Τετάρτη 3 Αυγούστου 2022

Clinical characteristics, outcomes, and seasonality of acute respiratory infection associated with single and co‐detected rhinovirus species among hospitalized children in Amman, Jordan

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Abstract

Background

Rhinovirus (RV)-specific surveillance studies in the Middle East are limited. Therefore, we aimed to study the clinical characteristics, outcomes, and seasonality of RV-associated acute respiratory infection among hospitalized young children in Jordan.

Methods

We conducted a prospective viral surveillance study and enrolled children <2 years old admitted to a large public hospital in Amman, Jordan (2010–2013). Demographic and clinical data were collected by structured interviews and chart abstractions. Nasal and/or throat swabs were collected and tested for a panel of respiratory viruses, and RV genotyping and speciation was performed.

Results

At least one virus was detected in 2,641/3,168 children (83.4%). RV was the second most common virus detected (n=1,238; 46.9%) and was co-detected with another respiratory virus in 730 cases (59.0%). Children with RV co-detection were more likely than those with RV-only detection to have respiratory distress but had similar outcomes. RV-A accounted for about half of RV-positive cases (54.7%), while children with RV-C had a higher frequency of wheezing and reactive airway disease. RV was detected year-round and peaked during winter.

Conclusions

Though children with RV co-detection had worse clinical findings, neither co-detection nor species affected most clinical outcomes.

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The diagnostic yield of head and neck imaging in symptomatic patients with a normal clinical examination

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Abstract

Aim

Nationally, concern has been raised about the overuse of diagnostic testing. In patients with unilateral otalgia and no history of Head and Neck Cancer (HNC), 1% had a malignancy detected on imaging that was not detected on clinical examination.

Methods

We performed a retrospective review of "MRI soft tissue neck" scans performed at our hospital from May 2020 to May 2021. Patients were excluded if their scan was not ordered for HNC symptoms. Previous HNC patients undergoing follow-up imaging were also included.

Results

In total, 326 scan requests were analyzed. Of the 132 patients without clinical features of overt disease, only one received a new diagnosis of HNC. This patient had previously had a HNC and was undergoing routine follow-up imaging.

Conclusion

Our data demonstrate that performing MRI scans in symptomatic patients with a normal examination, FNE, and no history of HNC does not benefit the diagnosis or management of these patients.

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Overexpression of circFNDC3B promotes the progression of oral tongue squamous cell carcinoma through the miR‐1322/MED1 axis

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Abstract

Background

The potential role of circFNDC3B in regulating oral tongue squamous cell carcinoma development (OTSCC) remains unknown.

Methods

The level of circFNDC3B in OTSCC tissues or cell lines was measured and its function in vitro and in vivo was analyzed. Interactions among circFNDC3B, miR-1322, and MED1 were verified by luciferase reporter and RNA pull-down assays.

Results

The level of circFNDC3B in tissues or cell lines of OTSCC was higher than that in control groups. siRNA-mediated circFNDC3B inhibition resulted in weakened proliferation, migration, and invasion, which was reversed by miR-1322. Overexpression of MED1 in OTSCC cells partially reversed the tumor suppression functions of si-circFNDC3B or miR-1322 mimics in vitro. circFNDC3B overexpression dramatically promoted tumor growth in vivo. circFNDC3B directly bound with miR-1322 and consequently promoted the MED1 expression in OTSCC cells.

Conclusions

The circFNDC3B/miR-1322/MED1 axis participates in OTSCC progression, which may provide novel therapeutic targets for OTSCC.

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Particular body odors matter: Disgust sensitivity differs across attachment groups

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Abstract

Extensive research has highlighted how one's attachment style influences the development and maintenance of romantic relationships. Disgust is a construct that conceptually overlaps with attachment style given both include elements of behavioral avoidance. However, no previous study has examined how one's attachment style may influence disgust-based avoidance of intimacy in romantic relationships. Therefore, the aim of the current study is to determine if adult attachment style is associated with olfactory disgust ratings towards eight body odor (BO) sources from their partner, previous partner, or others. The results revealed that disgust ratings of a partner's BO differed depending on attachment style. Specifically, the participants with a dismissing-avoidant attachment style rated their partner's BO as more disgusting than the secure, fearful-avoidant, or preoccupied styles. Moreover, participants with a dismissing-avoidant attachment style rated their partner's and strangers' BO equally disgusting whereas those in the other attachment groups rated strangers' BO as more disgusting than their partner's.

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Transposition nasolabial flap: A versatile flap for sensate reconstruction of lip defects

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Abstract

Introduction

Lip reconstruction aims at maintaining the function and aesthetics of the facial subunits. Sensation in the reconstructed lip helps in bolus formation, tactile discrimination, and thermal sensation. In this study, we aim to describe random pattern nasolabial flap for lip reconstruction using various functional parameters.

Methodology

This is a retrospective study of 22 patients with carcinoma lip who underwent surgical resection and reconstruction with sensate nasolabial flap. Several clinicopathological parameters were studied. Outcome parameters like oral competence, tactile sensation, thermal sensitivity of reconstructed lip and speech outcomes were evaluated.

Result

A functional outcome with 2–4 mm of two-point discrimination was obtained in 19 patients. All patients had intelligible speech. A mean sulcus depth of 19.59 mm was achieved. One patient had partial flap loss owing to wound infection.

