Outcomes of Ttracheostomy in COVID-19 Patients: A Single Centre Experience

xlomafota13 shared this article with you from Inoreader Outcomes of Ttracheostomy in COVID-19 Patients: A Single Centre Experience Via Otolaryngology Indian Abstract The rapid emergence of COVID-19 has led to increase in the number of patients requiring prolonged ventilation and tracheostomy. Though global guidelines are evolving, there is a paucity of literature about optimal timing and outcome after tracheostomy in COVID-19 patients. We set out to assess the clinical characteristics and outcome of COVID-19 patients who underwent tracheostomy.This single-center, prospective observational cohort study analyzed all the consecutive tracheostomy performed on COVID-19 patients from April 1 2020 to January 31, 2021. The primary outcome measure was the 30-day mortality rate following tracheostomy and association with various prognostic risk factors. The secondary outcome measures included various tracheostomy-related events, perioperative complications, and decannulation rate.The study included 51 patients with a median age of 52 years and the majority were male (62.74%). 62.74% (32 of 51) tracheostomies were done early (withi n 10 days of intubation) and the mean duration from endotracheal intubation to tracheostomy was 10.27 days. The 30-day mortality rate was 66.66% (34 of 51) with no tracheostomy-related mortality and the mean duration between tracheostomy and death was 8.29 days. The presence of sepsis was associated with a higher rate of mortality (p = 0.002) while the timing of tracheostomy was not related to increased mortality (p = 0.365). The most common perioperative complication was tracheostoma bleeding (16.64%). At a median follow-up of 7.5 months, only four patients were decannulated.Though associated with a higher rate of 30-day mortality rate, tracheostomy among COVID-19 patients is a safe and an effective weaning tool. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of expressions of Arg-1, Hep Par-1, and CK19 in the diagnosis of the primary hepatocellular carcinoma cubtypes and exclusion of the metastases

xlomafota13 shared this article with you from Inoreader Efficacy of expressions of Arg-1, Hep Par-1, and CK19 in the diagnosis of the primary hepatocellular carcinoma cubtypes and exclusion of the metastases Via Cellular and Molecular Biology Histol Histopathol. 2021 Jul 13:18361. doi: 10.14670/HH-18-361. Online ahead of print. ABSTRACT Many conflicts arise using immunohistochemistry of Hepatocellular carcinoma (HCC), some of these conflicts arise from the biliary part within the tumor itself or from liver metastasis. The aim of this study is to investigate the extent of Arg-1, HepPar-1, and CK-19 expressions in the primary HCC subtypes as well as studying of some metastatic cases to find a distinctive immunohistochemical panel utilizing it to differentiate between these entities. MATERIAL AND METHODS: A paraffin-embedded block including 62 cases of primary HCC, and 18 cases diagnosed as metastatic tumors, were subjected for this study using Anti-liver Arginase antibody (ab125134 Cambridge, USA, polyclonal antibody, 3.75 µg/ml), HepPar-1 (polyclonal mouse antibody OCH1E5; 1:600; DAKO, CA, USA), and CK 19 Anti-Cytokeratin 19 antibody (ab15463, rabbit polyclonal antibo dy; 1:100; Cambridge, USA). The intensity of immunostaining was scored (0 to 3+). Nuclear and cytoplasmic staining with Arg-1 and cytoplasmic for both HepPar-1 and CK 19 are reported. RESULTS: The histopathological patterns were mainly trabecular no= (24, 38.7%), and pseudoglandular (no=14, 22.5 %), mixed hepatocellular cholangiocarcinoma was observed in one case (1.6%). Arginase-1 positivity was in 55 cases (88.7%) opposite to 46 (74.19%) and 8 (12.9%) for HepPAr.1% -1 and CK 19, respectively. The intensity of expression was marked in well and moderate differentiation for Arg-1 and HepPar-1and in poorly differentiated for CK 19. Metastatic carcinoma cases revealed two cases positive for Arg-1 (11.1%), 4 cases (22.2%) positive for HepPar-1, and 13 cases (72.2%) positive for CK 19. CONCLUSION: Arg-1 and HepPar-1 are confirmative in the diagnosis of primary HCC in most cases, either separately or collectively but the priority of selection leans more towards Arg-1. Arg-1 an d HepPar-1 positive with negative CK 19 expressions give more support to diagnosis of primary HCC while the reverse will support the diagnosis of tumour of biliary origin or liver metastasis. PMID:34254284 | DOI:10.14670/HH-18-361 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study

