Opioid Usage and Pain Control in Benign Oropharyngeal Surgery: An Observational Prospective Study

xlomafota13 shared this article with you from Inoreader Opioid Usage and Pain Control in Benign Oropharyngeal Surgery: An Observational Prospective Study Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Oct 25:34894211053290. doi: 10.1177/00034894211053290. Online ahead of print. ABSTRACT OBJECTIVES: Little data is available on opioid usage in the adult population for benign oropharyngeal surgery. The objective here is to evaluate opioid prescribing patterns, opioid consumption, and patient pain patterns following benign oropharyngeal surgery, specifically tonsillectomy and adenoidectomy, tonsillectomy alone, and expansion sphincter pharyngopla sty. METHODS: Patients aged ≥18 years old and received a tonsillectomy, tonsillectomy and adenoidectomy, or expansion sphincter pharyngoplasty between November 2019 and August 2020 were included. Patients were provided a survey which included a visual analog scale for recording their pain postoperatively and the amount of opioid they had remaining. RESULTS: About 103 patients completed the post-operative questionnaire. Patients were prescribed 38 837 morphine milligram equivalents and used 28 644: approximately 26% went unused, which is the equivalent of 1346 5 mg oxycodone pills. Opioid consumption correlated with the initial dosage: patients consumed 12% more narcotic on average as the initial prescription went upwards by 50 morphine milligram equivalents. Obstructive sleep apnea, history of smoking, and being female predicted increased opioid usage in this cohort. Pain was reported the highest on postoperative day 1. A prescription of approximately 225 morphine mill igram equivalents (150 mg oxycodone) was associated with decreased opioid use in this cohort. Larger initial prescriptions did not result in fewer requests for refills. CONCLUSION: A significant amount of opioid medication went unused in this study. A prescription of 225 morphine milligram equivalents (or 150 mg oxycodone) provided appropriate analgesia for the majority of patients. Larger prescriptions may result in increased opioid consumption and may not reduce the amount of refills. More study is needed to confirm these findings. PMID:34694150 | DOI:10.1177/00034894211053290 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Understanding Extremely Elevated Dizziness Handicap Inventory Scores: An Analysis of Predictive Factors

xlomafota13 shared this article with you from Inoreader Understanding Extremely Elevated Dizziness Handicap Inventory Scores: An Analysis of Predictive Factors Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Oct 25:34894211053788. doi: 10.1177/00034894211053788. Online ahead of print. ABSTRACT BACKGROUND: The Dizziness Handicap Inventory (DHI) measures impairment in quality of life due to dizziness, with higher scores indicating greater impairment. Little is known about the clinical features that predict extremely elevated DHI scores (eeDHI). OBJECTIVE: To identify clinical features associated with eeDHI. METHODS: A retrospective analysi s was conducted of 217 patients with dizziness between October 2016 and April 2019. Patients with eeDHI had DHI scores 1 standard deviation higher than the mean. Analyses were performed to generate odds ratios (OR) for having eeDHI based on clinical features and exam findings. RESULTS: The cut-off for eeDHI scores was 71. In total, 20.7% had eeDHI. Logistic regression identified 6 independent predictors for eeDHI scores: numbness in the face or body during dizziness (OR = 5.99, 95% CI 1.77-20.30), history of falls (OR = 4.37, 95% CI 1.74-10.97), female sex (OR = 2.81, 95% CI 1.18-6.66), caloric weakness (OR = 2.61, 95% CI 1.36-5.01), total number of diagnoses associated with dizziness (OR = 2.17, 95% CI 1.11-4.28), and total number of symptoms during dizziness (OR = 1.25, 95% CI 1.07-1.45). CONCLUSIONS: These findings suggest that patients with eeDHI have severe disease and should be screened for falls. By understanding the drivers of high DHI scores, we can alleviate di sease related suffering for vestibular disorders. PMID:34694153 | DOI:10.1177/00034894211053788 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Human papillomavirus testing in metastatic squamous cell carcinoma of the neck with unknown primary using PCR on fine-needle aspiration smears: a prospective clinical study

