Tuesday, June 29, 2021

Exploratory analysis on the association of mental health disorders with in‐hospital postoperative complications and mortality in head and neck cancer surgery

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Abstract

Background

The objective was to assess the association of mental health disorders with in-hospital complication and mortality rates in patients undergoing head and neck cancer surgery.

Methods

In this exploratory retrospective study, the Nationwide Inpatient Sample was queried from 2003 to 2014 for all patients with a diagnosis of head and neck cancer who underwent surgery. Univariate cross-tabulation, logistic regression, and propensity score matching (PSM) were used to compare demographics, procedure-related variables, and in-hospital postoperative complications and mortality between patients with and without selected comorbid mental health disorders.

Results

Of 39 600 included patients, 3390 (8.6%) had a selected comorbid mental health disorder diagnosis. After PSM, patients with selected mental health disorders had increased risk of overall medical complications on multivariable analysis (OR 1.28 [CI 1.12–1.46], P < 0.001) but not overall surgical complications or mortality.

Conclusions

Patients with a mental health disorder diagnosis have increased risk of in-hospital medical, certain surgical, and total complications.

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Possible Involvement of Type 2 Cytokines in Alloknesis in Mouse Models of Menopause and Dry Skin

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ABSTRACT

Alloknesis, an abnormal itch sensation induced by innocuous stimuli, is a key phenomenon in the vicious itch-scratch cycle in patients with atopic dermatitis. Dry skin and pruritus, including alloknesis, are major health problems in peri- and post-menopausal women. We recently reported permeability barrier dysfunction in ovariectomised (OVX) mice—a model of menopause—and found that the dysfunction was related to dry skin. However, the mechanism of the itch remains unknown. Therefore, we examined touch- and pruritogen-evoked alloknesis and epidermal innervation in OVX mice and acetone, diethyl ether, and water (AEW)-treated mice, for the experimental dry skin model. Both alloknesis and epidermal innervation were comparable in OVX and AEW mice. Neutralising antibodies against IL-4 and IL-13 inhibited alloknesis in both OVX and AEW mice as early as 30 min after intradermal administration. Comparable values close to the measurement limit of IL-4 were found in the skin of HRT and S ham mice as well as AEW and the control mice, but the levels of IL-4 were within the measurement limit in OVX mice. We could not detect mRNAs of IL-4 or IL-13 in any groups of mice. On the other hand, the number of eosinophils and basophils was increased in OVX and AEW mice. These results suggest that impaired barrier function in cooperation with type 2 cytokines derived from eosinophils and basophils in the skin or with endogenous type 2 cytokine may trigger the development of alloknesis, and thus, these cytokines could be a therapeutic target for sensitive skin.

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Neck Masses: Clinico-Radio-Pathological Evaluation

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Abstract

Neck masses are defined as any swelling or enlargement of the structures in between the inferior border of mandible and clavicle and are a common clinical finding that can be encountered in patients of all age groups. There are many potential causes of neck masses so it is important to proceed in affordable, easy available and cost effective diagnostic technique for the proper and early diagnosis of neck masses. As there is very few study data available over clinico-radio-pathological analysis of neck masses, that's why this study is done. The present study has been carried out on 200 patients with clinically palpable neck masses presenting at ENT department in a tertiary care hospital. Neck swellings were classified into four main headings i.e. Lymph node swelling, Thyroid swelling, Salivary gland swellings and Skin and soft tissue swelling. After taking detailed history followed by complete General, Local and ENT examination, FNAC was done followed by USG. We came to the conclusion that neck masses have very variable presentations, and FNAC is a riskless, easy and fast tool which can be used in forming a diagnosis and appropriate management of neck masses.

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Comparing ultrasound assessment of thyroid nodules using BTA U classification and ACR TIRADS measured against histopathological diagnosis

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Abstract

Introduction

The British Thyroid Association (BTA) recommend ultrasound assessment of thyroid nodules using the U classification. The American College of Radiologists (ACR) recommend assessment with the Thyroid Imaging Reporting and Data System (TIRADS). We conduct the first UK study to compare these two systems.

Methods

Ultrasound (US) reports of patients who underwent surgical excision of thyroid nodules over a 10-year period in one UK centre were reviewed. US findings were collected, and the classifications were retrospectively applied. The systems were compared to histopathological diagnosis.

Results

308 nodules in 296 patients are included. 135 nodules (43.8%) were malignant. U classification showed sensitivity of 88.1% in recommending FNA, significantly higher than TIRADS at 73.3% (p=0.0002). The U classification showed specificity of 41.6%, significantly lower than TIRADS at 64.2% (p=<0.0001). PPV between classifications at equivalent levels showed no significant difference at U3/TR-3 (p=0.81), U4/TR-4 (p=0.30) or U5/TR-5 (p=0.90).

Discussion

Classification systems enable risk stratification of potentially malignant thyroid nodules. This study shows BTA U classification has a higher sensitivity but lower specificity than TIRADS.