xlomafota13 shared this article with you from Inoreader Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study Via Head and neck cancers by Hirotaka Kinoshita, Junichi Saito, Daiki Takekawa, Tasuku Ohyama, Tetsuya Kushikata, Kazuyoshi Hirota Postoperative delirium (POD) is a well-recognized postoperative complication and is associated with increased morbidity and mortality. We investigated whether the preoperative neutrophil-lymphocyte ratio (NLR) could be an effective predictor of POD after head and neck free-flap reconstruction. This was a single-center, retrospective, observational study. We analyzed the perioperative data of patients who had undergone elective head and neck free-flap reconstruction surgery. POD was assessed with the Intensive Care Delirium Screening Checklist (ICDSC) during admission to our intensive care unit (ICU). POD was defined as an ICDSC score ≥4. Risk factors for POD were evaluated by univariate and multivariate logistic regression analysis. We included 97 patients. The incidence of POD was 20.6% (20/97). Significantly longer ICU stays were observed in the patients with POD compared to those without POD (median [interquartile range]: 5 [4–6] vs. 4 [4–5], p = 0.031). Higher preoperative NLR values (3 3.0 (adjusted Odds Ratio: 23.6, 95% Confidence Interval: 6.6–85.1; p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intrathecal catheter and port placement for nusinersen infusion in children with spinal muscular atrophy and spinal fusion

xlomafota13 shared this article with you from Inoreader Intrathecal catheter and port placement for nusinersen infusion in children with spinal muscular atrophy and spinal fusion Via leak of cerebrospinal fluid Pediatr Radiol. 2021 Jul 12. doi: 10.1007/s00247-021-05126-4. Online ahead of print. ABSTRACT BACKGROUND: Spinal administration of medications is challenging in patients with complete posterior spinal fusion. We describe percutaneous image-guided intrathecal port placement for administration of the antisense oligonucleotide nusinersen for children and young adults with spinal muscular atrophy. OBJECTIVE: To describe and present our initial experience with a new technique for administering nusinersen in patients with spinal muscular atrophy and posterior spinal fusion. MATERIALS AND METHODS: We reviewed medical records of 13 patients who received intrathecal ports using DynaCT, biplane fluoroscopy and iGuide from April 2018 through June 2019, and we describe the clinical course over 1 year. RESULTS: Image-guided catheter and port implantation was successful in all cases. Two ports were subsequently removed, one for persistent cerebrospinal fluid leak and one for superficial infection. The other 11 have functioned successfully for a minimum of 23 months. CONCLUSION: We report our experience with image-guided intrathecal port placement in children with complete posterior spine fusion. The implanted port permits dosing in an outpatient setting and avoids the need for multiple future radiologic procedures, and it reduces discomfort, procedural costs and potential risks and sequelae of multiple anesthetics and radiation exposures. Further studies are needed to define the relative risks and benefits of intrathecal ports compared to other approaches such as repeated transforaminal lumbar punctures. PMID:34254153 | DOI:10.1007/s00247-021-05126-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Petrous bone cholesteatoma: our experience of 20 years and management of two giant cases affecting rhinopharynx

xlomafota13 shared this article with you from Inoreader Petrous bone cholesteatoma: our experience of 20 years and management of two giant cases affecting rhinopharynx 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 Jul 13. doi: 10.1007/s00405-021-06969-1. Online ahead of print. ABSTRACT PURPOSE: To demonstrate our experience in the treatment of petrous bone cholesteatoma (PBC). METHODS: Data of PBC patients in our hospital from January 2000 to December 2019 were collected. Surgical approaches and facial function were mainly discussed and compared with the literature. The management of 2 giant PBC cases affecting rhinopharynx has been demonstrated. RESULTS: The supralabyrinthine type was the most frequent type followed by the massive type. There were 5 cases with cholesteatoma extending into the clivus (2 cases), sphenoid (1 case) and rhinopharynx (2 cases). The translabyrinthine approach (40%) was our most frequently used approach followed by the middle fossa approach (36%) and the transmastoid approach (11%). There were 10 cases managed with the assistance of endoscope, including 3 cases with cholestea toma extending into clivus, sphenoid and rhinopharynx separately. Obliteration of the cavity was performed in 70.3% (135/192) cases; 3 of them recurred. For the 2 giant PBC cases affecting rhinopharynx, traditional microscopic surgery assisted with transnasal endoscope was performed. The reduced exposure was beneficial for postoperative recovery, and the approach in the nasal cavity provided a permanent drainage for postoperative examination. CONCLUSION: Otologic endoscope combined with traditional microscopic surgery could reduce the exposure in surgery. For extremely extended cases of PBC, supplementary transnasal endoscopic approach deserves to be considered for the traditional temporal bone approach. PMID:34255147 | DOI:10.1007/s00405-021-06969-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tailoring the approach to radioactive iodine treatment in thyroid cancer

