Laryngeal and Tracheal Pressure Injuries in Patients With COVID-19

xlomafota13 shared this article with you from Inoreader Laryngeal and Tracheal Pressure Injuries in Patients With COVID-19 Via JAMA Otolaryngology–Head & Neck Surgery Online First To the Editor The important study by Fiacchini and colleagues of laryngotracheal complications in ventilated patients with coronavirus disease 2019 (COVID-19) reported a staggering 47% incidence of full-thickness tracheal erosion (FTTE) and tracheoesophageal fistulae (TEF). These findings raise critical questions about ensuring safe, high-quality care for intubated patients. Although intense research has focused on the molecular basis of COVID-19, pathogenesis of pneumonitis, and novel therapeutics; far less work has addressed the prevalence and pathogenesis of iatrogenic injury—particularly with respect to airway device-related pressure injuries. Injury at the level of the tracheal cuff likely accounts for the preponderance of FTTE and TEF reported, and tissue injury may occur at any site where there is contact between a device and the aerodigestive tract. Risk is highest in patients with overzealous cuff inflation, high-dose steroids, prone ventilation, prolonged intubation, feeding tubes, or impaired wound healing from diabetes or radiation—a perfect storm for patients with COVID-19. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea Via The Laryngoscope Objective/Hypothesis Studies have suggested preterm birth, defined as gestational age (GA) <37 weeks, is a risk factor for obstructive sleep apnea (OSA) in later childhood. However, little is known about the characteristics, severity, and degree of intervention of childhood OSA in former preterm infants compared to term infants. This study compares polysomnographic characteristics and surgical interventions in former preterm and term infants presenting with sleep disordered breathing. Study Design Retrospective cohort study from 2015 to 2019 at a single tertiary referral center. Methods Electronic Medical Records of pediatric patients ages 0 to 18 presenting with sleep disordered breathing were reviewed for gestational age, polysomnographic findings, clinical characteristics, and OSA surgical interventions. Association between gestational age, polysomnographic characteristics, and surgical interventions for OSA were reported. Results A total of 615 patient records were analyzed. Adjusting for covariates, prematurity was associated with a 2.97× higher likelihood of development of severe OSA (aOR (95%CI): 2.97 (1.40–6.32)), increased apneic‐hypoxic index (AHI) (mean (SD): 6.5 (9.8) vs. 4.6 (6.4), P < .05), increased end tidal CO2 (50.5 (5.11) vs. 48.5 (5.8), P < .05), decreased REM latency (116 (64.7) vs. 132.4 (69.9), P < .05), and increased number of surgeries for OSA (0.65 (.95) vs. 0.45 (0.69), P < .05) compared to children born at term. Children born with GA < 32 weeks presented at a significantly later age with sleep disordered breathing (7.04 (.80) vs. 5.1 (0.15), P < .05) than children born at term. Conclusions Prematurity was associated with increased likelihood of severe OSA, increased AHI, as well as increased number of surgical interventions for OSA compared to children born at term. These results suggest an association with preterm birth and increased severity of childhood OSA. Level of Evidence III Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome: Relapse and Tonsillar Regrowth After Childhood Tonsillectomy

xlomafota13 shared this article with you from Inoreader Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome: Relapse and Tonsillar Regrowth After Childhood Tonsillectomy Via The Laryngoscope Objectives/Hypothesis Tonsillectomy is an effective treatment for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome, but the role of adenoidectomy, as well as later tonsillar regrowth, is unclear. To find out if the volume of lymphoid tissue is pivotal to the efficacy, we analyzed the association between the relapse of the symptoms of PFAPA syndrome and regrowth of tonsillar tissue after tonsillectomy or adenotonsillectomy. Study Design Prospective cohort study of operated PFAPA pateints. Methods We invited all patients that had undergone tonsillectomy or adenotonsillectomy due to PFAPA syndrome at the Oulu University Hospital, Oulu, Finland, between the years 1990 and 2007, at the age of ≤12 years, to a follow‐up visit, after an average period of 9.8 years after their diagnoses. Out of the 132 invited, 94 (71%) participated in the follow‐up study. Results At the follow‐up study visit, 5 (5%) of the 94 PFAPA syndrome cases experienced recurrent fevers. The regrowth of palatine tonsillar tissue was seen in four of them (80%) as compared to 19/89 (21%) of symptom‐free patients (P = .006). Two of the patients with clear PFAPA relapse at the time of the study visit were reoperated with clear effect on the symptoms. At the time of the study visit, 59/63 (94%) of the patients who had undergone adenotonsillectomy and 30/31 of the patients (97%) who had undergone tonsillectomy earlier were free of fever flares (P = .99). Conclusion Palatine tonsil regrowth was associated with PFAPA syndrome relapse after tonsillectomy. Reoperation might be a treatment option in these patients. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Expression of Claudin-1 in laryngeal squamous cell carcinomas (LSCCs) and its significance

