Comparison of TIVA with different combinations of ketamine–propofol mixtures in pediatric patients

Abstract

Purpose

Adding ketamine to propofol has been suggested to be useful for sedation and general anesthesia. This study aimed to determine the effect of TIVA with different ratios of ketofol on recovery in children.

Methods

Seventy-five children aged 3–12 years and undergoing adenoidectomy and/or tonsillectomy surgery were randomized into three groups. Ratios of 1:5, 1:6.7 and 1:10 ketamine–propofol mixture (ketofol) were prepared in the same syringe for groups I, II and III, respectively. Induction and maintenance of anesthesia were performed with 1:5, 1:6.7 and 1:10 ratios of ketofol in groups I, II and III, respectively. A McFarlan infusion dose regimen was used (15 mg/kg/h for 15 min, 13 mg/kg/h for 15 min, 11 mg/kg/h for 30 min) and infusion rates were decreased for the different ratios. Infusion rates were reduced to 67, 80 and 90% of the McFarlan dose regimen for groups I, II and III, respectively. Extubating time, length of stay in PACU, postoperative PAED and FLACC scores were recorded.

Results

Extubating time was significantly lower [mean 254.3 ± 92.7 s (95% CI 216.6–292.6, p = 0.001)] in group III than in groups I and II [371.3 ± 153 s (308.1–434.48) and 343.2 ± 123.7 s (292.2–394.3), respectively]. Length of stay in the PACU was lower in group III [median 15 min (interquartile range 15–20, p = 0.001)] than in groups I and II: 20 (15–27.5) and 20 min (20–27.5), respectively.

Conclusion

TIVA with a 1:10 ratio of ketofol admixture with a 90% reduction of McFarlan regimen can provide improved recovery conditions.

Trial registration

ClinicalTrials.gov identifier: NCT02848963.

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Prevalence of True Median Cleft of Upper Lip as Reflected from a Small Central Indian Population: Attempt to Report and Review the True Median Cleft of Upper Lip

Abstract

Aims and Objectives

The median clefts of the facial skeleton and soft tissue are least in occurrence. Here we have attempted to analyze and review the prevalence of median clefts in our center.

Materials and Methods

All the patients who reported with congenital deformities from January 2013 to June 2016 were included in the study. A detailed list of patients was then re-evaluated to preclude duplication of the record which could have occurred during the admission process. All the characteristics which can be evaluated epidemiologically were individually tabulated and evaluated in detail.

Results

Out of the 1184 patients included in the study only 2 were affected with median cleft. The prevalence of true median cleft was hence determined to be 0.17% among the cleft population.

Conclusion

The prevalence of the true median cleft lip is rare and hence makes it difficult to classify these clefts, and also the treatment protocol needs to be fabricated for the treatment of such clefts.

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Human c-SRC kinase (CSK) overexpression makes T cells dummy

Abstract

Adoptive cell therapy with T-cell receptor (TCR)-engineered T cells represents a powerful method to redirect the immune system against tumours. However, although TCR recognition is restricted to a specific peptide–MHC (pMHC) complex, increasing numbers of reports have shown cross-reactivity and off-target effects with severe consequences for the patients. This demands further development of strategies to validate TCR safety prior to clinical use. We reasoned that the desired TCR signalling depends on correct pMHC recognition on the outside and a restricted clustering on the inside of the cell. Since the majority of the adverse events are due to TCR recognition of the wrong target, we tested if blocking the signalling would affect the binding. By over-expressing the c-SRC kinase (CSK), a negative regulator of LCK, in redirected T cells, we showed that peripheral blood T cells inhibited anti-CD3/anti-CD28-induced phosphorylation of ERK, whereas TCR proximal signalling was not affected. Similarly, overexpression of CSK together with a therapeutic TCR prevented pMHC-induced ERK phosphorylation. Downstream effector functions were also almost completely blocked, including pMHC-induced IL-2 release, degranulation and, most importantly, target cell killing. The lack of effector functions contrasted with the unaffected TCR expression, pMHC recognition, and membrane exchange activity (trogocytosis). Therefore, co-expression of CSK with a therapeutic TCR did not compromise target recognition and binding, but rendered T cells incapable of executing their effector functions. Consequently, we named these redirected T cells "dummy T cells" and propose to use them for safety validation of new TCRs prior to therapy.

