Sunday, March 21, 2021

Spaced Intranasal Corticosteroid Therapy: A Better Treatment Option in Allergic Rhinitis?

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Abstract

Intranasal corticosteroids are first-line therapy in the treatment of allergic rhinitis (AR) and are conventionally prescribed once daily as continuous therapy. The decreased consumption of drugs is proposed to have decreased side effects. The present study aimed at comparing the effect of INCS as a spaced therapy with the conventional continuous therapy. Case records of patients with Allergic Rhinitis, who were started on INCS were studied and improvement in symptom score was compared between continuous and spaced therapy groups. In total 182 patients with AR were studied, with 91 patients in each group. Among the total group, 57% were males, 54% were < 40 years of age, 54% had > 10 years of allergy history and 94% had no family history. There was significant improvement in mean Visual Analogue Score (VAS) for all patients in both groups (p = 0.001). However, the comparison of differences in VAS before and after therapy did n ot show significant difference for the two groups (p = 0.791). Our study suggests that the efficacy of INCS in controlling AR symptoms is observed to be similar with spaced therapy, as in continuous therapy. Spaced therapy may therefore be recommended for better patient compliance, lesser cost and avoidance of the side effects resulting in overall improvement of quality of life for allergic patients.

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Ultra‐high frequency ultrasound and machine‐learning approaches for the differential diagnosis of melanocytic lesions

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Abstract

Malignant melanoma (MM) is one of the most dangerous skin cancers. The aim of this study is to present a potential new method for the differential diagnosis of MM from melanocytic naevi (MN).

We examined 20 MM and 19 MN with a new ultra‐high frequency ultrasound (UHFUS) equipped with a 70 MHz linear probe. Ultrasonographic images were processed for calculating 8 morphological parameters (area, perimeter, circularity, area ratio, standard deviation of normalized radial range, roughness index, overlap ratio and normalized residual mean square value) and 122 texture parameters. Color‐Doppler images were used to evaluate the vascularization. Features reduction was implemented by means of Principal Component Analysis (PCA) and 23 classification algorithms were tested on the reduced features using histological response as ground‐truth. Best results were obtained using only the first component of the PCA and the weighted k‐nearest neighbor classifier; this combination led to an accuracy of 76.9%, area under the ROC curve of 83%, sensitivity of 84% and specificity of 70%. The histological analysis still remains the gold‐standard, but the UHFUS images processing using a machine‐learning approach could represent a new non‐invasive approach.

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Inhibition of pyruvate oxidation as a versatile stimulator of the hair cycle in models of alopecia

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Abstract

Hair follicle stem cells (HFSCs) are known to be responsible for the initiation of a new hair cycle, but typically remain quiescent for very long periods. In alopecia, or hair loss disorders, follicles can be refractory to activation for years or even permanently. Alopecia can be triggered by autoimmunity, age, chemotherapeutic treatment, stress, disrupted circadian rhythm or other environmental insults. We previously showed that hair follicle stem cells and the hair cycle can be manipulated by regulation of pyruvate entry into mitochondria for subsequent oxidation to fuel the TCA cycle in normal adult mice with typical hair cycling. Here, we present new data from our efforts to develop murine models of alopecia based on environmental triggers that have been shown to do the same in human skin. We found that inhibition of pyruvate transport into mitochondria can accelerate the hair cycle even during refractory hair cycling due to age, repeated chemotherapeutic treatment and stress. Hair cycle acceleration in these alopecia models led to the formation of histologically normal hair follicles within 30–40 days of treatment without any overt signs of toxicity or deleterious effects. Therefore, we propose inhibition of pyruvate entry into mitochondria as a versatile treatment strategy for alopecia in humans.

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MDCT evaluation of pancreatic contour variations in head, neck, body and tail: surgical and radiological significance

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Surg Radiol Anat. 2021 Mar 18. doi: 10.1007/s00276-021-02735-4. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations.

METHODS: A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally total of 524 patients were included in the study. For simplification, we classified the pancreatic contour variations as classified by Ross et al. and Omeri et al. Pancreatic head-neck variations was classified into Type I-anterior, Type II-posterior and Type III-horizontal variety. Pancreatic body-tail variation was divided into Type Ia-anterior projection; Ib-posterior projection and Type IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail.

RESULTS: The most common type of variation in the head was Type II (n = 112, 21.3%) followed by Type III (n = 37, 7%) and Type I (n = 21, 4%). The most common type of variation in the body of pancreas was Type Ia (n = 33, 6.2%) followed by Type Ib (n = 13, 2.4%). In the tail region of pancreas, the most common variation was Type IIb (n = 21, 4%) followed by Type IIa (n = 19, 3.6%).