xlomafota13 shared this article with you from Inoreader Expression of Claudin-1 in laryngeal squamous cell carcinomas (LSCCs) and its significance Via Cellular and Molecular Biology Histol Histopathol. 2021 Feb 25:18320. doi: 10.14670/HH-18-320. Online ahead of print. ABSTRACT BACKGROUND: A large body of scientific evidence points to the important roles of tight junction proteins in tumor development, progression and dissemination. The larynx has only a few studies, analyzing the role of this group of junctional proteins in its oncogenesis. In this study, the author sheds some light on the expression and possible role of claudin-1 in laryngeal squamous cell carcinomas. MATERIALS AND METHODS: This study analyzed the expression of claudin-1, using immunohistochemistry, in a tissue microarray of 80 cases of laryngeal squamous cell cancers. Clinicopathological parameters were analyzed according to claudin-1 expression in the tissue microarray. Furthermore, the expression of slug/snail1, an Epithelial-Mesenchymal Transition (EMT) linked protein, was analyzed by immunohistochemistry in the same microarray, and the expressions of the two proteins were assessed for correlation. RESULTS: A significant majority of laryngeal squamous cell cancers exhibited positive expression of claudin-1 proteins. The majority of those tumors expressed claudin-1 in their cytoplasm. The overall majority of those same tumors also exhibited a cytoplasmic shift of the slug-snail-1 protein from the nuclei to the cytoplasm. There was also evidence of correlation of the two proteins' expressions in the cytoplasm of laryngeal tumors. CONCLUSION: The above may suggest a role for claudin-1 in the development and progression of laryngeal squamous cell carcinoma. Overall, claudin-1's aberrant expression in laryngeal cancer is in line with evidence seen in other head and neck cancers. Its co-expression with slug/snail-1 in LSCC patients should be investigated further to understand the nature of the relationship of the two proteins in LSCC and their possible contribution to its development and progression. P MID:33629735 | DOI:10.14670/HH-18-320 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pilot Study of External Beam Radiotherapy for Recurrent Unremitting Tracheal Stenosis

xlomafota13 shared this article with you from Inoreader Pilot Study of External Beam Radiotherapy for Recurrent Unremitting Tracheal Stenosis Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Feb 25:3489421995064. doi: 10.1177/0003489421995064. Online ahead of print. ABSTRACT OBJECTIVE: Tracheal stenosis can have a variety of presentations, severities, causes, and be a difficult condition to treat. Some patients demonstrate recurrent stenosis after multiple endoscopic treatments and are either poor candidates for open procedures or do not desire open surgery. We sought to evaluate low-dose postoperative external beam radiotherapy (EB RT) as a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies. METHOD: We performed a retrospective review of patients with recurrent tracheal stenosis who underwent EBRT in addition to endoscopic dilation. We compared the number of endoscopic procedures required in the 6 months before EBRT to the number required in the 6 months after EBRT. RESULTS: Six patients met criteria for inclusion in our study. The cause of stenosis was variable among the study population. In the 6 months leading up to EBRT, patients underwent an average 6.2 endoscopic procedures. This dropped to an average 1.9 procedures in the 6 months following EBRT (P < .001). CONCLUSION: Herein, we show that low-dose postoperative external beam radiotherapy (EBRT), a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies, is effective in decreasing the frequency of endoscopic dilations. LEVEL OF EVIDENCE: 4. PMID:33629593 | DOI:10.1177/0003489421995064 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gray-Scale Inversion on High Resolution Computed Tomography of the Temporal Bone: An Observational Study

