Wednesday, October 19, 2022

Autoimmune seronegative limbic encephalitis following ChAdOx1‐S/nCoV‐19 vaccination in a patient with ankylosing spondylitis

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Abstract

Here we present a case in which a patient developed autoimmune seronegative limbic encephalitis following ChAdOx1-S/nCoV-19 (AZD1222; AstraZeneca) vaccination. Although it is known that vaccines containing SARS-CoV-2 antigens might enhance autoimmunity, such cases are rarely reported. We discuss this case with the present literature.

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Sequence Analysis of Epstein‐Barr virus RPMS1 Gene in malignant hematopathy

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Abstract

The RPMS1 gene is the only member of the BamHI-A rightward transcripts (BARTs) family for which a full-length cDNA has been identified, and RPMS1 transcript has been confirmed in many EBV-positive malignancies. However, the effects of sequence variations of RPMS1 in hematological malignancies and their biological significance are unclear. To explore the association between RPMS1 gene variations and hematological malignancy, the RPMS1 gene of 391 EBV-positive samples from patients with EBV-positive leukemia, myelodysplastic syndromes (MDS) and lymphoma in northern China were sequenced. On the basis of phylogenetic tree and mutation characteristics of RPMS1, all the sequences were divided into five major types: RPMS1-A, RPMS1-B, RPMS1-C, RPMS1-E, and RPMS1-F. RPMS1-A type, similar to the prototype B95-8, was identified in 71.87% (281/391) of samples and was the major typ e in all subpopulations. The frequency of RPMS1-F type was significantly higher in all malignant hematopathy groups than in healthy donors. The Hodgkin lymphoma (HL) group contained more RPMS1-F than other malignant hematopathy groups, and acute myeloid leukemia (AML) contained more RPMS1-C type than other malignant hematopathy groups. Therefore, RPMS1-A is the main type of RPMS1 gene in northern China, and RPMS1-F may be associated with hematologic malignancies.

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Development and validation of a potential biomarker to improve the assessment of liver fibrosis progression in patients with chronic hepatitis B

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Abstract

Objectives

We aimed to develop and validate a novel combined score to improve the assessment of liver fibrosis progression in patients with chronic hepatitis B (CHB).

Methods

The serum levels of hub genes were examined by qRT-PCR in three cohorts of CHB patients.

Results

For significant liver fibrosis (≥S2), the areas under the receiver operating characteristics curves (AUROCs) of the combined score were 0.838, 0.842 and 0.881 in the three cohorts, respectively. And for advanced liver fibrosis (≥S3), the AUROCs were 0.794, 0.801 and 0.901, respectively. Compared with the results of AUROCs for aspartate aminotransferase-to-platelet ratio (APRI) and fibrosis index based on four factors (FIB-4) in the validation cohorts, better clinical diagnostic value for assessing the progression of liver fibrosis was found in the combined score. Additionally, univariate ordered logistic regression analysis indicated that the combined score could serve as a more superior and stable risk factor than APRI and FIB-4 in the assessment of liver fibrosis. For CHB patients with normal alanine aminotransferase (ALT), our results further emphasized the diagnostic value of the combined score for significant fibrosis (≥S2) and advanced fibrosis (≥S3). Moreover, it was found that patients with the high combined score, who were associated with the advanced fibrosis stage, had higher levels of drug sensitivity and immune checkpoint expression.

Conclusion

The novel combined score could serve as a potential biomarker and contribute to improving the assessment of fibrosis stage in CHB patients.

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Prevalence and risk factors associated with readmission with acute kidney injury in patients receiving vancomycin outpatient parenteral antimicrobial therapy

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Prevalence and risk factors associated with readmission with acute kidney injury in patients receiving vancomycin outpatient parenteral antimicrobial therapy

The MarketScan® Commercial Database was queried from 2010 to 2016 to identify patients aged 18–64 years discharged from an inpatient hospitalization on vancomycin OPAT. The primary endpoint was hospital readmission with AKI within 42 days of index hospital discharge. A total of 14,196 patients were included in the study. Readmission with AKI occurred in 385 (2.7%) and was independently associated with chronic kidney disease, congestive heart failure, chronic liver disease, hypertension, septicemia, and concomitant OPAT with IV penicillins.


Abstract

Introduction

Vancomycin is commonly used during outpatient parenteral antimicrobial therapy (OPAT). Therapeutic drug monitoring (TDM) of vancomycin is recommended to ensure effective and safe therapy, as use has been associated with acute kidney injury (AKI).

Methods

The MarketScan® Commercial Database was queried from 2010 to 2016 to identify patients aged 18–64 years discharged from an inpatient hospitalization on vancomycin OPAT. The primary endpoint was hospital readmission with AKI within 6 weeks of index hospital discharge. TDM was defined as at least one vancomycin level obtained during outpatient therapy. Bivariate analysis was used to examine associations with outcomes; significant factors were incorporated into a multivariable logistic regression model.