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E-cadherin: Its dysregulation in carcinogenesis and clinical implications

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Sonia How Ming Wong, Chee Mun Fang, Lay-Hong Chuah, Chee Onn Leong, Siew Ching Ngai
E-cadherin is a transmembrane glycoprotein which connects epithelial cells together at adherens junctions. In normal cells, E-cadherin exerts its tumour suppressing role mainly by sequestering β-catenin from its binding to LEF (Lymphoid enhancer factor)/TCF (T cell factor) which serves the function of transcribing genes of the proliferative Wnt signaling pathway. Despite the ongoing debate on whether the loss of E-cadherin is the cause or effect of epithelial-mesenchymal transition (EMT), E-cadherin functional loss has frequently been associated with poor prognosis and survival in patients of various cancers. The dysregulation of E-cadherin expression that leads to carcinogenesis happens mostly at the epigenetic level but there are cases of genetic alterations as well. E-cadherin expression has been linked to the cellular functions of invasiveness reduction, growth inhibition, apoptosis, cell cycle arrest and differentiation. Studies on various cancers have shown that these different cellular functions are also interdependent. Recent studies have reported a rapid expansion of E-cadherin clinical relevance in various cancers. This review article summarises the multifaceted effect E-cadherin expression has on cellular functions in the context of carcinogenesis as well as its clinical implications in diagnosis, prognosis and therapeutics.



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Epigenetic regulation of the Hedgehog and Wnt pathways in cancer

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Leon J Wils, Maarten F Bijlsma
The Hedgehog (Hh) and wingless-Int1 (Wnt) pathways are important for tissue patterning in the developing embryo. In adult tissue, both pathways are typically dormant but are activated under certain conditions such as tissue damage. Aberrant activation of these pathways by mutations in key pathway regulators contributes to the genesis and progression of several cancer types. In addition, the impact of epigenetic regulation of the Hh and Wnt pathways on cancer is becoming increasingly clear. In this review, current knowledge on the epigenetic control of Hh and Wnt and the impact on tumor formation will be discussed. First, the role of epigenetic control on ligand production will be discussed, followed by the epigenetic regulation of the extra– and intracellular pathway members. Furthermore, the epigenetic control of pathway target genes will be highlighted. Lastly, an overview of current therapeutic strategies to target aberrant epigenetic control of the Hh and Wnt pathways is provided.



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Systematic review and survival meta-analysis of real world evidence on first-line pazopanib for metastatic renal cell carcinoma

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Miguel A. Climent, José Muñoz-Langa, Laura Basterretxea-Badiola, Carmen Santander-Lobera
A systematic review was conducted to identify real world studies reporting outcomes after first-line pazopanib in patients with metastatic renal cell carcinoma. Studies had to be observational and report survival data in terms of progression-free survival and overall survival in order to conduct meta-analysis techniques. These real-world data were compared to those obtained in the phase II and III randomized controlled trials of pazopanib. Real world evidence showed that the clinical and safety outcomes were consistent with those observed in the clinical trials despite the inclusion of unselected patients with a wide spectrum of prognostic features and comorbidities. Similarly to the results of the pivotal studies, good prognosis patients had the most benefit from pazopanib. Further investigation is needed to complement evidence from clinical trials, in particular focused on patient-centered outcomes.



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Meta-analyses evaluating surrogate endpoints for overall survival in cancer randomized trials: A critical review

Publication date: Available online 23 November 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Marion Savina, Sophie Gourgou, Antoine Italiano, Derek Dinart, Virginie Rondeau, Nicolas Penel, Simone Mathoulin-Pelissier, Carine Bellera
BackgroundIn cancer randomized controlled trials (RCT), alternative endpoints are increasingly being used in place of overall survival (OS) to reduce sample size, duration and cost of trials. It is necessary to ensure that these endpoints are valid surrogates for OS. We aimed at identifying meta-analyses evaluating surrogate endpoints and assessing the strength of evidence for each study.Materials and methodsWe performed a systematic review to identify meta-analyses of cancer RCTs assessing surrogate endpoints for OS. We evaluated the strength of the association between the endpoints based on (i) the Institute of Quality and Efficiency in Health Care guidelines and (ii) the Biomarker-Surrogate Evaluation Schema.Results53 publications reported on 164 meta-analyses, with heterogeneous statistical methods Disease-free survival (DFS) and progression-free survival showed good surrogacy properties for OS in colorectal cancer, lung cancer and head and neck cancer. DFS was also highly correlated to OS in gastric cancer.Conclusion(s)Clinical settings with validated surrogate endpoints for OS remain limited. Harmonization of the statistical methodology used to evaluate surrogate endpoints is required.



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A review of the literature on the relationships between genetic polymorphisms and chemotherapy-induced nausea and vomiting

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Komal P. Singh, Anand A. Dhruva, Elena Flowers, Kord M. Kober, Christine Miaskowski
Despite current advances in antiemetic treatments, between 30% to and 60% of oncology patients experience chemotherapy-induced nausea (CIN) and 13% to 33% report chemotherapy-induced vomiting (CIV). Inter-individual differences are observed in the occurrence and severity of chemotherapy-induced nausea and vomiting (CINV). This review summarizes and critiques studies on associations between occurrence and severity of CINV and polymorphisms in serotonin receptor, drug metabolism, and drug transport pathway genes. Sixteen studies evaluated the associations between the occurrence and/or severity of CINV and single nucleotide polymorphisms (SNPs). Across these studies, three SNPs in 5-hydroxytryptamine receptor (5-HT3R) genes, two alleles of the cytochrome P450 family 2 subfamily D member 6 (CYP2D6) gene, and three SNPs in ATP binding cassette subfamily B member 1 (ABCB1) gene were associated with the occurrence and severity of CINV. Given the limited number of polymorphisms evaluated, additional research is warranted to identify new mechanisms to develop more targeted therapies.