xlomafota13 shared this article with you from Inoreader Tailoring the approach to radioactive iodine treatment in thyroid cancer Via radioactive iodine Endocr Relat Cancer. 2021 Jul 1:ERC-21-0161.R1. doi: 10.1530/ERC-21-0161. Online ahead of print. ABSTRACT The treatment of differentiated thyroid cancer continues to move away from a 'one size fits all' approach to a process of tailored therapeutic decision-making that incorporates disease-specific factors and individual patient preferences. Management options range from active surveillance to thyroid lobectomy to total thyroidectomy with or without the use of postoperative radioac tive iodine (RAI). RAI may be administered for one or more reasons: Thyroid remnant ablation, adjuvant therapy, or therapy for persistent structural disease. It is important to be cognizant of the therapeutic intent of RAI and weigh the risks and benefits of treatment for each individual patient. Risk stratification should be used to identify those patients who are most likely to benefit from RAI and guide therapeutic choices. Available data suggest that RAI can be safely deferred for most patients considered at low risk for structural recurrence, while adjuvant RAI is associated with improved disease-free survival in patients with higher risk disease. Although progress has been made, many areas of uncertainty related to the use of RAI remain. These include: 1) The appropriate selection of intermediate risk patients to receive adjuvant RAI, 2) the superiority or inferiority of different RAI dosing activities, 3) the optimal approach to the use of RAI in special populations, includin g patients with ESRD and children and 4) the management of patients with RAI-refractory disease. PMID:34254949 | DOI:10.1530/ERC-21-0161 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Scutellarin improves the radiosensitivity of non-small cell lung cancer cells to iodine-125 seeds via downregulating the AKT/mTOR pathway

xlomafota13 shared this article with you from Inoreader Scutellarin improves the radiosensitivity of non-small cell lung cancer cells to iodine-125 seeds via downregulating the AKT/mTOR pathway Via radioactive iodine Thorac Cancer. 2021 Jul 13. doi: 10.1111/1759-7714.14077. Online ahead of print. ABSTRACT BACKGROUND: In our previous study, we indicated that scutellarin (SCU) induced an anticancer effect in A549 cells. However, whether SCU regulates the radiosensitivity of non-small cell lung cancer (NSCLC) and its related mechanism is still unclear. METHODS: In this study, we explored the anticancer effect induced by iodine-125 (125 I) and SCU at a sensitizing concentration in A 549 and H1975 cells. Cellular apoptosis and proliferation were detected by flow cytometry, Bcl-2/Bax expression level, cell cycle, CCK-8, and EdU staining. A tumor model using nude mice was also carried out to investigate the combined effect of 125 I and SCU in vivo. In addition, the expression level of AKT/mTOR pathway was detected to investigate whether it is linked to the anticancer effect of 125 I and SCU. RESULTS: SCU at a sensitizing concentration promoted the 125 I-induced apoptosis and antiproliferative effect in A549 and H1975 cells. Moreover, the same results were obtained in vivo. Based on our findings, the AKT/mTOR pathway was significantly downregulated after combined treatment with 125 I and SCU. CONCLUSIONS: The results of our study suggested that SCU promotes the anticancer effects induced by 125 I in NSCLC cells by downregulating the AKT/mTOR pathway and lays a foundation for future application of th is combined treatment. PMID:34255431 | DOI:10.1111/1759-7714.14077 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Utility of Non-EPI DWI MRI Imaging in Cholesteatoma: The Indian Perspective

xlomafota13 shared this article with you from Inoreader Utility of Non-EPI DWI MRI Imaging in Cholesteatoma: The Indian Perspective Via Otolaryngology Indian Abstract The purpose of this prospective observational study was to evaluate the diagnostic performance of non–EPI-based techniques, in detecting both primary and residual/recurrent cholesteatoma in a tertiary care center. 56 patients (25 female and 31 male) aged between 6 and 59 years were prospectively evaluated for the presence or absence of cholesteatoma. This included both primary and postoperative recurrent cholesteatoma (16). All the patients underwent sequential CT scans of temporal bones and non-EPI DWI (Non-Echo Planar Diffusion-Weighted Imaging) MRI techniques. The findings were correlated with surgical findings regarding the presence or absence of cholesteatoma. The size of cholesteatoma that was diagnosed on non-EPI DWI MRI was measured. The smallest size was 6 mm and the largest one was 21 mm. The accuracy of non-EPI DWI MRI in diagnosing cholesteatoma (primary and recurrent) was 97.5%. Whereas in diagnosing recurrent cholesteatoma accuracy was 100%. Accuracy of non-EPI DWI MRI is very high in diagnosing cholesteatoma especially in recurrent cholesteatoma and can potentially replace second look surgery when intact canal wall techniques are used. The technique is best used with a CT Scan of the temporal bone to depict bony changes, anatomical variants, or complications. The combination of HRCT and non-EPI DWI needs to be employed in diagnosing primary and recurrent cholesteatoma to maximize the diagnostic benefit as they are complimentary. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bone quality and quantity of the mandibular symphyseal region in autogenous bone grafting using cone-beam computed tomography: a cross-sectional study