Results

A total of 14,196 patients were included in the study; median age was 54 years and 53.8% were male. Readmission with AKI occurred in 385 (2.7%) and was independently associated with chronic kidney disease (aOR 2.63 [95%CI 1.96–3.52]), congestive heart failure (1.81 [1.34–2.44]), chronic liver disease (1.74 [1.17–2.59]), hypertension (1.73 [1.39–2.17]), septicemia (1.61 [1.30–2.00]), and concomitant OPAT with IV penicillins (1.73 [1.21–2.49]) while skin and soft tissue infection (0.67 [0.54–0.83]) and surgical site infection (0.74 [0.59–0.93]) were associated with lower risk of readmission with AKI. TDM was not associated with lower risk of readmission with AKI.

Conclusion

Chronic kidney disease, congestive heart failure, hypertension, chronic liver disease, septicemia, and concomitant OPAT with IV penicillins were significantly associated with higher risk of readmission with AKI during vancomycin OPAT.
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Cochlear Implants for Single‐Sided Deafness: Quality of Life, Daily Usage, and Duration of Deafness

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Cochlear Implants for Single-Sided Deafness: Quality of Life, Daily Usage, and Duration of Deafness

The current study was undertaken to report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD). We present the largest cohort of patients with SSD treated with CI to date. This group demonstrates significant benefit with regards to speech recognition scores, tinnitus measures, and quality of life metrics. We present novel insights regarding the CIQOL-10 measure, correlation of speech recognition and QoL scores with daily usage "datalogging" as well as the impact of duration of deafness on outcomes for patients with CI for SSD.


Objective

To report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD).

Methods

This is a retrospective case series for adults with SSD who underwent CI between January 2013 and May 2021 at our institution. CNC and AzBio speech recognition scores, Tinnitus Handicap Inventory (THI), Speech, Spatial, and Qualities of Hearing Scale (SSQ12), datalogging, and the Cochlear Implant Quality of Life (CIQOL)-10 Global measure were utilized.

Results

Sixty-six adults underwent CI for SSD (median 51.3 years, range 20.0–74.3 years), and 57 (86.4%) remained device users at last follow-up. Compared to pre-operative performance, device users demonstrated significant improvement in speech recognition scores and achieved peak performance at six months post-activation for CNC (8.0% increased to 45.6%, p < 0.0001) and AzBio in quiet (12.2% increased to 59.5%, p < 0.0001). THI was decreased at 6 months post-implantation (58.1–14.6, p < 0.0001), with 77% of patients reporting improved or resolved tinnitus. Patients demonstrated improved SSQ12 scores as well as the disease-specific CIQOL-10 Global questionnaire. Duration of deafness was not associated with significant differences in speech recognition performance. Average daily wear time was positively associated with CNC and AzBio scores as well as post-operative CIQOL-10 scores.

Conclusions

Herein we present the largest cohort of adult CI recipients with SSD with data on speech recognition scores, tinnitus measures, and SSQ12. Novel insights regarding the correlation of datalogging, duration of deafness, and CI-specific quality of life (CIQOL-10) metrics are discussed. Data continue to support CI as an efficacious treatment option for SSD.

Level of Evidence

IV Laryngoscope, 2022
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Cholesterol granuloma of the maxillary sinus in association with a dental implant—A case report

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Abstract

Background

Cholesterol granuloma is typically a benign granulomatous growth seen mostly in the mastoid process and the petrous temporal bone. Although cholesterol granuloma in maxillary sinus was first reported in the scientific literature in 1978, the occurrence is very rare and it is usually clinically and radiographically manifested ambiguously as maxillary sinusitis.

Purpose

The presence of cholesterol granuloma in the maxillary sinus in association with a dental pathology or prosthesis has been scarcely known. In this case report, we present a case of cholesterol granuloma in the maxillary sinus of a middle-aged male who had previously undergone dental implant placement in relation to that anatomical location.

Materials and Methods

A 64-year-old man reported to the Dental OP with a chief complaint of oral malodor, swelling, and tenderness over the right middle third of the face for the past 3 months. A cone beam computed tomography scan showed a well-defined radio-opaque lesion along with sclerosis and thinning of bone within the right maxillary antrum in relation to the dental implant placed in the 16 regions. The left maxillary sinus appeared normal. The Caldwell-Luc procedure was performed and a solitary soft lesion with yellowish-gray contents was evident within the right maxillary sinus. Histopathological examination revealed cholesterol clefts surrounded by foreign body giant cell reaction and granulation tissue formation, along with the presence of old and recent hemorrhage. A final diagnosis of cholesterol granuloma was made based on the histopathological examination report.

Conclusion

Based on the evidence available in the present case, we hypothesize that the localized trauma and hemorrhage initiated by implant placement in this particular anatomical location could have plausibly resulted in the occurrence of cholesterol granuloma in our patient.
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Comparison of propeller flaps versus skin grafts for coverage of osteocutaneous fibula free flap donor site defects

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Abstract

Background

Authors compare use of propeller flaps versus skin grafts in defect coverage after fibula flap harvest.