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Anti-hypertensive drugs and skin cancer risk: a review of the literature and meta-analysis

Publication date: February 2018
Source:Critical Reviews in Oncology/Hematology, Volume 122
Author(s): Sara Gandini, Domenico Palli, Giuseppe Spadola, Benedetta Bendinelli, Emilia Cocorocchio, Ignazio Stanganelli, Lucia Miligi, Giovanna Masala, Saverio Caini
IntroductionSeveral anti-hypertensive drugs have photosensitizing properties, however it remains unclear whether long-term users of these drugs are also at increased risk of skin malignancies. We conducted a literature review and meta-analysis on the association between use of anti-hypertensive drugs and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).MethodsWe searched PubMed, EMBASE, Google Scholar and the Cochrane Library, and included observational and experimental epidemiological studies published until February 28th, 2017. We calculated summary relative risk (SRR) and 95% confidence intervals (95% CI) through random effect models to estimate the risk of skin malignancies among users of the following classes of anti-hypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and β-blockers. We conducted sub-group and sensitivity analysis to explore causes of between-studies heterogeneity, and assessed publication bias using a funnel-plot based approach.ResultsNineteen independent studies were included in the meta-analysis. CCB users were at increased skin cancer risk (SRR 1.14, 95% CI 1.07–1.21), and β-blockers users were at increased risk of developing cutaneous melanoma (SRR 1.21, 95% CI 1.05–1.40), with acceptable between-studies heterogeneity (I² < 50%). There was no association between thiazide diuretics, ACEi or ARB use and skin cancer risk. We found no evidence of publication bias affecting the results.ConclusionFamily doctors and clinicians should inform their patients about the increased risk of skin cancer associated with the use of CCB and β-blockers and instruct them to perform periodic skin self-examination. Further studies are warranted to elucidate the observed associations.



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Long-term toxicity of the treatment for germ cell-cancer. A review

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): P. Maroto, G. Anguera, C. Martin
Testicular germ-cell cancer (GCC) is a curable disease. Stage I patients are mostly cured by surgery alone. For those with good prognosis advanced disease, radiotherapy in some patients with stage II Seminoma and chemotherapy for all other patients, are responsible for 95% of long-term survivors. Unfortunately, despite this high level of curability, overall survival has been reported lower for those patients receiving either radiotherapy or chemotherapy versus patients treated by surgery alone. Long-term survivors face a higher incidence of second neoplasms, and a higher risk of cardiovascular disease and metabolic syndrome than expected. Other non-life-threatening toxicities such as ototoxicity, neurotoxicity and fertility problems are common. This paper reviews the potential causes of the higher mortality among long-term survivors of testicular tumors, the incidence of them and some recommendations for the diagnoses and prevention of long-term sequelae in patients with GCC.



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The relationship between body mass index and short term postoperative outcomes in patients undergoing potentially curative surgery for colorectal cancer: A systematic review and meta-analysis

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Arwa S. Almasaudi, Stephen T. McSorley, Christine A. Edwards, Donald C. McMillan
BackgroundThe prevalence of obesity has increased worldwide over the last few decades, and is a well-recognized risk factor for colorectal cancer. Surgical site infection is the most frequent complication following surgery for colorectal cancer, and the main cause of postoperative morbidity. The aim of the present systematic review and meta-analysis was to examine the relationship between increasing BMI and postoperative surgical site infection following surgery for colorectal cancer.MethodsA systemic literature search was conducted using Medline, PubMed, Embase (Ovid) and Web of Science databases from inception to the end of August 2016. Studies examining the relationship between obesity and surgical site infection following surgery for colorectal cancer were included. Analysis of the data was performed using Review Manager version 5.3(The Nordic Cochrane Centre, The Cochrane Collaboration, Copen-hagen, Denmark,)ResultsIn this meta-analysis, a total of 9535 patients from 16 studies were included. BMI <30 vs ≥30kg/m² was used to examine the association of obesity and surgical site infection in patients from Western countries. The estimated pooled OR demonstrated that obesity increased the risk of surgical site infection by approximately 100% (OR=2.13; 95% CI 1.66-2.72, p<0.001).BMI <25 vs ≥25kg/m² was used to examine the association of obesity and surgical site infection from Asian countries. The estimated pooled OR demonstrated that obesity increased the risk of surgical site infection by approximately 60% (OR=1.63; 95% CI 1.29-2.06, p<0.001). There was little evidence of publication bias in the meta-analysis.ConclusionFrom this systematic review and meta-analysis there was good evidence that obesity was associated with a significantly higher risk of developing surgical site infection following surgery for colorectal cancer in both ethnic groups. The magnitude of the effect warrants further investigation.