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Anthropometric analysis of linear parameters of the Indian nose: A cross-sectional study and comparison with literature

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J Plast Reconstr Aesthet Surg. 2021 Jun 2:S1748-6815(21)00260-6. doi: 10.1016/j.bjps.2021.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Many studies have been done to find out the accepted "ideal" appearance and proportions of the nose. However, much of this work has been limited to the facial architecture of the North American Caucasian population. Therefore, most beauty standards are driven by Western influences.

AIMS AND OBJECTIVES: To measure different standard linear parameters of Indian faces and compare them with the studies found in the literature, in an endeavor to help in preoperative planning in rhinoplasty while maintaining their ethnicity.

METHODS: This was a hospital-based cross-sectional study of 500 subjects. A total of 21 standard measurements were noted directly from the faces, and 11 proportional values calculated. Mean values with standard deviations were statistically used for comparisons with stu dies in the literature.

RESULTS: There were significant differences between male and female subjects of our study in 16 variables. The proportional indices calculated also revealed significant differences statistically in 6 out of 11 measurements between male and female subjects. Significant differences were found in most of the parameters when our data were compared with Indian American, North American white population, Korean, Chinese, and African American.

CONCLUSIONS: Facial measurements in the Indian population are different from those of other races, such as nasal index: (al-al × 100/n-sn), sn-prn x 100/ al-al index, and sn-prn x 100/n-Sn index, and it is important to have own set of parameters to act as standards guiding esthetic nasal surgeries while maintaining ethnicities. Our study is an attempt at the same. However, because of the huge diversity of the Indian population, it requires larger studies from different regions to achieve the final aim to create sta ndards for cosmetic rhinoplasties.

PMID:34183286 | DOI:10.1016/j.bjps.2021.05.008

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Identification of secondary predictive factors for acute hypocalcemia following thyroidectomy in patients with low postoperative parathyroid hormone levels without overt calcium deficiency: A cohort study

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Publication date: November–December 2021

Source: American Journal of Otolaryngology, Volume 42, Issue 6

Author(s): Genival Barbosa de Carvalho, Letícia Ricardo Diamantino, Luiz Felipe Schiaveto, Carlos Henrique Quartucci Forster, Élcio Hideti Shiguemori, Daisy Hirata, Hugo Fontan Kohler, Renan Bezerra Lira, José Guilherme Vartanian, José Elias Matieli, Luiz Paulo Kowalski

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The use of solvent-preserved human and bovine cancellous bone blocks for lateral defect augmentation - an experimental controlled study in vivo

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The aim of this study was to compare new bone formation, resorbed bone matrix, and fibrous enclosed residual bone substitute material in laterally augmented alveolar bone defects using allogeneic, pre-treated ...
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Anatomical Variations Associated With Maxillary Sinus Fungal Ball

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Ear Nose Throat J. 2021 Jun 28:1455613211028470. doi: 10.1177/01455613211028470. Online ahead of print.

ABSTRACT

OBJECTIVE: We investigated the anatomical and dental factors associated with unilateral maxillary sinus fungal ball (MSFB). Also, we evaluated the effect of combinations of those factors on the incidence of MSFB.

METHODS: Three hundred patients were divided into MSFB, normal, and chronic rhinosinusitis (CRS) groups. We reviewed paranasal computed tomography scans for the presence of deviated nasal septum, concha bullosa (CB), Haller cells, and various dental factors. Also, we measured the ethmoid infundibulum, maxillary natural ostium, and CB.

RESULTS: Maxillary sinus fungal ball showed a more significant association with CB compared to the other 2 groups (37%, P < .05). The MSFB group had a lower rate of Haller cells than the normal group (10% vs 22%, respectively; P < .05). Also, the MSFB group had a wider maxillary sinus ostium than the normal group (7.07 ± 1.8 vs 5.48 ± 1.3 mm; P < .01). Moreover, the combination of CB and Haller cells was significantly associated with a decreased rate of the fungal ball (P = .047, odds ratio = 0.694). The dental factors were more prevalent in the MSFB and CRS groups (73% and 75%, respectively) than in the normal group (32%, P < .001).

CONCLUSIONS: Maxillary sinus fungal ball is significantly associated with CB, Haller cells, an increased maxillary sinus ostium size, and dental factors.

PMID:34182819 | DOI:10.1177/01455613211028470

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Influence of the Electrode Array Design on Incidence of Vertigo Symptoms and Vestibular Function After Cochlear Implantation

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Ear Nose Throat J. 2021 Jun 28:1455613211022075. doi: 10.1177/01455613211022075. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate if a specific type of cochlear implant (CI) electrode array (EA) reveals higher rates/prevalence of vestibular symptoms and to characterize their respective relationship to intracochlear position and objective vestibular function.

