Pediatric vs Adult Septoplasty Revision Rates

alexandrossfakianakis shared this article with you from Inoreader Pediatric vs Adult Septoplasty Revision Rates via JAMA Otolaryngology–Head & Neck Surgery Online First This cohort study used data from the IBM MarketScan Commercial Database to compare rates of revision surgery among pediatric vs adult patients undergoing septoplasty. View on Web

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BMI and Venous VTE Rates in Patients on Standard Chemoprophylaxis Regimens After H&N Surgery

alexandrossfakianakis shared this article with you from Inoreader BMI and Venous VTE Rates in Patients on Standard Chemoprophylaxis Regimens After H&N Surgery via JAMA Otolaryngology–Head & Neck Surgery Online First This cohort study assesses whether there is an association bet ween body mass index (BMI) and postoperative venous thromboembolism (VTE) and hematoma rates in patients treated with prophylactic enoxaparin 30 mg twice daily. View on Web

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Differentiation of eosinophilic and non‐eosinophilic chronic rhinosinusitis on preoperative computed tomography using deep learning

alexandrossfakianakis shared this article with you from Inoreader Differentiation of eosinophilic and non‐eosinophilic chronic rhinosinusitis on preoperative computed tomography using deep learning via Clinical Otolaryngology Abstract Objective This study aimed to develop deep learning (DL) models for differentiating between eosinophilic chronic rhinosinusitis (ECRS) and non-ECRS (NECRS) on preoperative CT. Methods A total of 878 chronic rhinosinusitis (CRS) patients undergoing nasal endoscopic surgery at Renmin Hospital of Wuhan University (Hubei, China) between October 2016 to June 2021 were included. Axial spiral CT images were pre-processed and used to build the dataset. Two semantic segmentation models based on U-net and Deeplabv3 were trained to segment the sinus area on CT images. All patient images were segmented using the better-performing segmentation model and used for training and testing of the transferred efficientnet_b0, resnet50, inception_resnet_v2, and Xception neural networks. Additionally, we evaluated the performances of the models trained using each image and each patient as a unit. The precision of each model was assessed based on the receiver operating characteristic curve. Further, we analyzed the confusion matrix and accuracy of each model. Results The Dice coefficients of U-net and Deeplabv3 were 0.953 and 0.961, respectively. The average area under the curve and mean accuracy values of the four networks were 0.848 and 0.762 for models trained using a single image as a unit, while the corresponding values for models trained using each patient as a unit were 0.893 and 0.853, respectively. Conclusion Combining semantic segmentation with classification networks could effectively distinguish between patients with ECRS and those with NECRS based on preoperative sinus CT images. Furthermore, labeling each patient to build a dataset for classification may be more reliable than labeling each medical image. This article is protected by copyright. All rights reserved. View on Web

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Is COVID‐19 to Blame for Sensorineural Hearing Deterioration? A Pre/Post COVID‐19 Hearing Evaluation Study

alexandrossfakianakis shared this article with you from Inoreader Is COVID‐19 to Blame for Sensorineural Hearing Deterioration? A Pre/Post COVID‐19 Hearing Evaluation Study via The Laryngoscope Our study aimed to evaluate the associations between COVID-19 infection and deterioration in sensorineural hearing thresholds among a cohort of patients from Meuhedet healthcare services (the third largest of four public healthcare provider organizations in Israel) that had undergone hearing evaluations pre- and post-COVID-19. Our findings suggest that COVID-19 does not appear to be associated with deterioration of the sensorineural hearing among unvaccinated patients who had known hearing loss pre-infection, after correcting for age-related hearing loss. Moreover, our findings do not validate previous reports of a greater deterioration in the hearing of infected patients who possess background risk factors such as smoking, hypertension, and diabetes, suggesting no interaction between risk factors and hearing deterioration post-infection. Objectives Here, we aimed to (a) determine whether a clinically significant sensorineural hearing loss (SNHL) change could be detected in post-coronavirus disease (COVID-19) hearing levels on comparing them with pre-infection hearing levels after controlling for the effect of age and (b) to identify risk factors, such as hypertension, diabetes, and smoking, which increase the likelihood of hearing loss in COVID-19 patients. Methods We retrospectively analyzed hearing thresholds in unvaccinated patient's pre- and post-COVID-19 infection. Thresholds were controlled for age and the duration between the pre- and post-COVID-19 hearing evaluations. Correlations between additional COVID-19-related symptoms, hypertension, diabetes, and smoking and hearing threshold changes were analyzed. Results A significant (but not clinical) threshold elevation was found post-COVID-19 infection. However, on controlling for age and the duration between the pre- and post-COVID-19 hearing evaluations, no significant threshold elevation was found. No significant correlation was found between hearing threshold changes and additional COVID-19-related symptoms, hypertension, diabetes, or smoking. Conclusion COVID-19 did not lead to a significant hearing threshold elevation in our cohort, even among patients with additional COVID-19 symptoms, hypertension, or diabetes mellitus or among those who smoked. Level of Evidence 3. nonrandomized controlled cohort, follow-up study Laryngoscope, 2022 View on Web