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A question of class: Treatment options for patients with relapsed and/or refractory multiple myeloma

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Gordon Cook, Sonja Zweegman, María-Victoria Mateos, Florence Suzan, Philippe Moreau
Multiple classes of agent with distinct mechanisms of action are now available for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM), including immunomodulatory agents, proteasome inhibitors, histone deacetylase inhibitors and monoclonal antibodies. Additionally, several different drugs may be available within each agent class, each with their own specific efficacy and safety profile. This expansion of the treatment landscape has dramatically improved outcomes for patients. However, as the treatment options for RRMM become more complex, choosing the class of agent or combination of agents to use in the relapsed setting becomes increasingly challenging. Furthermore, treatment options for specific patient populations such as the elderly, those with high-risk cytogenetic abnormalities and those with refractory disease are yet to be defined in the current treatment landscape. When choosing an appropriate treatment approach, physicians must consider multiple criteria including both patient-related and disease-related factors. The aim should be to provide patient-specific treatment in order to gain a clinical benefit while minimizing toxicity. This review provides an overview of the mechanism of action and efficacy and safety profiles of each class of agent and of treatment regimens that combine different classes of agent, with a special focus on treating specific patient populations.



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The Therapeutic use of human albumin in cancer patients’ management

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Elissar Moujaess, May Fakhoury, Tarek Assi, Hanine Elias, Fadi El Karak, Marwan Ghosn, Joseph Kattan
Human albumin (HA) has been widely used in clinical practice due to its unique physiological characteristics and pharmacokinetics. However, with the absence of clear institutional recommendations, its uncontrolled prescription remains largely controversial. An extensive review on the albumin chemistry, pharmacology, physiology and pathology was performed, and data on commercially available HA, its cost, medical usage and the related available guidelines, particularly in oncology patients were gathered.Studies assessing the appropriate use and safety of HA in cancer patients are lacking. A retrospective survey of the appropriateness of HA infusions according to the SIMTI guidelines (2009) was performed in our department. Among 53 patients who received HA infusions, only 5.7% of the indications were appropriate for HA administration. Occasionally appropriate and inappropriate indications were considered in 10% and 84.3% of the prescriptions respectively with a relatively high cost. The adoption of strict guidelines may substantially reduce the inappropriate use and the subsequent healthcare costs.



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Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis of randomized trials

Publication date: Available online 16 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Sapna Oberoi, Paula D. Robinson, Danielle Cataudella, Nicole Culos-Reid, Hailey Davis, Nathan Duong, Faith Gibson, Miriam Götte, Pamela Hinds, Sanne L Nijhof, Deborah Tomlinson, Patrick van der Torre, Sandra Cabral, LLee Dupuis, Lillian Sung
PurposeObjective was to determine whether physical activity reduces the severity of fatigue in patients with cancer or hematopoietic stem cell transplant (HSCT) recipients.MethodsWe conducted a meta-analysis of randomized trials comparing physical activity with control interventions for the management of fatigue in patients with cancer or HSCT recipients.ResultsThere were 170 trials included. Physical activity reduced the severity of fatigue when compared to all control groups (standardized mean difference −0.49, 95% confidence interval −0.60 to −0.37; P < 0.00001). Aerobic, neuromotor, resistance and combination exercises were all effective in reducing fatigue although smaller effects were observed with resistance exercises (P interaction = 0.01). Other intervention and patient characteristics did not influence the effect of physical activity on the severity of fatigue.ConclusionsPhysical activity was effective at reducing fatigue in patients with cancer and HSCT recipients across patient sub-groups. Determining the best approaches for safe implementation should be a priority.



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The role of Stereotactic body radiotherapy (SBRT) in reirradiation of Head and Neck cancer recurrence

Publication date: Available online 15 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): A. Román A., C. Jodar, A. Perez-Rozos, Y. Lupiañez-Perez, JA Medina, J. Gomez-Millan
IntroductionHead and neck cancer recurrence is a therapeutic challenge due to the anatomical and functional constraints of the head and neck area. Stereotactic body radiotherapy (SBRT) is a high-precision technique of radiotherapy that consists of delivering a high ablative biological dose in 1–5 high-dose fractions, requiring a very high precision of the radiotherapy process with potential application in this clinical setting.MethodsDifferent studies that investigate the role of SBRT in the treatment of recurrent head and neck cancer have been reviewed. Indications to properly select patients for this treatment are presented.ResultsRetrospective studies and phase I–II trials with selected patients have shown low to moderate toxicity, with an efficacy at least similar to that of treatment with combinations of radiotherapy and chemotherapy. In selected patients, SBRT is a treatment option for recurrent head and neck cancer with low toxicity.DiscussionNew prospective studies should clarify data regarding the efficacy and toxicity of SBRT in head and neck cancer recurrence.