CONCLUSION: Pancreatic contour variations are not very uncommon in daily practice. Knowledge of these variations is important for surgeons, radiologists and avo ids misjudgement of normal pancreatic tissue as tumor or lymph node especially on unenhanced or single phase MDCT.

PMID:33738524 | DOI:10.1007/s00276-021-02735-4

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Brain Gene Expression in Systemic Hypothyroidism and Mouse Models of MCT8 Deficiency: The Mct8-Oatp1c1-Dio2 Triad

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Thyroid, Ahead of Print.
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Safety of (rhino)septoplasty without nasal packing in routine ENT practice

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Eur Arch Otorhinolaryngol. 2021 Mar 18. doi: 10.1007/s00405-021-06713-9. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective study assesses the risks and benefits linked to the non-use of nasal packing after a (rhino)septoplasty, compared with post-operative care with anterior nasal packing such as Merocel®.

METHODS: Complication rates observed during the first week after surgery were compared between groups with and without use of classic nasal packing over a large sample of 534 patients, who had undergone either a closed or open procedure, with bilateral turbinoplasty, and with or without osteotomies. Complications listed include epistaxis, haematoma, impetiginization, septal perforation, hyperalgesia, and dyspnoea.

RESULTS: No significant difference was observed between the group with and without packing regarding the immediate post-operative complications of epistaxis (4.4% of the cases with nasal packing versu s 3% without, p = 0.918) and impetiginization (3% of the cases with nasal packing versus 4.2% without, p = 0.478). The technique used, as well as any osteotomies performed, had no impact on the results.

CONCLUSION: Non-use of nasal packing after a (rhino)septoplasty is a safe alternative to classic post-operative methods. Provided that there is a rigorous surgical technique and strict clinical control, it should be used as a principal technique in any routine practice due to its safety for patients immediately post-surgery.

PMID:33738566 | DOI:10.1007/s00405-021-06713-9

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Injection laryngoplasty under ultrasonographic control

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Eur Arch Otorhinolaryngol. 2021 Mar 18. doi: 10.1007/s00405-021-06666-z. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical ultrasound allows real-time visualization of the laryngeal structures. We describe its application for injection laryngoplasty in the voice clinic.

METHODS: Hyaluronic acid infiltration of the vocal fold under ultrasonographic control.

CONCLUSIONS: With this technique, the position of the needle in the depth of the vocal fold and its spatial relations with nearby structures can be assessed. This allows for an accurate infiltration of the material in contrast to other techniques and avoids discomfort related to the gag reflex with nasofibrolaryngoscopy. No specific complications have been observed so far, however, this technique may be difficult in cases with calcified cartilages or uncooperative patients.

PMID:33738568 | DOI:10.1007/s00405-021-06666-z

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Evolution of voice after transoral laser cordectomy for precancerous lesions and early glottic cancer

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Eur Arch Otorhinolaryngol. 2021 Mar 18. doi: 10.1007/s00405-021-06751-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate voice quality evolution after a transoral laser cordectomy (TLC) for precancerous lesions and early glottic cancer.

METHODS: This prospective study enrolled 18 patients scheduled for TLC for high-grade dysplasia, Tis, T1, and T2 glottic squamous cell cancers, from May 2017 to March 2020. Patients were grouped according to the extent of TLC: Group I (n = 11, 61.1%): unilateral subepithelial or subligamental cordectomy; Group II (n = 7, 38.9%): unilateral transmuscular, total, or extended cordectomy. Voice quality parameters, including dysphonia grade (G), roughness (R), breathiness (B), maximal phonation time (MPT), jitter, and shimmer, were evaluated before, and at 6 weeks and 6 months after the TLC.

RESULTS: In Group I, the degree of G and R items remained without substantial improvement 6 weeks aft er surgery; however, improved above the pre-surgery level up to 6 months after surgery. The MPT, jitter, and shimmer did not change significantly at 6 weeks or 6 months post-TLC. In Group II, G, R, and B remained significantly impaired even 6 months post-surgery. Jitter, and shimmer worsened at 6 weeks, but reached preoperative levels at 6 months post-surgery. MPT was significantly worse at 6 weeks and remained deteriorated at 6 months post-surgery. All measured parameters were significantly worse in Group II than in Group I at 6 weeks and 6 months post-surgery. No patient required a phonosurgical procedure.

