Determining Invasion Depth in Superficial Pharyngeal Carcinoma by Transoral Ultrasonography

alexandrossfakianakis shared this article with you from Inoreader Determining Invasion Depth in Superficial Pharyngeal Carcinoma by Transoral Ultrasonography via The Laryngoscope Classification for transoral US findings. (A) US-EP. (B) US-SEP slight. (C) US-SEP deep. White arrow: Tumor. EP, epithelium; SEP, subepithelial propria; US, ultrasonography. Objectives To examine the clinical usefulness of transoral ultrasonography (US) in determining the invasion depth of superficial pharyngeal carcinoma (SPC). Determining the invasion depth of SPC is crucial for transoral surgery including determining treatment strategy. This study aimed to examine the usefulness of transoral US in determining the invasion depth of SPC. Methods Forty-six patients with 51 lesions who underwent both magnifying endoscopy with narrow-band imaging (ME-NBI) and transoral US were included. The primary outcomes were the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of ME-NBI and transoral US findings for pathological tumor depth in SPCs. Results The accuracy (82.4%), sensitivity (85.2%), PPV (82.1%), and NPV (82.6%) rates of US for subepithelial propria (SEP) were higher than those of ME-NBI and macroscopic classification, indicating that transoral US is superior to ME-NBI in determining the invasion depth. All cases where the SEP was clearly invaded (SEP deep) could be diagnosed as SEP by transoral US. Conclusions Transoral US may be useful in determining the invasion depth of SPCs. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Effectiveness and safety of path‐based analgesic regimens designed by clinical pharmacists based on the type of biliary and pancreatic surgery

alexandrossfakianakis shared this article with you from Inoreader Effectiveness and safety of path‐based analgesic regimens designed by clinical pharmacists based on the type of biliary and pancreatic surgery via Journal of Clinical Pharmacy and Therapeutics Based on the characteristics of biliary and pancreatic diseases, clinical pharmacists have designed path-based postoperative analgesia regimens based on the surgeries included in the diseases (benign biliary surgery; malignant biliary surgery; benign pancreatic surgery; malignant pancreatic surgery). Abstract What Is Known and Objective As the incidence of postoperative pain in patients with biliary and pancreatic diseases has gradually increased, how to control postoperative pain has received increasing research attention. By reading pain management guidelines and multidisciplinary communication and cooperation, clinical pharmacists designed multi-mode analgesia regimens based on surgical types, in order to provide strong evidence for the effectiveness and safety of postoperative analgesia regimens and better serve patients. Methods Data from biliary or pancreatic surgery performed at Nanjing Drum Tower Hospital from 2019 to 2021 were collected. Take October 2020 as the time point to compare the outcomes before and after the implementation of the path-based postoperative analgesic regimens. The primary outcomes were NRS pain scores, sleep quality, and incidence of adverse reactions. Length of stay was a secondary outcome. Results and Discussion A total of 268 and 239 patients were enrolled in the study and control groups, respectively. Four path-based postoperative analgesic management regimens significantly reduced patients' static and dynamic NRS scores in the 24 h (p < 0.05). The patients' sleep quality were better than controls (p > 0.05). The incidence of adverse reactions and the length of stay in the study group were numerically lower than controls. Moderate analysis indicated that four analgesia regimens are more precise and better meet actual clinical needs. What Is New and Conclusion Effective and safe postoperative pain management is particularly important for clinical purposes. Path-based postoperative analgesia regimens based on different types of surgery overcome the disadvantages of overly broad and generalized traditional guidelines, which play an important role in providing personalized and precise clinical services. Further, study findings provide evidence that four path-based analgesic regimens can reduce postoperative pain and reduce the length of hospital stay, which may provide a better direction for clinical postoperative pain management. View on Web