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Publishers Note - Tribute to Matti

Publication date: Available online 14 December 2017
Source:Critical Reviews in Oncology/Hematology





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Systemic treatment in adult uterine sarcomas

Publication date: Available online 14 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): I.M.E. Desar, P.B. Ottevanger, C. Benson, W.T.A. van der Graaf
Uterine sarcomas (US) are rare mesenchymal tumours of the uterus and are divided mainly into uterine leiomyosarcoma (uLMS), low grade endometrial stromal sarcoma (LG-ESS), high grade endometrial stromal sarcoma (HG-ESS), adenosarcomas and high grade undifferentiated sarcoma (HGUS). US are often high-grade tumours with a high local recurrence rate and metastatic risk. We here discuss the current standard of care and knowledge of systemic therapy for adult uterine sarcomas, in particular uLMS, LG-ESS, HG-ESS and HGUS, in both the adjuvant as well as the metastatic setting.



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Protective effects of curcumin against doxorubicin-induced toxicity and resistance: a review

Publication date: Available online 14 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Mohammad Mohajeri, Amirhossein Sahebkar
Doxorubicin (DOX)-induced toxicity and resistance are major obstacles in chemotherapeutic approaches. Despite effective in the treatment of numerous malignancies, some clinicians have voiced concern that DOX has the potential to cause debilitating consequences in organ tissues, especially the heart. The mechanisms of toxicity and resistance are respectively related to induction of reactive oxygen species (ROS) and up-regulation of ATP-binding cassette (ABC) transporter. Curcumin (CUR) with several biological and pharmacological properties is expected to restore DOX-mediated impairments to tissues. This review is intended to address the current knowledge on DOX adverse effects and CUR protective actions in the heart, kidneys, liver, brain, and reproductive organs. Coadministration of CUR and DOX is capable of ameliorating DOX toxicity pertained to antioxidant, apoptosis, autophagy, and mitochondrial permeability.



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An attempt to conceptualize the individual onco-functional balance: why a standardized treatment is an illusion for diffuse low-grade glioma patients

Publication date: Available online 13 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Emmanuel Mandonnet, Hugues Duffau
In the era of evidence-based medicine, clinicians aim to establish standards of care from randomized studies. Following, personalized medicine has emerged, as new individualized biomarkers could help to predict sensitivity to specific treatment.In this paper, we show that, for diffuse low-grade glioma, some specificities – dual goal of both survival and functional gain, long duration of the disease with multistep treatments, multiparametric evaluation of the onco-functional balance of each treatment modality – call for a change of paradigm. After summarizing how to weight the benefits and risks of surgery, chemotherapy and radiotherapy, we show that the overall efficacy of a treatment modality cannot be assessed per se, as it depends on its integration in the whole sequence. Then, we revisit the notion of personalized medicine: instead of decision-making based solely on molecular profile, we plead for a recursive algorithm, allowing a dynamic evaluation of the onco-functional balance, integrating many individual characteristics of the patient's tumor and brain function.



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Continuity and diversity

Publication date: Available online 7 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Matti Aapro




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Editorial Board

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120





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Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Nathan Duong, Hailey Davis, Paula D. Robinson, Sapna Oberoi, Danielle Cataudella, S. Nicole Culos-Reed, Faith Gibson, Miriam Götte, Pamela Hinds, Sanne L. Nijhof, Deborah Tomlinson, Patrick van der Torre, Elena Ladas, Sandra Cabral, L. Lee Dupuis, Lillian Sung
PurposeTo determine whether non-physical activity mind and body practices reduce the severity of fatigue in patients with cancer or hematopoietic stem cell transplant (HSCT) recipients compared to control interventions.MethodsWe included randomized trials which compared non-physical activity mind and body practices compared with control interventions for the management of fatigue in cancer and HSCT patients.ResultsAmong 55 trials (4975 patients), interventions were acupuncture or acupressure (n=12), mindfulness (n=11), relaxation techniques (n=10), massage (n=6), energy therapy (n=5), energizing yogic breathing (n=3) and others (n=8). When combined, all interventions significantly reduced fatigue severity compared to all controls (standardized mean difference −0.51, 95% confidence interval −0.73 to −0.29). More specifically, mindfulness and relaxation significantly reduced fatigue severity.ConclusionsMindfulness and relaxation were effective at reducing fatigue severity in patients with cancer and HSCT recipients. Future studies should evaluate how to translate these findings into clinical practice across different patient groups.