xlomafota13 shared this article with you from Inoreader Human papillomavirus testing in metastatic squamous cell carcinoma of the neck with unknown primary using PCR on fine-needle aspiration smears: a prospective clinical study Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 24. doi: 10.1007/s00405-021-07133-5. Online ahead of print. ABSTRACT PURPOSE: Squamous cell carcinoma metastasis of the head and neck with unknown primary tumor (CUP) comprises a diagnostic challenge. Human papillomavirus (HPV) testing on cytologic specimens is gaining increasing focus as this may facilitate an early diagnosis of HPV-induced oropharyngeal carcinoma. This study aimed to prospectively assess PCR-based HPV-DNA testing on FNA smears in a clinical setting. METHODS: Patients referred to a tertiary Head and Neck Cancer Center with suspected CUP were included from November 2016 to November 2018. Scraped cell material from FNA smears was analyzed for HPV-DNA with PCR using general primers (GP5 + /GP6 +) and correlated with the origin and histology of the primary tumor (oropharynx vs. outside oropharynx or benign tumor). The turn-around time reflecting the workflow for HPV-DNA testing by PCR was also calculated. RESULTS: A total of 93 patients were enrolled in the study. The sensitivity and specificity were 86.7% [95% CI 75.4-94.1%] and 92.0% [95% CI 74.0-99.0%], and the positive and negative predictive values were 96.3% [95% CI 87.3-99.0%] and 74.2% [95% CI 59.9-84.7%], respectively. The turn-around time for HPV testing was a mean four calendar days. CONCLUSION: HPV-DNA testing on FNA smears can be performed within a reasonable timeframe and can guide for the detection of an HPV-positive oropharyngeal primary tumor in the clinical setting for patients presenting with CUP of the head and neck. PMID:34689237 | DOI:10.1007/s00405-021-07133-5 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical significance of the cognition-related pathogenic proteins in plasma neuronal-derived exosomes among normal cognitive adults over 45 years old with olfactory dysfunction

xlomafota13 shared this article with you from Inoreader Clinical significance of the cognition-related pathogenic proteins in plasma neuronal-derived exosomes among normal cognitive adults over 45 years old with olfactory dysfunction Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 24. doi: 10.1007/s00405-021-07143-3. Online ahead of print. ABSTRACT OBJECTIVES: Exosomal Phospho-Tau-181(P-T181-tau), Total tau (T-tau), and amyloid-β peptide 42 (Aβ42) have been proved the capacity for the amnestic mild cognitive impairment (MCI) and the diagnosis of Alzheimer's disease (AD). This study aimed to explore the cognitive function and the levels of P-T181-tau, T-tau, and Aβ42 in neuronal-derived exosomes (NDEs) extracted from plasma in normal cognitive adults over 45 years old with olfactory dysfunction. METHODS: A cross-sectional survey of 29 participants aged over 45 was conducted. Plasma exosomes were isolated, precipitated, and enriched by immuno-absorption with anti- L1 cell adhesion molecule (L1CAM) antibody. NDEs were characterized by CD81, and extracted NDE protein (P-T181-tau, T-tau, and Aβ42) biomarkers were quantified by enzyme-linked immunosorbent assay (ELISAs). O lfactory performance was assessed by Sniffin' Sticks and cognitive performance was assessed by Montreal Cognitive Assessment (MoCA). RESULTS: There was no significant difference between adults with olfactory dysfunction and without olfactory dysfunction regarding the cognitive function as measured by MoCA and all the participants showed normal cognition. Adults with olfactory dysfunction showed a higher concentration of P-T181-tau in plasma NDEs than did adults without olfactory dysfunction (P = 0.034). Both the levels of P-T181-tau (r = - 0.553, P = 0.003) and T-tau (r = - 0.417, P = 0.034) negatively correlated with the odor identification scores. In addition, the level of T-tau negatively correlated with MoCA scores (r = - 0.597, P = 0.002). The levels of P-T181-tau (r = - 0.464, P = 0.022) and T-tau (r = - 0.438, P = 0.032) negatively correlated with the delayed recall scores. CONCLUSIONS: This study demonstrated that cognition-related pathogenic proteins including P -T181-tau in plasma NDEs were significantly increased in adults over 45 years old with olfactory dysfunction before the occurrence of cognitive impairment. The impaired odor identification and the delayed recall function were highly associated with the increased levels of P-T181-tau and T-tau in plasma NDEs. PMID:34693486 | DOI:10.1007/s00405-021-07143-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical Biomarkers in Otolaryngology-Head and Neck Surgery