Materials and Methods

Retrospective review of patients who received either PFPF or STSG. Primary predictor variable was technique, and secondary predictor variables were comorbidities. Primary outcome variable was flap/graft healing, and secondary outcome variables were cosmesis, adverse events, effect on activities of daily living (ADLs), pain, additional procedures, and cost. Statistical analysis performed via independent sample t tests, ANOVA, and χ 2 tests. Logistic regression analysis was performed.

Results

Study sample was 50 patients. PFPFs showed higher rates of success, while STSG showed increased complications and adverse events. Pain and ADLs significantly affected in STSG group. Cosmesis was better in the PFPF group, and overall cost was significantly higher in STSG group.

Conclusion

PFPFs show greater success rates, fewer complications, improved cosmesis, less pain, reduced cost compared to STSG for wound coverage after fibula flap harvest.
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Proton pump inhibitors and myocardial infarction: an application of active comparators in a self-controlled case series

alexandrossfakianakis shared this article with you from Inoreader

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Abstract
BackgroundPrevious studies investigating potential cardiovascular adverse events of acid-suppressing drugs are susceptible to protopathic bias and confounding. We aimed to investigate the association between short-term risk of myocardial infarction (MI) and proton pump inhibitors (PPIs) using a self-controlled case series (SCCS) with an active comparator.
Methods
We conducted a SCCS using a population-wide database from Hong Kong from 2003–2014. Adult with ≥1 outpatient oral PPI prescription or H2 receptor antagonist (H2RA) and MI during the observation period were included. We used both simple ratio and effect modifier approaches to SCCS with active comparators to obtain comparator adjusted estimates.
Results
A total of 2802 and 1889 people with MI who had exposure to PPIs and H2RA were included respectively. We observed a higher risk of MI during days 1–14 following the start of PPI prescription (Incidence rate ratio (IRR): 2.30, 95 % confidence interval (CI): 1.76–3.00) versus baseline. Similarly, we observed a higher risk of MI during days 1–14 following the start of H2RA prescription (IRR: 2.46, 95%CI: 1.92–3.16) versus baseline. In the novel SCCS analyses, comparator adjusted estimates were 0.93 (95%CI: 0.57–1.30) and 0.83 (95%CI: 0.58–1.20) during days 1–14 in simple ratio and effect modifier approach, respectively.
Conclusions
We observed no difference in risk of MI associated with PPIs compared with baseline using H2RA as the active comparator. The elevated risk of MI associated with PPIs is likely due to protopathic bias. More studies are required to explore the feasibility of using active comparators in SCCS to address protopathic bias in addition to confounding.
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A novel de novo KCNB1 variant altering channel characteristics in a patient with periventricular heterotopia, abnormal corpus callosum, and mild seizure outcome

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Associations of Prenatal First Trimester Essential and Nonessential Metal Mixtures with Body Size and Adiposity in Childhood.

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Background: Prenatal nonessential metals may contribute to postnatal adiposity, while essential metals may have metabolic benefits. We evaluated joint and individual associations between prenatal metals and childhood adiposity. Methods: We measured concentrations of six nonessential (arsenic, barium, cadmium, cesium, lead, mercury) and four essential (magnesium, manganese, selenium, zinc) metals in first trimester maternal blood from a pre-birth cohort. We collected anthropometric measures in early childhood, mid-childhood, and early adolescence including subscapular+tricep skinfold thickness (mm) (N=715-859), waist circumference (cm) (N=717-882), and BMI (z-score) (N=716-875). We measured adiposity in mid-childhood and early adolescence using bone densitometry total- and trunk fat-mass index (kg/m2) (N=511-599). We estimated associations using adjusted quantile g-computation and linear regression. Results: The nonessential metal mixture was associated with higher total (β=0.07, 95% CI: 0.01, 0.12) and trunk fat-mass index (β=0.12, CI: 0.02, 0.22), waist circumference (β=0.01, CI: 0.00, 0.01), and BMI (β=0.24, CI: 0.07, 0.41) in mid-childhood, and total fat-mass index (β=0.07, CI: 0.01, 0.14) and BMI (β=0.19, CI: 0.02, 0.37) in early adolescence. The essential metal mixture was associated with lower early adolescence total (β= –0.11, CI: -0.17, -0.04) and trunk fat-mass index (β=-0.13, CI: -0.21, -0.05), subscapular+tricep skinfold thickness (β=-0.02, CI: -0.03, -0.00), waist circumference (β=-0.003, CI: -0.01, -0.00), and BMI (β=-0.16, CI: -0.28, -0.04). Cadmium and cesium were individually associated with childhood adiposity at different timepoints. Conclusions: Prenatal first trimester essential metals were associated with lower childhood adiposity, whereas nonessential metals were associated with higher adiposity into adolescence. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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