xlomafota13 shared this article with you from Inoreader Gray-Scale Inversion on High Resolution Computed Tomography of the Temporal Bone: An Observational Study Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Feb 25:3489421996844. doi: 10.1177/0003489421996844. Online ahead of print. ABSTRACT OBJECTIVES: This is a qualitative study to explore the utility of gray-scale inversion or the "invert" function of high-resolution computed tomography (HRCT) scans in the diagnosis of temporal bone anatomy and pathology. METHODS: This is a case series describing an innovative application of an existing image processing tool to visualize temporal bone anat omy and pathology. Illustrative patients at a tertiary referral center with otologic symptoms and findings leading to HRCT scans of the temporal bone were included. Diagnostic HRCT scans were evaluated utilizing the gray-scale inversion function (invert function). RESULTS: Nine illustrative cases which demonstrate conditions such as persistent stapedial artery, membranous stapes footplate, total ossicular prosthesis migration into the vestibule, third window syndrome such as superior semicircular canal dehiscence (SSCD) and cochlea-facial nerve dehiscence, otosclerosis, and ossicular chain discontinuity are included. The enhanced visualization was confirmed surgically in 3 cases, and 1 had physiological confirmation using cervical vestibular evoked myogenic potentials (cVEMP). CONCLUSIONS: Gray-scale inversion can be used to improve visualization of temporal bone anatomy and pathologic changes when diagnoses are in doubt. The invert function is a useful adjunct in the ar mamentarium of both radiologists and otologists when evaluating HRCT of the temporal bone. PMID:33629604 | DOI:10.1177/0003489421996844 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current Status of Handheld Otoscopy Training: A Systematic Review

xlomafota13 shared this article with you from Inoreader Current Status of Handheld Otoscopy Training: A Systematic Review Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Feb 25:3489421997289. doi: 10.1177/0003489421997289. Online ahead of print. ABSTRACT OBJECTIVE: Otoscopy is a frequently performed procedure and competency in this skill is important across many specialties. We aim to systematically review current medical educational evidence for training of handheld otoscopy skills. METHODS: Following the PRISMA guideline, studies reporting on training and/or assessment of handheld otoscopy were identifi ed searching the following databases: PubMed, Embase, OVID, the Cochrane Library, PloS Medicine, Directory of Open Access Journal (DOAJ), and Web of Science. Two reviewers extracted data on study design, training intervention, educational outcomes, and results. Quality of educational evidence was assessed along with classification according to Kirkpatrick's model of educational outcomes. RESULTS: The searches yielded a total of 6064 studies with a final inclusion of 33 studies for the qualitative synthesis. Handheld otoscopy training could be divided into workshops, physical simulators, web-based training/e-learning, and smartphone-enabled otoscopy. Workshops were the most commonly described educational intervention and typically consisted of lectures, hands-on demonstrations, and training on peers. Almost all studies reported a favorable effect on either learner attitude, knowledge, or skills. The educational quality of the studies was reasonable but the educational outcomes were mostly evaluated on the lower Kirkpatrick levels with only a single study determining the effects of training on actual change in the learner behavior. CONCLUSION: Overall, it seems that any systematic approach to training of handheld otoscopy is beneficial in training regardless of learner level, but the heterogeneity of the studies makes comparisons between studies difficult and the relative effect sizes of the interventions could not be determined. PMID:33629599 | DOI:10.1177/0003489421997289 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Induction of IL‐1β and antimicrobial peptides as a potential mechanism for topical dithranol

xlomafota13 shared this article with you from Inoreader Induction of IL‐1β and antimicrobial peptides as a potential mechanism for topical dithranol Via Experimental Dermatology Abstract Topical dithranol is effective in autoimmune conditions like alopecia areata, inducing hair regrowth in a high percentage of cases. Exact mechanisms of dithranol in alopecia areata, with seemingly healthy epidermis besides altered hair follicles, are not well understood. To better understand dithranol's mechanisms on healthy skin, we analysed its effect on normal murine as well as xenografted human skin. We found a strong increase in mRNA expression of anti‐microbial peptides (AMPs) (eg Lcn2, Defb1, Defb3, S100a8, S100a9), keratinocyte differentiation markers (eg Serpinb3a, Flg, Krt16, Lce3e) and inflammatory cytokines (eg Il1b and Il17) in healthy murine skin. This effect was paralleled by inflammation and disturbed skin barrier, as well as an injury response resulting in epidermal hyperproliferation, as observed in murine and xenografted adult human skin. This contact response and disturbed barrier in duced by dithranol might lead via a vicious loop between AMPs such as S100a8/a9 (that led to skin swelling itself after topical application) and cytokines such as IL‐1β to an immune suppressive environment in the skin. A better understanding of the skin's physiologic response to dithranol may open up new avenues for the establishment of novel therapeutics (including AMP‐related/interfering molecules) for certain skin conditions, such as alopecia areata. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of constant light exposure on allergic and irritant contact dermatitis in mice reared under constant light conditions