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Genetic Overview of Syndactyly and Polydactyly

Summary: Syndactyly and polydactyly—respectively characterized by fused and supernumerary digits—are among the most common congenital limb malformations, with syndactyly presenting at an estimated incidence of 1 in 2,000–3,000 live births and polydactyly at a frequency of 1 in approximately 700–1,000 live births. Despite their relatively regular manifestation in the clinic, the etiologies of syndactyly and polydactyly remain poorly understood because of their phenotypic and genetic diversity. Further, even though concrete knowledge of genotypic links has been established for some variants of syndactyly and polydactyly, there appears to be no single comprehensive published summary of all syndromic and nonsyndromic syndactyly and polydactyly presentations, and there is decidedly no resource that maps all syndromic and nonsyndromic syndactylies and polydactylies to their genetic bases. This gap in the literature problematizes comprehensive carrier screening and prenatal diagnosis and complicates novel diagnostic attempts. This review thus attempts to collect all that is known about the genetic bases of syndromic and nonsyndromic syndactylies and polydactylies, as well as to highlight the dactyly manifestations for which no genetic bases are as yet known. Then, having established a summation of existing and missing knowledge, this work briefly outlines the diagnostic techniques that a genetics-reinforced understanding of syndactyly and polydactyly could inform.

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Factors impacting hearing aid performance outcomes for Egyptian hearing impaired children

Publication date: Available online 15 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Eman Abdel-Fattah Said
Despite recent technological advances in the audiologic assessment of children, their hearing aid fitting remains a daunting task.Aims of studyTo assess effectiveness of amplification in children using aided sound field tests and Auditory Behavior in Everyday Life (ABEL) questionnaire and to elucidate factors contributing to poor outcomes.MethodsDetailed medical history, otoscopic examination, basic audiological evaluation, aided sound field tests and ABEL questionnaire for 114 hearing impaired children aged 4–16 years.ResultsCongenital HL considered the commonest cause of HL (55.3%), 36% had unknown cause and 8.8% of HI had acquired cause. Profound loss in 67.5%, severe in 17% and 54.4% of them (54.4%) were fitted around the age of 3 years. Binaural HA in 88.6% and digital type for 61.4%. There were statistically significant differences between unaided and aided values in sound field tests for HI children.Poor performance in direct measures and ABEl in children with congenital and profound degree of hearing loss, better response when they were fitted earlier with digital aids. ABEL scores showed negative correlations with aided tonal sound field test and positive with aided speech discrimination score.ConclusionsInappropriate amplification, late age of fitting with no speech therapy were clinical red flags for poor outcomes. ABEL questionnaire was a valid procedure to assess the hearing aids appropriateness.



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Childhood hearing loss is a key feature of CAPOS syndrome: A case report

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Stéphanie Paquay, Elsa Wiame, Naima Deggouj, Antonella Boschi, Romolo Daniele De Siati, Yves Sznajer, Marie-Cécile Nassogne
CAPOS syndrome (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss) is a rare neurological disorder, recently associated with the c.2452G > A hotspot mutation in the ATP1A3 gene, with sensorineural hearing loss as a prominent feature. We herein report on a girl who has experienced hearing loss for three years following an initial encephalitic episode when aged 15 months old. CAPOS was diagnosed only when she was six years old by targeted testing whilst she displayed optic atrophy, cerebellar signs and areflexia. CAPOS syndrome should be considered in the differential diagnosis of acquired childhood deafness, prompting clinicians to search for associated neurological features.



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Genetic analysis of CLDN14 in the Chinese population affected with non-syndromic hearing loss

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Yajie Lu, Jun Yao, Qinjun Wei, Jin Xu, Guangqian Xing, Xin Cao
ObjectiveThe CLDN14 gene, encoding the tight junction protein Claudin-14, has been proposed as a candidate causative gene affecting autosomal recessive non-syndromic hearing loss (ARNSHL). Genetic analysis of nonsynonymous single-nucleotide variations (nsSNVs) in CLDN14 has been performed in different populations. The role of CLDN14 nsSNVs in contributing to hearing loss in Chinese populations would be investigated in this study.MethodsTarget screening for CLDN14 variations were conducted in 500 unrelated patients diagnosed with non-syndromic hearing loss (NSHL).ResultsNo reported pathogenic CLDN14 nsSNVs in heterozygote or homozygote were detected in this study, however, we identified 4 heterozygous nsSNVs [c.11C > T, p.(Thr4Met); c.16G > A, p.(Val6Met); c.68T > C, p.(Ile23Thr); c.367A > C, p.(Thr123Pro)] in CLDN14. The 4 nsSNVs are located at claudin-14 transmembrane domains, but assessed to be poorly conservative and non-pathogenic via multiple in silico algorithms. The structure-based analysis also suggested that the 4 nsSNVs had less structural and functional impact on claudin-14.ConclusionOur findings indicated that CLDN14 might not be a major causative gene for NSHL in Chinese populations, which would contribute to fully understanding the genetic cause of NSHL in the East Asian populations.