CONCLUSION: After a TLC, voice quality evolution depended on the extent of surgery. It did not improve at 6 weeks post-surgery. Improvements in less extent cordectomies occurred between 6 weeks and 6 months post-surgery. Understanding voice development over time is important for counseling patients when considering phonosurgical procedures.

PMID:33738567 | DOI:10.1007/s00405-021-06751-3

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Non-aesthetic uses of botulinum toxin in the head and neck

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Eur Arch Otorhinolaryngol. 2021 Mar 18. doi: 10.1007/s00405-021-06750-4. Online ahead of print.

ABSTRACT

INTRODUCTION: The use of botulinum toxin in the specialty of aesthetic surgery in the head and neck is well known. However, it has also been used for other conditions affecting the head and neck, and in recent years its use, as well as the number of relevant applications, has expanded enormously.

REVIEW: This article presents a summary of the current range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles and salivary glands. We highlight particular conditions focusing on dystonia (laryngeal, craniocervical, oromandibular and cervical), multiple system atrophy, migraines, facial nerve palsy, post-laryngectomy, cricopharyngeal dysphagia, Zenker's diverticulum, retrograde cricopharyngeal dysfunction disorder, sialorrhea and gustatory sweating (Frey's syndrome).

CONCLUSION: This article should aid the ear, nose and throat surgeon garner knowledge about the range of uses for botulinum toxin in the head and neck.

PMID:33738565 | DOI:10.1007/s00405-021-06750-4

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Voluminous parotid cyst of the first branchial arch: a case report

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Pan Afr Med J. 2020 Dec 10;37:334. doi: 10.11604/pamj.2020.37.334.17191. eCollection 2020.

ABSTRACT

Parotid branchial cysts are rare and poorly known congenital malformations of the first branchial cleft. They are characterized by three types of manifestations which may be associated to it or isolated, including inflammatory swelling of the subauricular and inferior portion of the parotid with or without cervico-cutaneous fistula projecting into the cervico-mandibular area and a fistula in the floor of the external auditory canal with or without otorrhea, with or without pretimpanic bridle on otoscopy. They often go unnoticed, except for superinfections. Diagnosis is based on interview, the occurrence of recurrent abscesses or superinfections. No complementary imaging examination should be systematically performed. In atypical forms, ultrasound as well as magnetic resonance imaging (MRI) could be necessary, particularly in patients with parot id swellings, in order to confirm cystic structure. Abscesses and recurrent superinfections are the most common complications. Treatment is based on surgical resection. We report the case of a patient with voluminous parotid cyst of the pharyngeal arch.

PMID:33738022 | PMC:PMC7934193 | DOI:10.11604/pamj.2020.37.334.1 7191

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Purpose‐built Septal Splints for control of Hereditary Haemorrhagic Telangiectasia related epistaxis: A prospective study

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Abstract

Hereditary haemorrhagic telangiectasia is an autosomal dominant disorder characterised by friable mucocutaneous telangiectasia with an incidence of 1:5000. Recurrent epistaxis due to HHT affects more than 90% of the individuals with no curative options. Purpose built silicone nasal septal splints reduced epistaxis significantly in all patients and the need for blood transfusion and iron supplements. Nasal congestion and crusting were experienced by some patients. This was not troublesome, and these patients preferred the splints rather than epistaxis. Quality of life outcomes significantly improved in all patients.

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Test Utilization for Thyroglobulin and Anti-Thyroglobulin Antibody Assays in Korea

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Clin Lab. 2021 Mar 1;67(3). doi: 10.7754/Clin.Lab.2020.200802.

ABSTRACT

BACKGROUND: When measuring thyroglobulin (Tg), simultaneous measurement of Tg autoantibodies (Ab) is recommended by clinical guidelines for follow-up of patients with differentiated thyroid cancers after thyroidectomy and radioactive iodine ablation. We aimed to investigate test utilization of Tg and Tg Ab assays in local clinics and hospitals in Korea.

METHODS: We retrospectively reviewed data from the l aboratory information system between November 6, 2017 and December 31, 2019.

RESULTS: During the study period, 10,551 Tg tests were performed on 2,592 Korean adults from 97 local clinics and hospitals. Among them, 3,924 (37.2%) test results lacked concurrent Tg Ab assays, while 6,627 test results had concurrently measured Tg Ab, and 528 (8.0%) showed positive Tg Ab results, which could interfere with measurement of Tg concentration.

CONCLUSIONS: The results of this study provide basic information regarding test utilization of Tg Ab assays to improve test utilization for accurate Tg measurement in Korean patients.

PMID:33739057 | DOI:10.7754/Clin.Lab.2020.200802

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