Pharmacokinetic/pharmacodynamic analysis of high‐dose tigecycline, by Monte Carlo simulation, in plasma and sputum of patients with hospital‐acquired pneumonia

alexandrossfakianakis shared this article with you from Inoreader Pharmacokinetic/pharmacodynamic analysis of high‐dose tigecycline, by Monte Carlo simulation, in plasma and sputum of patients with hospital‐acquired pneumonia via Journal of Clinical Pharmacy and Therapeutics The study collected 108 blood specimens and60 sputum specimens from 12 enrolled patients Subsequently, these specimens were assayedfor tigecycline drug concentrations by high-performance liquid chromatography (HPLC).The relevant pharmacokinetic (PK) parameters were estimated by the non-compartmental model usingWinNonlin software. And Crystal Ball software was used to carry out Monte Carlosimulations. The results of this study showed that the mean lung penetrationrate calculated by the sputum was 127.27% and the probability of targetattainments (PTAs) in plasma and sputum ≥90.00% when the minimal inhibit concentration (MIC) ≤ 4 mg/L. Hence, the findings of PK/PD parameters of high-dosetigecycline in patients with HAP caused by MDRB demonstrated that high-dosetigecycline could achieve better antimicrobial effects when the MIC was ≤4 mg/L. Abstract What is Known and Objective To Investigate the pharmacokinetic/pharmacodynamic (PK/PD) parameters of high-dose tigecycline in plasma and sputum of patients with hospital-acquired pneumonia (HAP), and provide a therapeutic regimen of multidrug-resistant bacteria (MDRB) infections. Methods Blood/sputum samples were collected at intervals after tigecycline had reached a steady-state. Tigecycline concentrations in specimens were determined by high-performance liquid chromatography (HLPC), PK parameters were evaluated by WinNonlin software using a non-compartment model. The probability of target attainments (PTAs) at different minimal inhibitory concentrations (MICs) were calculated for achieving the PK/PD index with Crystal Ball software by 10,000-patient Monte Carlo Simulation. Results In plasma, the maximum concentration (C max) and area under the concentration–time curve from 0 to 12 h (AUC0–12h) were 2.21 ± 0.17 mg/L and 15.29 ± 1.13 h mg/L, respectively. In sputum, they were 2.48 ± 0.21 mg/L and 19.46 ± 1.82 h mg/L, respectively. The mean lung penetration rate was 127.27%. At the MIC ≤4 mg/L, the PTAs in plasma and sputum were 100.00%. When the MIC increased to 8 mg/L, the PTAs in plasma and sputum mostly were < 90.00% according to two criteria. What is New and Conclusion In this study, we explored PK/PD of high-dose tigecycline in plasma and sputum. From a PK/PD perspective, high-dose tigecycline had greater therapeutic outcomes in HAP treatment caused by MDRB. Antimicrobial-drug concentrations should be determined to optimize their clinical use. View on Web

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Assessing the Feasibility of Using the Ketogenic Diet in Autism Spectrum Disorder

alexandrossfakianakis shared this article with you from Inoreader Assessing the Feasibility of Using the Ketogenic Diet in Autism Spectrum Disorder via Journal of Human Nutrition and Dietetics Abstract Evidence demonstrating efficacy of dietary interventions for autism spectrum disorder (ASD) remains inconsistent. Recent research on the ketogenic diet (KD) for the treatment of ASD has suggested benefit. Children with ASD often demonstrate ritualized food specific behaviors, taste and texture aversions, and an increased prevalence of food restrictions and allergies. There is a need to investigate how these features contribute to initiation and adherence of the KD. Two surveys were administered to assess the feasibility of utilizing the KD for ASD. First, paper surveys were given to caregivers of children presenting to outpatient neurology clinics. Next, experienced clinicians were recruited and surveyed online using Redcap. χ2 analysis was used to compare ASD and non ASD caregiver responses. Descriptive metrics were used to present clinician responses. Responses to each question were evaluated individually. This article is protected by copyright. All rights reserved. View on Web