xlomafota13 shared this article with you from Inoreader Bone quality and quantity of the mandibular symphyseal region in autogenous bone grafting using cone-beam computed tomography: a cross-sectional study Via Head & Face Medicine Bone volume plays a pivotal role in the success of dental implant treatment. Autogenous bone grafts should be harvested from reliable sites in the maxillofacial region. This study sought to assess the quantity... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Essential inpatient otolaryngology: what COVID-19 has revealed

xlomafota13 shared this article with you from Inoreader Essential inpatient otolaryngology: what COVID-19 has revealed 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 Jul 10. doi: 10.1007/s00405-021-06963-7. Online ahead of print. ABSTRACT PURPOSE: To identify areas of critical otolaryngology contributions to inpatient care resistant to disruption by the COVID-19 pandemic. METHODS: Medical records of 614 otolaryngology consults seen between January and June of 2019 and 602 seen between January and June of 2020 were reviewed. Extracted data included patient demographics, SARS-CoV-2 status, medical comorbidities, consult location, consult category, reason for consult, procedures performed, and overall outcome. Prevalence of data items was compared using t tests and Chi-squared tests. RESULTS: The number of monthly consults to the otolaryngology service remained approximately stable after the onset of the COVID-19 pandemic. However, there was a substantial increase in ICU consults and a decrease in ER and floor consults. The proportion of otology, rhinology, and head and neck consults decreased while that of airway consults-most of which were tracheostomy-related-greatly increased. While the top ten reasons for consult remained essentially the same, they dramatically increased as a percentage of consults during COVID-19 (55-92%), whereas there was a dramatic decrease in the proportion of less frequent consults. CONCLUSION: The changes in otolaryngology consultation patterns seen after the onset of the pandemic are multifactorial, but may be attributed to novel pathologies, attitudes, and policies. Nonetheless, these patterns reveal that a set of core otolaryngologic issues, including acute airway issues, head and neck lesions, severe sinusitis and epistaxis, are essential and need to be addressed in the inpatient setting, whereas the significant drop in other consults suggests that they may be appropriately managed on an outpatient basis. PMID:34247264 | DOI:10.1007/s00405-021-06963-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of Conventional and Platelet-Rich Plasma-Assisted Fat Grafting: A Systematic Review and Meta-analysis

xlomafota13 shared this article with you from Inoreader Comparison of Conventional and Platelet-Rich Plasma-Assisted Fat Grafting: A Systematic Review and Meta-analysis Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 12:S1748-6815(21)00298-9. doi: 10.1016/j.bjps.2021.05.046. Online ahead of print. ABSTRACT BACKGROUND: Autologous fat grafting (FG) is a popular technique for soft-tissue augmentation, but the fat survival rate is unpredictable. Platelet-rich plasma (PRP) has emerged as an adjuvant to enhance fat graft survival. OBJECTIVES: This literature review and meta-analysis aimed to investigate the effect of PRP on the survival rate of fat grafting. METHODS: A comprehensive systematic literature search was done to identify clinical studies on PRP and fat cotransplantation in PubMed, Cochrane Library, Web of Science, and EMBASE databases up to May 2020. The reference lists of selected articles were reviewed to identify any additional related articles. A meta-analysis was conducted to compare PRP + FG and conventional FG in terms of fat graft survival rate, patient satisfaction rate, and recovery time after surgery. RESULTS: Eleven studies consisting of 1125 patients were analyzed. Patients were followed up from 3 to 24 months post-FG. The fat survival rate varied from 20.5% to 54.8% in FG alone and from 24.1% to 89.2% in the PRP + FG groups. The survival rate was significantly higher and recovery time was significantly lower in the PRP + FG group than in the FG alone group. However, there was no significant difference in the patient satisfaction rate between the groups. CONCLUSIONS: This study demonstrates that PRP-enhanced fat transplantation has better efficacy than conventional fat grafting. Further studies are required to provide the optimum concentration of PRP and the long-term efficacy of the technique. There is not enough evidence to compare the rate of complications with PRP and fat cotransplantation and conventional fat grafting. PMID:34246590 | DOI:10.1016/j.bjps.2021.05.046 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.