xlomafota13 shared this article with you from Inoreader Message: The number of biomarkers in use in otolaryngology is rapidly expanding representing a new diagnostic modality for our field. This review defines the key biomarkers that are currently or likely to be soon translated into clinical use within the field of otolaryngology. The majority of these biomarkers are in the form of proteins such as beta-2 transferrin, thyroglobulin, and P16. Given their growing impact on diagnosis, management and surveillance of otolaryngologic disorders periodic surveys are needed for education and to guide further advances and applications of otolaryngologic biomarkers. What is a beta 2 transferrin test? Beta-2-transferrin is a form of the protein transferrin that is present in cerebrolspinal fluid (CSF), but not usually found in blood, nasal secretions or other body fluids. It is used to distinguish CSF from other watery discharge from the nose or ear after a traumatic injury to the brain and or spine. What does a high thyroglobulin mean? Your thyroglobulin levels are high and/or have increased over time. This may mean thyroid cancer cells are growing, and/or cancer is starting to spread. Little or no thyroglobulin was found. This may mean that your cancer treatment has worked to remove all thyroid cells from your body. What is p16 positive mean? Abstract. Expression of p16INK4A (p16 positive) is highly correlated with human papilloma virus (HPV) infection in head and neck squamous cell carcinoma (HNSCC), however, p16-positivity is not limited to HPV positive tumors and therefore, not a perfect surrogate for HPV. Clinical Biomarkers in Otolaryngology-Head and Neck Surgery Via ear nose throat Ear Nose Throat J. 2021 Oct 25:1455613211050698. doi: 10.1177/01455613211050698. Online ahead of print. ABSTRACT OBJECTIVE: The purpose of this paper is to review the literature and compile promising and clinically relevant biomarkers in otolaryngology-head & neck surgery not related to autoimmune disorders. STUDY DESIGN: Narrative review. METHODS: PubMed and Google Scholar were queried using combined key words such as "biomarkers" and "otolaryngology." Addit ional queries were made with combined key words such as "biomarkers" and a particular subspecialty such as "rhinology" or "otology" to maximize yield of relevant titles. Subsequently, specific biomarkers identified, such as "beta-2 transferrin," were used as key words. Relevant titles were reviewed and selected for abstract review. Applicable abstracts were then selected for review of the full text. RESULTS: Biomarkers currently in clinical use within the field of otolaryngology were included in this review. The compiled biomarkers were then detailed individually regarding their molecular characteristics, function, and clinical significance. CONCLUSIONS: The number of biomarkers in use in otolaryngology is rapidly expanding representing a new diagnostic modality for our field. This review defines the key biomarkers that are currently or likely to be soon translated into clinical use within the field of otolaryngology. The majority of these biomarkers are in the form of p roteins such as beta-2 transferrin, thyroglobulin, and P16. Given their growing impact on diagnosis, management and surveillance of otolaryngologic disorders periodic surveys are needed for education and to guide further advances and applications of otolaryngologic biomarkers. PMID:34694171 | DOI:10.1177/01455613211050698 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictive Impact of Metastatic Lymph Node Burden on Distant Metastasis Across Papillary Thyroid Cancer Variants

xlomafota13 shared this article with you from Inoreader Predictive Impact of Metastatic Lymph Node Burden on Distant Metastasis Across Papillary Thyroid Cancer Variants Via liebertpub1 Thyroid, Volume 31, Issue 10, Page 1549-1557, October 2021. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Real-World Efficacy and Safety of Multi-Tyrosine Kinase Inhibitors in Radioiodine Refractory Thyroid Cancer

xlomafota13 shared this article with you from Inoreader Real-World Efficacy and Safety of Multi-Tyrosine Kinase Inhibitors in Radioiodine Refractory Thyroid Cancer Via liebertpub1 Thyroid, Volume 31, Issue 10, Page 1531-1541, October 2021. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.