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Endoscopic Reconstruction of the Anterior Skull Base Following Tumor Resection: Application of a Novel Bioabsorbable Plate

alexandrossfakianakis shared this article with you from Inoreader Endoscopic Reconstruction of the Anterior Skull Base Following Tumor Resection: Application of a Novel Bioabsorbable Plate via The Laryngoscope Endoscopic repair of skull base defects is required following resection of intracranial pathology via the endoscopic endonasal approach. We report outcomes of 560 EEA procedures of skull base reconstruction performed on 508 patients over a 15-year period. Halfway through this period, we adopted the use of a rigid, bioabsorbable extrasellar plate for reconstruction, enabling a comparison between this technique and those used previously. CSF leak rate decreased from 8.5% in the 272 cases prior to incorporation of the bioabsorbable Resorb-X plate to 1.7% following its implementation. Objective Endoscopic repair of skull base defects is required following resection of intracranial pathology via the endoscopic endonasal approach (EEA). Many closure techniques have been described, but choosing between techniques remains controversial. We report outcomes of 560 EEA procedures of skull base reconstruction performed on 508 patients over a 15-year-period. Halfway through this period, we adopted the use of a rigid, bioabsorbable extrasellar plate for reconstruction, enabling a comparison between this technique and those used previously. Methods All patients undergoing EEA from 2005 to 2019 at our institution were retrospectively reviewed. Demographic information, surgical pathology, tumor dimensions and radiographic features, reconstructive technique, and patient-related outcomes were collected and analyzed with univariate and multivariate statistical modeling. Results Five-hundred sixty procedures were performed on 508 patients. The series complication rate was 8.2%. Overall, cerebrospinal fluid (CSF) leak rate was 5.0% but varied significantly across closure techniques (p < 0.001). Critically, the CSF leak rate in the 272 cases prior to our 2013 adoption of the Resorb-X Plate (RXP) was 8.5%, whereas leak rate in the subsequent 288 cases was 1.7%. RXP was protective against CSF leak (p = 0.001), whereas gross total resection (GTR) correlated with increased leak rate (p = 0.001). Patient BMI was significantly associated with risk of leak (p = 0.047). Other variables did not impact leak risk. Conclusion Reconstructive technique, extent of resection, and patient BMI significantly contributed to CSF leak rate. GTR was associated with increased leak risk while the RXP was protective. The bioabsorbable RXP is an effective option for rigid skull base repair with comparatively few complications. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Quantifying Neck Fibrosis: Establishing the Domain Structure of the Neck Fibrosis Scale

alexandrossfakianakis shared this article with you from Inoreader Quantifying Neck Fibrosis: Establishing the Domain Structure of the Neck Fibrosis Scale via The Laryngoscope In this submission, we confirm domain structure and validate a scoring system for the Neck Fibrosis Scale. We present a revised 14 item questionnaire. Exploratory factor analysis confirms a two-factor solution and establishes a physical and emotional domain. Objective We recently described the development of the Neck Fibrosis Scale (NFS). In this submission, we confirm domain structure and validate a scoring system for the NFS. Study Design Prospective cross-sectional study. Methods Between January 2020 and December 2021, 127 head and neck cancer patients with varying degrees of cutaneous neck fibrosis completed the original 15 item NFS. Exploratory factor analysis was used to identify optimal groupings with similar underlying factors. The association between the domains of the NFS and various measures of neck morbidity (i.e., construct validity) were assessed using gamma regression. Results Exploratory factor analysis confirmed 13 of the 15 items from the NFS mapped onto two factors, which were labelled 'physical' and 'emotional' domains. Of the remaining two items, 'energy' did not load uniquely onto one factor and was removed. 'Neck-swelling' did not load on either factor (loadings <0.3) but was retained within the physical domain based on clinical importance. This resulted in a revised 14-item questionnaire. Internal consistency for these two domains was high (>0.8, p < 0.01). Both the physical and emotional domains of the revised NFS show strong correlation with the neck dissection impairment index and neck range of motion. The physical domain strongly correlated with neck elasticity (0.902 [95%CI 0.839–0.972], p < 0.01). Patients receiving multimodal therapy had physical domain scores that were 31.6% [95% 13.9–51.8] higher (worse) than unimodal therapy patients. Conclusions A domain structure and scoring strategy have been developed for the NFS. Future efforts should be directed toward an evaluation of responsiveness. Level of Evidence NA Laryngoscope, 2022 View on Web

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Endonasal Lacrimal Transposition to Expand Pre‐Lacrimal Medial Maxillectomy Approach

alexandrossfakianakis shared this article with you from Inoreader Endonasal Lacrimal Transposition to Expand Pre‐Lacrimal Medial Maxillectomy Approach via The Laryngoscope EPLA lacrimal transposition facilitates management of maxillary sinus/pterygopalatine fossa lesions and overcomes limitations such as the Simmen type I recess or IPMS pedicled on the medial wall, without increasing peri-operative morbidity. Laryngoscope, 2022 View on Web