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SLC52A2 mutations cause SCABD2 phenotype: A second report

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Mojgan Babanejad, Omid Ali Adeli, Nooshin Nikzat, Maryam Beheshtian, Hakimeh Azarafra, Farnaz Sadeghnia, Marzieh Mohseni, Hossein Najmabadi, Kimia Kahrizi
IntroductionAutosomal recessive cerebellar ataxias (ARCAs) are a large group of neurodegenerative disorders that manifest mainly in children and young adults. Most ARCAs are heterogeneous with respect to age at onset, severity of disease progression, and frequency of extracerebellar and systemic signs.MethodsThe phenotype of a consanguineous Iranian family was characterized using clinical testing and pedigree analysis. Whole-exome sequencing was used to identify the disease-causing gene in this family.Results and conclusionUsing whole exome sequencing (WES), a novel missense mutation in SLC52A2 gene is reported in a consanguineous Iranian family with progressive severe hearing loss, optic atrophy and ataxia. This is the second report of the genotype-phenotype correlation between this syndrome named spinocerebellar ataxia with blindness and deafness type 2 (SCABD2) and SLC52A2 gene.



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Pediatric Meniere's disease

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Chi Wang, Chien-Hao Wu, Po-Wen Cheng, Yi-Ho Young
ObjectiveThis study adopted an inner ear test battery comprising audiometry, and ocular vestibular evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests to investigate the sequence of inner ear deficits in pediatric Meniere's disease (MD).MethodsFrom 2005 to 2016, a total of 24 MD children aged <15 years old underwent otoscopy, CT scan, blood test, and an inner ear test battery. Nine subjects were males and 15 were females, with mean age of 12 years. Right ear was affected in 3 patients, left ear in 5 patients, and both ears in 16 patients (67%). Eight (33%) of the 24 MD children had positive family history.ResultsInner ear deficits in MD children ran from abnormal hearing (25%) to abnormal cVEMP (20%), oVEMP (13%), and caloric (12%) tests, exhibiting a significantly declining sequence from the cochlea, to the saccule, utricle and semicircular canals. Analysis between the laterality and family history revealed a significantly positive correlation.ConclusionPediatric MD is rare, accounting for 2.3% prevalence in MD patients. The inner ear deficits in pediatric MD showed a significantly declining sequence from the cochlea, to the saccule, utricle and semicircular canals, mimicking the sequence in adult MD. One-third MD children had positive family history, which may explain the high rate of bilateral affliction and symmetrical hearing levels on both ears.



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Papillary thyroid carcinoma presenting as acute suppurative thyroiditis: A case report and review of the literature

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Shabana Kalladi Puthanpurayil, Gary L. Francis, Adele O. Kraft, Uma Prasad, Rajanya S. Petersson
Acute suppurative thyroiditis is a rare, potentially life-threatening condition. We report the case of a 17-year-old male who initially presented with a thyroid abscess. Due to persistent symptoms and lack of evidence for underlying predisposing factors, he was followed closely and subsequently diagnosed with papillary thyroid cancer. He was successfully managed with surgery. His clinical course, radiological evaluation, and pathology reports are presented here along with a review of the literature. This case of papillary thyroid cancer highlights the need for close follow-up of patients presenting with a thyroid abscess, when other predisposing risk factors are not evident.



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Long-term outcomes of Universiti Kebangsaan Malaysia Cochlear Implant Program among pediatric implantees

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Bee-See Goh, Noraziana Fadzilah, Asma Abdullah, Basyariatul Fathi Othman, Cila Umat
ObjectivesCochlear implant (CI) greatly enhances auditory performance as compared to hearing aids and has dramatically affected the educational and communication outcomes for profoundly deaf children. Universiti Kebangsaan Malaysia (UKM) pioneered CI program in 1995 in the South East Asia. We would like to report the long-term outcomes of UKM paediatric cochlear implantation in terms of: the proportion of children who were implanted and still using the device, the children's modes of communication, their educational placements, and their functional auditory/oral performance. We also examined the factors that affected the outcomes measured.Study designThis was a cross sectional observational study.MethodsTwo sets of questionnaires were given to 126 parents or primary caregivers of the implantees. The first set of questionnaire contained questions to assess the children's usage of CI, their types of education placement, and their modes of communication. The second set of questionnaire was the Parent's Evaluation Of Aural/Oral Performance of Children (PEACH) to evaluate the children's auditory functionality.ResultsOur study showed that among the implantees, 97.6% are still using their CI, 69.8% communicating orally, and 58.5% attending mainstream education. For implantees that use oral communication and attend mainstream education, their mean age of implantation is 38 months. This is significantly lower compared to the mean age of implantation of implantees that use non-oral communication and attend non-mainstream education. Simple logistic regression analysis shows age of implantation reliably predicts implantees (N = 126) would communicate using oral communication with odds ratio of 0.974, and also predict mainstream education (N = 118) with odds ratio of 0.967. The median score of PEACH rating scale is 87.5% in quiet, and this significantly correlates with an earlier age of implantation (r = −0.235 p = 0.048).ConclusionsUKM Cochlear Implant Program has achieved reasonable success among the pediatric implantees, with better outcomes seen in those implanted at the age of less than 4 years old.