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Incidence of Sinus Inflammation After Endoscopic Skull Base Surgery in the Pediatric Population

alexandrossfakianakis shared this article with you from Inoreader Incidence of Sinus Inflammation After Endoscopic Skull Base Surgery in the Pediatric Population via The Laryngoscope The extended endonasal approach has been utilized in the resection of anterior skull base lesions in the pediatric population. There are unique challenges to these patients in the post-operative setting, including patient compliance with medical therapy and post-operative debridements, and a smaller nasal airway that may increase propensity towards scarring. Our objective for this study is to evaluate the incidence of post-operative radiographic inflammation in this patient population using the Lund-Mackay (LM) score. Background The extended endonasal approach has been utilized in the resection of anterior skull base lesions in the pediatric population. There are unique challenges to these patients in the post-operative setting, including patient compliance with medical therapy and post-operative debridements, and a smaller nasal airway that may increase propensity toward scarring. Our objective for this study is to evaluate the incidence of post-operative radiographic inflammation in this patient population using the Lund-Mackay (LM) score. Methods A single-center, retrospective review of pediatric patients undergoing endoscopic approach to the skull base between 2009 and 2021 was performed. Demographic and clinicopathologic data and pre- and post-operative imaging were analyzed. One-way ANOVA followed by Tukey multiple pairwise comparisons statistical tests were used to compare mean LM scores between groups. Results Seventy-two patients (52 males, 20 females) were identified with a median follow-up of 27 months. All patients underwent an extended endonasal approach for resection of skull base lesions. The mean LM scores were compared between pre-operative MRI, first post-operative MRI > 30 days after surgery, and most recent post-operative MRI. One-way ANOVA was performed with significant differences noted between the groups (p < 0.001). Tukey multiple pairwise comparisons test was then performed and noted significant differences between the pre-operative and first post-operative LM (p < 0.0001) and the first post-operative and most recent LM (p < 0.0001). There was no significant difference noted between the pre-operative LM score and most recent LM score (p = 0.14). Conclusion Despite concerns regarding possible subsequent development of chronic rhinosinusitis following endoscopic skull base surgery in pediatric patients, the current study suggests that transient radiographic evidence of sinus inflammation can be seen up to six months postoperatively, which appears to resolve by approximately two years after surgery. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Impact of respiratory infection and chronic comorbidities on early pediatric antibiotic dispensing in the United States

alexandrossfakianakis shared this article with you from Inoreader Impact of respiratory infection and chronic comorbidities on early pediatric antibiotic dispensing in the United States via Clinical Infectious Diseases Advance Access Abstract Background In the United States, children under age 5 receive high volumes of antibiotics, which may contribute to antibiotic resistance. It has been unclear what role preventable illnesses and chronic comorbidities play in prompting antibiotic prescriptions. Methods We conducted an observational study with a cohort of 124,759 children under age 5 born in the United States between 2008 and 2013 with private medical insurance. Study outcomes included the cumulative number of antibiotic courses dispensed per child by age 5 and the proportion of children for whom at least one antibiotic course was dispensed by age 5. We identified which chronic medical conditions predicted whether a child would be among the top 20% of antibiotic recipients. Results Children received a mean of 6.8 (95% confidence interval [CI] 6.7, 6.9) antibiotic courses by age five, and 91% (95% CI 90, 92) of children had received at least one antibiotic course by age five. Most antibiotic courses (71%, 95% CI 70, 72) were associated with respiratory infections. Presence of a pulmonary/respiratory, otologic, and/or immunological comorbidity substantially increase a child's odds of being in the top 20% of antibiotic recipients. Children with at least one of these conditions received a mean of 10.5 (95% CI 10.4, 10.6) antibiotic courses by age 5. Conclusions Privately insured children in the US receive high volumes of antibiotics early in their lives, largely related to respiratory infections. Antibiotic dispensing is unequally distributed among children, with substantially more antibiotics dispensed to children with select comorbidities. View on Web

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Booster vaccination against SARS-CoV-2 induces potent immune responses in people with HIV

alexandrossfakianakis shared this article with you from Inoreader Booster vaccination against SARS-CoV-2 induces potent immune responses in people with HIV via Clinical Infectious Diseases Advance Access Abstract Background People with HIV on antiretroviral therapy with good CD4 T cell counts make effective immune responses following vaccination against SARS-CoV-2. There are few data on longer term responses and the impact of a booster dose. Methods Adults with HIV were enrolled into a single arm open label study. Two doses of ChAdOx1 nCoV-19 were followed twelve months later by a third heterologous vaccine dose. Participants had undetectable viraemia on ART and CD4 counts >350 cells/µl. Immune responses to the ancestral strain and variants of concern were measured by anti-spike IgG ELISA, MesoScale Discovery (MSD) anti-spike platform, ACE-2 inhibition, Activation Induced Marker (AIM) assay and T cell proliferation. Findings 54 participants received two doses of ChAdOx1 nCoV-19. 43 received a third dose (42 with BNT162b2; 1 with mRNA-1273) one year after the first dose. After the third dose, total anti-SARS-CoV-2 spike IgG titres (MSD), ACE-2 inhibition and IgG ELISA results were significantly higher compared to Day 182 titres (P < 0.0001 for all three). SARS-CoV-2 specific CD4+ T cell responses measured by AIM against SARS-CoV-2 S1 and S2 peptide pools were significantly increased after a third vaccine compared to 6 months after a first dose, with significant increases in proliferative CD4 + and CD8+ T cell responses to SARS-CoV-2 S1 and S2 after boosting. Responses to Alpha, Beta, Gamma, and Delta variants were boosted, although to a lesser extent for Omicron. Conclusions In PWH receiving a third vaccine dose, there were significant increases in B and T cell immunity, including to known VOCs. View on Web

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