. The patient underwent reconstructive nasal septum surgery, using an autologous auricular cartilage graft. This resulted in a good nasal function and cosmetic outcome.Conclusions:Medical health care professionals should be aware of a septal abscess in case of an acute blocked nose even without prior nasal or facial trauma or nasal surgery. Reconstruction of the septal nasal cartilage using autologous conchal cartilage is a good solution to preserve nasal function as well as tip support.

(1) Epistaxis, (2) Cricothyrotomy/tracheostomy, (3) Peritonsillar abscess/auricular hematoma, (4) Nasal bone reduction/zygoma reduction/lateral canthotomy/canalicular trauma and probing, (5) Local nerve blocks, and (6) Soft tissue reconstruction,Multi-Institutional Regional Otolaryngology Bootcamp

Multi-Institutional Regional Otolaryngology Bootcamp: Annals of Otology, Rhinology &Laryngology, Ahead of Print.

Introduction:In order to increase junior resident physician proficiency and improve patient safety, simulation-based procedural training courses, or bootcamps, have been become an emerging educational tool.Objectives:To compare pre- and post-course confidence levels and to assess station efficacy after completion of our single day bootcamp.Methods:We developed the University of California (UC) Davis otolaryngology bootcamp, a single day course including six cadaveric task trainer stations and four simulations. The six task trainer stations included (1) Epistaxis, (2) Cricothyrotomy/tracheostomy, (3) Peritonsillar abscess/auricular hematoma, (4) Nasal bone reduction/zygoma reduction/lateral canthotomy/canalicular trauma and probing, (5) Local nerve blocks, and (6) Soft tissue reconstruction. The simulations comprised of airway fire during tracheostomy, pediatric respiratory code during airway evaluation, dislodged pediatric tracheostomy tube in the ICU, and angioedema in the emergency department with inability to intubate or ventilate. Junior residents from multiple locoregional institutions were recruited to participate. Pre- and post-course Likert surveys assessing participant confidence and station efficacy were collected and analyzed.Results:There was a statistically significant increase in resident confidence levels for all task trainer stations. All stations had a station efficacy Likert score average of 4 “very effective” or 5 “most effective.”Conclusion:A multi-institutional, locoregional, simulation-based bootcamp can be a valuable adjunct to junior resident training. It can promote camaraderie, pool limited resources, and may be cost-effective.