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The efficacy of oral corticosteroids for treatment of Tietze syndrome: A pragmatic randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader The efficacy of oral corticosteroids for treatment of Tietze syndrome: A pragmatic randomized controlled trial via Journal of Clinical Pharmacy and Therapeutics The addition of short-term oral corticosteroids showed a clear benefit for use at 1, 2 and 3 weeks in improvement of pain and quality of life in patients with Tietze syndrome. The difference found by adding corticosteroids was maintained at mid-term follow up of patients with Tietze syndrome after treatment cessation. Joint swelling reported by patients with Tietze syndrome does not correlate with improvement in pain symptoms. Abstract What is known and objective Tietze syndrome is a rare form of chest wall costochondritis with joint swelling which can cause significant chest pain and decline in ability of daily activities. There is no standardized treatment protocol. The aim of this study was to assess the efficacy of adding oral steroids in addition to other non- steroidal treatment in improvement of pain and quality of life (QOL) in patients with Tietze syndrome. Methods Forty patients with Tietze syndrome were randomly divided into two treatment groups: (1) One week of prednisolone 40 mg daily followed by 1 week of prednisolone 20 mg daily followed by 1 week of 10 mg with 3 weeks of non-steroidal anti-inflammatory drug (NSAID) treatment (n = 20); (2) three weeks of NSAID treatment only (n = 20). A symptom questionnaire was used to rate the major symptoms of Tietze syndrome and costochondritis: Numeric rating scale (NRS) for pain on a scale of 0 (no pain) to 10 (severest pain); the resulting global symptom score was used to evaluate the efficacy of treatment with assessment of joint swelling resolution. The EQ-5D-5L instrument for measurement of QOL was used. Assessments were made on intention to treat basis at baseline and at 1, 2 and 3 weeks followed by a medium term follow period after treatment cessation. The trial was registered at www.isrctn.com ISRCTN11877533. Results and discussion There was a significant drop in mean NRS pain scores between the groups at 1, 2 and 3 weeks in favour of the steroid group (46.8% vs. 17.7%; p < 0.001, 56.3% vs. 35.8% p < 0.001 and 65.4% vs. 46.7% p < 0.001 respectively). There was a 25.8% (95% CI 13.2–38.8) difference in mean NRS score drop at a median of 6.5 months after treatment cessation in favour of the steroid group over the NSAID only group. Only three cases of mild GIT upset in the steroid group and two cases of mild nausea were reported in the NSAID group. There was an improvement in QOL using the median EQ-5D-5L scoring at 3 weeks in favour of the steroid group 7 (7, 8) versus 10 (8.5–11), (p < 0.001). The improvement in pain scoring and QOL did not correlate with improvement in joint swelling at 3 weeks after treatment with 2/20 (10%) in the steroid arm versus 1/20 (5%) in NSAID arm having an obvious improvement (p = 0.393). What is new and conclusion In this study, addition of short-term oral corticosteroids showed a clear benefit for use at 1, 2 and 3 weeks in improvement of pain and QOL in patients with Tietze syndrome. This difference was maintained at mid-term follow up after treatment cessation. This facilitates the advantage of using steroids as well as excluding their side effects for an accepted timeframe. View on Web

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Concomitant administration of warfarin and toremifene: A case report

alexandrossfakianakis shared this article with you from Inoreader Concomitant administration of warfarin and toremifene: A case report via Journal of Clinical Pharmacy and Therapeutics We reported a 50-year-old woman who was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. The results suggested when concomitant administration of warfarin and to remifene, the interaction between them is not serious, but the dose of warfarin needs to be reduced. Abstract What Is Known and Objective Antiestrogen agents have been reported to enhance the anticoagulant activity of warfarin. The use of tamoxifen with warfarin has been contraindicated. However, warfarin in combination with toremifene has not been reported. We report a case in which warfarin was combined with toremifene and applied warfarin dose prediction models to predict the dose of warfarin. Case Summary We report the case of a 50-year-old woman with a history of breast cancer, who underwent long-term toremifene therapy after mastectomy. The patient was treated with warfarin after prosthetic valve replacement and had a fluctuating international normalized ratio (INR) following the concomitant administration of toremifene. We applied the warfarin dose prediction model to adjust the warfarin dose during treatment. Finally, her INR stabilized with a lower dose of warfarin, and there was no serious bleeding during the 1-year follow-up. What Is New and Conclusion Warfarin does not have a serious interaction with toremifene in this case, but it needed about 37.5% dose reduction which was comparable to the interaction of some common antibiotics with warfarin. View on Web