xlomafota13 shared this article with you from Inoreader Effects of constant light exposure on allergic and irritant contact dermatitis in mice reared under constant light conditions Via Experimental Dermatology Abstract Environmental light levels can affect physiological functions, such as general activity, body temperature and metabolism. Irregular lifestyles, such as those involving exposure to light during the night, can exacerbate the clinical symptoms of several inflammatory skin diseases. However, the effects of constant light exposure on immune responses are not fully understood. This study aimed to elucidate the effects of constant light exposure on two major types of skin reactions, allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). BALB/c mice were kept under constant light conditions or a normal light and dark cycle, and their ACD and ICD responses were assessed after the topical application of 2,4,6‐trinitro‐1‐chlorobenzene and croton oil, respectively, to the ear skin. Interestingly, in both ACD and ICD, the ear‐swelling response and local leukocyte infiltration were aggravated by constant exposure to light, which has previously been shown to severely di sturb the behavioural rhythms of mice. In ACD, these findings were accompanied by increases in the numbers of degranulated mast cells and eosinophils. These results suggest that constant light exposure intensifies allergic and non‐allergic skin inflammation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anatomical variations of the mandibular canal and their clinical implications in dental practice: a literature review

xlomafota13 shared this article with you from Inoreader Anatomical variations of the mandibular canal and their clinical implications in dental practice: a literature review Via radiol anat Surg Radiol Anat. 2021 Feb 25. doi: 10.1007/s00276-021-02708-7. Online ahead of print. ABSTRACT INTRODUCTION: The anatomical variations of the mandibular canal have been described according to the number of additional branches it presents, bifid and trifid. Within the bifids we can also find subtypes of variations such as the retromolar mandibular canal. These anatomical variations can have important clinical implications for the work of dental professionals. METHODS: A systematic search of the literature was carried out in different databases that met the following criteria: articles published between 2000 and 2020, and articles that established a clinical correlation with variations in the mandibular canal. RESULTS: After applying inclusion and exclusion criteria, 32 articles were obtained, in which the variations of the mandibular canal were identified, their prevalence and incidence, which was very varied between the different articles, it was also found that the CBCT was the main technique to identify the anatomical variations of the mandibular canal. Lastly, the anatomical variations of the mandibular canal have a direct clinical correlation with pre-surgical, intra-surgical and postsurgical complications in pathologies that require surgical intervention. CONCLUSIONS: The anatomical variations of the mandibular canal have a high incidence, so knowing them is of vital importance both for clinicians and anatomy professors who prov ide morphological training. We believe that research should focus on describing and diagnosing the causes of these anatomical variations. That said, there is also a continuous challenge for all health professionals to learn about the different anatomical variations that the human body presents and how these can affect clinical practice. PMID:33630105 | DOI:10.1007/s00276-021-02708-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Virtual thanks giving to a cadaver by medical students exposed to learning anatomy before and amidst COVID-19 pandemic

xlomafota13 shared this article with you from Inoreader Virtual thanks giving to a cadaver by medical students exposed to learning anatomy before and amidst COVID-19 pandemic Via radiol anat Surg Radiol Anat. 2021 Feb 25. doi: 10.1007/s00276-021-02715-8. Online ahead of print. ABSTRACT PURPOSE: Due to COVID-19 pandemic, Thanks giving ceremony to cadaver was different this year in two ways: the students were partially exposed to cadaveric dissections (for 7 months) and later learned Anatomy via online classes due to lockdown (for 5 months) and secondly it was not feasible to gather for the ceremony so virtual platform was preferred. The purpose of this study was to discern the gratitude for cadaver and to recognize the importance of cadaveric dissection from the reflection of students who experienced hybrid anatomy learning amidst COVID-19. METHODS: The study was conducted on 48 first year medical students who were admitted to the college in August 2019 and were willing to participate. An online invitation was sent to students to participate in virtual thanks giving to cadaver ceremony on the last day of their anatomy class (August 2020). RESULTS: Though the students partially studied gross anatomy with the aid of dissections on the cadaver; however, they expressed respect and gratitude to the silent mentor in the form of a card, poem, drawing or paragraph and shared it via google classroom platform. The students wished if they could continue their anatomy course in dissection hall as paused due to COVID-19 pandemic. CONCLUSIONS: Reflection of these students may mark impact on future anatomy students who may or may not get the chance for dissections. The thanks-giving gesture will also help to bind medical science and humanity especially during the crisis of pandemic. PMID:33630106 | DOI:10.1007/s00276-021-02715-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.