METHODS: This retrospective study included 71 cochlear implantations in patients older than 18 years. The el ectrode position within the cochlea, electrode insertion angle, and cochlear coverage were determined from postoperative multiplanar reconstructed cone-beam computed tomography scans. All device manufacturers were represented. Data related to preoperative and postoperative PTA as well as vestibular symptoms in the preoperative and postoperative stages were collected from the patient's records.

RESULTS: Twelve of the 71 (16.9%) CI patients experienced vertigo symptoms in the early postoperative period. In 5 (7.0%) patients, the vertigo complaints lasted until the time of the first activation (5-6 weeks postoperative). Postoperative onset of vestibular symptoms was more often seen in patients receiving lateral wall (LW)/straight EAs (19%) compared to perimodiolar/precurved EAs (7%), but this was only a trend and no statistical significance was observed. Moreover, preoperative pathologic caloric responses (CRs) better predicted the postoperative onset of vestibular symptoms.

< p>CONCLUSION: The preoperative consideration of a complicated CI-induced vertigo is important in the counseling particularly of elderly patients. We identified some risk factors for post-CI vertigo that should be considered in the patient's counseling: preoperative pathologic CRs, the extent of surgical trauma, and possibly the use of an LW EA, regardless of the length.

PMID:34182811 | DOI:10.1177/01455613211022075

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Impact of intraepithelial capillary loops and atypical vessels in confocal laser endomicroscopy for the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma

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Eur Arch Otorhinolaryngol. 2021 Jun 29. doi: 10.1007/s00405-021-06954-8. Online ahead of print.

ABSTRACT

PURPOSE: Confocal laser endomicroscopy (CLE) allows surface imaging of the laryngeal and pharyngeal mucosa in vivo at a thousand-fold magnification. This study aims to compare irregular blood vessels and intraepithelial capillary loops in healthy mucosa and squamous cell carcinoma (SCC) via CLE.

MATERIALS AND METHODS: We included ten patients with confirmed SCC and planned total laryngectomy in this study between March 2020 and February 2021. CLE images of these patients were collected and compared with the corresponding histology in hematoxylin and eosin staining. We analyzed the characteristic endomicroscopic patterns of blood vessels and intraepithelial capillary loops for the diagnosis of SCC.

RESULTS: In a total of 54 sequences, we identified 243 blood vessels which were analyzed regarding structure, diameter, and F luorescein leakage, confirming that irregular, corkscrew-like vessels (24.4% vs. 1.3%; P < .001), dilated intraepithelial capillary loops (90.8% vs. 28.7%; P < .001), and increased capillary leakage (40.7% vs. 2.5%; P < .001), are significantly more frequently detected in SCC compared to the healthy epithelium. We defined a vessel diameter of 30 μm in capillary loops as a cut-off value, obtaining a sensitivity, specificity, PPV, and NPV and accuracy of 90.6%, 71.3%, 57.4%, 94.7%, and 77.1%, respectively, for the detection of malignancy based solely on capillary architecture.

CONCLUSION: Capillaries within malignant lesions are fundamentally different from those in healthy mucosa regions. The capillary architecture is a significant feature aiding the identification of malignant mucosa areas during in-vivo, real-time CLE examination.

PMID:34185145 | DOI:10.1007/s00405-021-06954-8

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Mild and moderate COVID-19 disease does not affect hearing function permanently: a cross-sectional study ınvolving young and middle-aged healthcare givers

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Eur Arch Otorhinolaryngol. 2021 Jun 29. doi: 10.1007/s00405-021-06883-6. Online ahead of print.

ABSTRACT

PURPOSE: To assess the hearing function of patients with mild and moderate COVID-19.

METHODS: The hospital staffs recovered from COVID-19 were included. The candidates who had an ear disease or progressive hearing loss prior to COVID-19, or having been hospitalised because of severe and critical COVID-19 were excluded. The age, sex, symptoms during COVID-19, and medications received for the disease were noted. The hearing thresholds (HT) of the participants who had an audiogram before having COVID-19 disease were recorded. A pure tone audiometry was conducted to all. The participants were classified into two groups; Group 1: participants who had an audiogram previously, Group 2: participants who didn't have an audiogram previously. The changes of the HTs of the participants in Group 1 were analyzed. The HTs of the participants in Group 2 were documented without any comparison. The HTs of all participants were also analyzed by classifying them into subgroups according to their symptoms during, and medications received for COVID-19.

RESULTS: Fifty-four males and 47 females (18-59 years) were included. The participants' HTs in Group 1 (n = 31) did not change significantly at any of the frequencies after having COVID-19 (p > 0.05). The pure tone averages of the participants in Group 2 (n = 70) were below 25 dB and none of the participants reported worsening of their hearing permanently. The differences between the HTs of none of the subgroups were statistically significant (p > 0.05, p > 0.05).

CONCLUSIONS: Mild and moderate COVID-19 and its treatments did not affect the hearing function permanently.

PMID:34185143 | DOI:10.1007/s00405-021-06883-6

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