Conclusion

Random pattern senate nasolabial flap offers a good functional outcome by maintaining the tactile and thermal sensitivity.

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Salivary bypass tube in total laryngectomy: Systematic review and meta‐analysis

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Abstract

The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of postoperative pharyngocutaneous fistula (PCF) and pharyngeal stenosis (PS). This study was conducted in conformity with the PRISMA statement. 1960 patients with a median age of 62.0 years were included. A SBT was placed in 980 (50%) patients (SBT group). The cumulative PCF incidence in the SBT group was 15.8% (95% CI: 9.3–23.6). The measured pooled OR comparing PCF incidence in patients with SBT compared to those without was 0.40 (95% CI: 0.24–0.65). The pooled PS incidence in the SBT group was 12.3% (95% CI: 5.4–21.6). The measured pooled OR comparing PS incidence in patients with SBT compared to those without was 0.43 (95% CI: 0.24–0.65). PCF and PS could be prevented by the intra-operative placement of a SBT.

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MRI has a limited role in investigating odynophagia if examination is normal: a binary logistic regression analysis of 484 patients presenting to a tertiary head and neck clinic

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Abstract

Introduction

Investigation of head and neck cancers places a significant burden on the National Health Service and effective resource allocation is of perpetual importance. Existing risk calculators are designed to stratify the likelihood of underlying malignancy according to symptoms, but are less relevant in secondary care as they do not integrate clinical examination findings (e.g. naso-endoscopy). We looked to evaluate the utility of magnetic resonance imaging (MRI) in investigating patients with unilateral odynophagia and a normal clinical examination.

Methods

A retrospective analysis was conducted over a 54-month period; 484 consecutively-recruited adult patients who underwent MRI of the neck for suspected malignancy were included. Imaging reports, case notes, and histopathology results were reviewed. Patients with previously diagnosed/treated malignancy, undergoing surveillance, or those with pathology of the salivary glands, oral cavity or thyroid gland, were excluded. A multivariate binary logistical regression model was performed to calculate the odds ratios and probabilities of malignancy for each presenting symptom, with and without negative nasoendoscopy findings.

Results

The overall incidence of malignancy within the cohort was 173/484 patients (35.7%; 95% CI 31.5 – 40.2%) with no cases of malignancy in patients presenting with odynophagia and a normal nasoendoscopy (0/39). The presence of a neck lump was significantly associated with malignancy, (OR 2.03 p = 0.001; 95% CI 1.59 – 2.58), as was dysphagia (OR 1.52 p = 0.009; 95%CI 1.11 - 2.11). Conversely, globus was found to have an inverse association (OR 0.41 p < 0.001; 95% CI 0.24 – 0.70).

Summary

New patients presenting with odynophagia alone and normal endoscopy or globus have a low likelihood of underlying malignancy, justifying reassurance and follow-up in the event of persistent symptoms. Contrariwise, patients with a neck lump, dysphagia, odynophagia and multiple concurrent aerodigestive tract symptoms, or an abnormal endoscopy have a high likelihood of underlying malignancy and should be investigated accordingly.

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A systematic review of the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with obstructive sleep apnoea

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Abstract

Introduction

Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA.

Methods

We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was done. The protocol of this systematic review was registered with PROSPERO (CRD42021273451).

Results

A total of 1836 patients from ten observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported.

Conclusion

Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria.

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The use of MRI in a tertiary smell and taste clinic: lessons learned based on a retrospective analysis

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Abstract

Background

Olfactory dysfunction (OD) is a common but underreported problem that can significantly impact a patient's quality of life. OD is prevalent in over 5% of the adult population and can be broadly categorised into conductive and sensorineural causes. Magnetic Resonance Imaging (MRI) can form part of the diagnostic work up, although its exact role is often debated.

Objectives

The aim of this study was to evaluate the value of MRI in managing patients with OD.

Design/ Method

A retrospective analysis of the records of patients presenting to a national smell and taste clinic over a five-year period was performed. Variables included demographics, endoscopic findings, final diagnosis, psychophysical smell test and imaging results.

Results

A total of 409 patients, with an age range of 10-93 years, underwent clinical assessment and smell testing, of which 172 patients (42%) had MRI scans. Imaging in younger age-groups was associated with a higher rate of positive findings, however identifiable causes for OD were recorded across the range. MRI provided both diagnostic and prognostic information in those with idiopathic, traumatic, and congenital causes of OD. For example, MRI provided information on the extent or absence of gliosis in those with a head trauma history allowing further treatment and prognosis.

Conclusion

We recommend the adjunct use of MRI in patients with a clear history and examination findings of head injury, congenital cases and in apparent idiopathic cases. MRI should be requested to compliment clinical findings with a view to aiding decision-making on treatment and prognosis independent of patient's age.

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Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes

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Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes

Our retrospective cohort study identified that Black patients comprised the greatest proportion of patients with iatrogenic laryngotracheal stenosis. Of all etiologies, the iatrogenic form of stenosis had the highest incidence of temporary tracheostomy and tracheostomy dependence.


Objective

Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency.

Methods

Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit.

Results

129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only.

Conclusion

This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study.

Level of Evidence

III Laryngoscope, 2022

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