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Association between masticatory dysfunction and gastroesophageal reflux disease: a population‐based study in the elderly

alexandrossfakianakis shared this article with you from Inoreader Association between masticatory dysfunction and gastroesophageal reflux disease: a population‐based study in the elderly via Journal of Oral Rehabilitation Abstract Background Caries and periodontal disease may cause tooth losses and chewing difficulty, especially in the elderly. Ingesting poorly chewed food may delay gastric emptying and favor the development of gastroesophageal reflux disease (GERD). Objective This study investigated the association between masticatory dysfunction and GERD in the elderly from a rural area in southern Brazil. Methods This census invited all 489 elderly from a city to participate. The study used a GERD symptoms questionnaire, followed by an oral examination. Masticatory dysfunction was analyzed based on the chewing difficulty for some food groups. Tooth loss and chewing self-perception were also considered as exposure variables. Poisson regression determined the association among variables by calculating the prevalence ratio [PR(95% confidence interval)]. Results The response rate was 93.1% (n=455, average age of 70.9 years, 50.5% men). The prevalence of GERD in this population was 36.9%. GERD was associated with chewing difficulty for vegetables (PR=1.54), meats (PR=1.34), and cereals (PR=1.43) but not with poor chewing self-perception (PR=0.80) and tooth loss (PR=1.22). GERD was also associated with xerostomia (PR=1.63) and the female gender (PR=1.35). Conclusions Elderly people from a rural area with a reduced number of teeth present chewing difficulty and a high prevalence of GERD, indicating an association between GERD and masticatory dysfunction. View on Web

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Online information on mandibular advancement device for the treatment of obstructive sleep apnea: a content, quality and readability analysis

alexandrossfakianakis shared this article with you from Inoreader Online information on mandibular advancement device for the treatment of obstructive sleep apnea: a content, quality and readability analysis via Journal of Oral Rehabilitation Abstract Background Despite increasing scientific interest in the effectiveness of mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA), laypeople lack knowledge about this treatment option. Objectives To investigate content, quality and readability of the online information regarding MAD. Methods Google, Yahoo and Bing were searched for "sleep apnea", "mandibular advancement device" and "oral appliance". Websites were analyzed for content (multidisciplinary care team, qualified dentist, treatment contraindications and side effects), as well as for quality (DISCERN instrument, HONcode) and readability scores (Flesch Reading Ease, FRE, and Flesch-Kincaid Reading Grade, FKG). Results 155 websites were included: 53% from health professionals, 20% commercial, 17% academic, 10% from non-health professionals. Content was incomplete, especially for commercial ones. 71.61% websites failed to acknowledge treatment contraindications, approximately 40.00% did not mention side effects and the need for a multidisciplinary care team, while 22.58% did not address the need to consult a qualified dentist. Quality and reliability were poor. Mean DISCERN score was 39.93 (95% CI 37.90-41.96), with lower scores for commercial websites compared with others. Only nine websites displayed HONcode certification. Readability was quite difficult, with mean FRE score of 59.50 (95% CI 57.58-61.42) and mean FKG level of 6.92 (95% CI 6.64-7.21). Conclusion Health care professionals should be aware that currently available online information do not fulfill the most important aspects of MAD therapy and may be difficult to understand by laypeople. This could contribute to cause delays in appropriate OSA care and unrealistic treatment expectations, increasing the risk of treatment discontinuation. View on Web

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Optimizing the Assessment of Olfactory Dysfunction

alexandrossfakianakis shared this article with you from Inoreader Optimizing the Assessment of Olfactory Dysfunction via JAMA Otolaryngology–Head & Neck Surgery Current Issue In this issue of JAMA Otolaryngology–Head & Neck Surgery, Lee et al report their development and validation of a novel patient-reported outcome measure (PROM) of smell loss–related quality of life, the 28-item Olfactory Dysfunction Outcomes Rating (ODOR). ODOR represents a visually appealing, straightforward, concise, and patient-centered instrument to assess the physical problems, functional limitations, and emotional consequences of olfactory dysfunction. View on Web

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Quantitative Evaluation of Aerosol Generation During In-Office Flexible Laryngoscopy

alexandrossfakianakis shared this article with you from Inoreader Quantitative Evaluation of Aerosol Generation During In-Office Flexible Laryngoscopy via JAMA Otolaryngology–Head & Neck Surgery Current Issue This cohort study evaluates whether flexible laryngoscopy is an aerosol-generating procedure. View on Web

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Taste Function in Patients With Head and Neck Cancer Receiving Intensity-Modulated Radiotherapy

alexandrossfakianakis shared this article with you from Inoreader Taste Function in Patients With Head and Neck Cancer Receiving Intensity-Modulated Radiotherapy via JAMA Otolaryngology–Head & Neck Surgery Current Issue With great anticipation, we read the recent article by Chen et al regarding the taste function in patients with head and neck cancer (HNC) receiving intensity-modulated radiotherapy (IMRT). We thank the authors for conducting this excellent study by collecting objective and subjective evaluations of taste function. However, we have some concerns about the study methodology and interpretations. View on Web

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