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Impact of magnetic resonance angiography parameters on stroke prevention therapy in pediatric patients with sickle cell anemia

alexandrossfakianakis shared this article with you from Inoreader Impact of magnetic resonance angiography parameters on stroke prevention therapy in pediatric patients with sickle cell anemia via Pediatric Blood & Cancer Abstract Background Degree of cerebrovascular stenosis in pediatric patients with sickle cell anemia (SCA) informs need for chronic transfusion therapy, which has significant risks. Flow artifact, intrinsic to magnetic resonance angiography (MRA), is dependent on technical parameters and can lead to overinterpretation of stenosis. The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA scanning protocol for patients with SCA. Methods A standardized MRA scanning protocol with an echo time of less than 5 ms was implemented at Montefiore Medical Center (MMC), NY in May 2016. Retrospective chart review identified 21 pediatric patients with SCA, with an MRA head both pre- and post-May 2016. Arterial stenosis on MRA, machine parameters, and treatment plans were compared pre- and post-implementation. Results Ten of the 21 patients met inclusion criteria. Previously seen stenosis was re-classified to a lower degree in six of the 10 patients, leading to discontinuation of transfusions in five patients. No patients required escalation of therapy to chronic transfusions. Conclusion Optimizing flow artifact by decreasing echo time to less than 5 ms can improve accurate interpretation of cerebrovascular disease, and ensure appropriate treatment plans are in place for stroke prevention. This is especially important for implementing "TCD With Transfusions Changing to Hydroxyurea (TWiTCH)" clinical trial results in the real-world setting. View on Web

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Differential Associations of Rheumatoid Arthritis and Periodontitis or Tooth Loss: A Cross‐Sectional Study

alexandrossfakianakis shared this article with you from Inoreader Differential Associations of Rheumatoid Arthritis and Periodontitis or Tooth Loss: A Cross‐Sectional Study via Journal of Clinical Periodontology Abstract Aims To study the association between periodontitis, tooth loss, and rheumatoid arthritis by using a large national dataset. Materials and Methods An observational cross-sectional study was performed using the National Health and Nutrition Examination Survey (NHANES) cycles (2009-2014). Rheumatoid arthritis status was detected by a questionnaire. Periodontal status was assigned based on clinical attachment level and periodontal pocket depth. Dentition status was assessed by the number of permanent teeth observed. We examined the association between rheumatoid arthritis as exposure and moderate/severe periodontitis and non-functional dentition as outcomes. We progressively adjusted our models for different sets of potential confounders. Results Moderate/severe periodontitis was more prevalent in participants reporting rheumatoid arthritis (53% vs. 41.5%, p= 0.0003). Non-functional dentition was more prevalent in participants with rheumatoid arthritis (41% vs. 15.5%, p= 0.0001). The fully adjusted model showed participants with rheumatoid arthritis had higher odds of having a non-functional dentition (Odds Ratio 1.8, 95% CI 1.3-2.3, p= 0.0001), but no association with moderate/severe periodontitis (Prevalence Ratio 1.01, 95% CI 0.9-1.1, p= 0.9). Conclusion Rheumatoid arthritis was associated with a higher likelihood of having non-functional dentition but did not show an association with periodontitis after adjustments of the risk factors to control their confounding effect. View on Web

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Mechanical properties of platelet-rich fibrin from patients on warfarin

alexandrossfakianakis shared this article with you from Inoreader Mechanical properties of platelet-rich fibrin from patients on warfarin via International Journal of Oral and Maxillofacial Surgery via MedWorm.com Platelet-rich fibrin (PRF) has been used increasingly in oral and maxillofacial surgery in recent years. The aim of this experimental study was to perform a mechanical evaluation of PRF from patients on warfarin. PRF samples were obtained from 21 patients on warfarin (mean INR 2.30  ± 0.89) and 21 non-anticoagulated patients (control; mean INR 1.08 ± 0.07). For the patients on warfarin, two experimental groups were formed based on the PRF centrifugation time: group A, 10 min (21 samples); group B, 18 min (20 samples). (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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