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Spontaneous retropharyngeal and mediastinal thoracic duct cyst in an infant with respiratory distress

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Vidur Bhalla, Thomas Schrepfer, Adam McCann, Pamela Nicklaus, Brenton Reading
Thoracic duct cysts (TDC) within the retropharyngeal space and mediastinum are exceedingly rare lesions, with the majority related to trauma or neoplasm. We describe a case of an otherwise healthy 8-month-old boy who presented with severe respiratory distress, which was found to be caused by a large, spontaneous TDC occupying most the retropharyngeal and mediastinal space. To our knowledge, this is the youngest patient to date presenting with TDC. Ultimately, his TDC was completely resolved with sclerotherapy, however the patient's age and size presented unique challenges to his medical management, which we describe below.



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Sirolimus for management of complex vascular anomalies – A proposed dosing regimen for very young infants

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Josephine A. Czechowicz, Janel R. Long-Boyle, Kristina W. Rosbe, Erin F. Mathes, Ilona J. Frieden, Kristin A. Shimano
Neonates with vascular anomalies causing airway compromise and other complications require early initiation of medical therapy. Sirolimus has emerged as a safe and effective treatment, but standard recommendations for dosing start at seven months. Guidelines are needed for dosing in very young infants, who have reduced hepatic metabolism of sirolimus. We present our experience treating six neonates (mean age 14.8 days) with complicated vascular anomalies. Standard dosing caused supratherapeutic levels in this population. Our modified dosing regimen has resulted in safe therapeutic concentrations. Properly dosed, sirolimus is a viable and potentially lifesaving option for neonates with severe morbidity from vascular anomalies.



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Using simulators to teach pediatric airway procedures in an international setting

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Marissa A. Schwartz, Katherine R. Kavanagh, Steven J. Frampton, Iain A. Bruce, Tulio A. Valdez
IntroductionThere has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology.ObjectivesThe objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting.MethodsPediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale.ResultsParticipants reported significant subjective improvement in confidence level after use of the simulation models (p < 0.05). Participants reported realistic representations of human anatomy and pathology. The models' tissue mechanics were adequate to practice operative technique including the ability to incise, suture, and suspend models.ConclusionThe pediatric laryngeal models demonstrate high quality anatomy, which is easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment.



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Pre- and post-operative evaluation of the frequency of nocturnal enuresis and Modified Pediatric Epworth Scale in pediatric obstructive sleep apnea patients

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Kerem Sami Kaya, Bilge Türk, Zeynep Nur Erol, Pınar Akova, Berna Uslu Coşkun
ObjectiveTo investigate the beneficial effect of adenotonsillectomy (AT) on nocturnal enuresis (NE) in children with adenotonsillar hypertrophy and evaluate the Modified Pediatric Epworth Scale (MPES).MethodsThis was a prospective study comparing preoperative and postoperative evaluation of the frequency of NE and MPES in pediatric obstructive sleep apnea (OSA). A questionnaire on NE history was prepared based on the Turkish Enuresis Guidelines. NE histories were evaluated pre- and postoperatively on the first month and third month, respectively. MPES questions were asked to the parents of all the OSA patients pre- and postoperatively, and scores were noted.ResultsEighty-four (84) pediatric OSA patients were involved in the study. Preoperatively, 19 patients (27%) complained about nocturnal enuresis. After the surgery, 52% of the patients with NE had complete resolution of NE (p < 0.001). Postoperatively, the average Epworth scores of both groups significantly decreased (p < 0.001).ConclusionThere is a strong correlation between OSA and NE. In the present study, enuresis in pediatric OSA patients significantly decreased after surgery. Also, Epworth scores decreased significantly after surgery. In children with nocturnal enuresis, the presence of OSA symptoms should be questioned.



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Readability of online patient education materials for velopharyngeal insufficiency

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Deborah X. Xie, Ray Y. Wang, Sivakumar Chinnadurai
ObjectiveEvaluate the readability of online and mobile application health information about velopharyngeal insufficiency (VPI).MethodsTop website and mobile application results for search terms "velopharyngeal insufficiency", "velopharyngeal dysfunction", "VPI", and "VPD" were analyzed. Readability was determined using 10 algorithms with Readability Studio Professional Edition (Oleander Software Ltd; Vandalia, OH). Subgroup analysis was performed based on search term and article source – academic hospital, general online resource, peer-reviewed journal, or professional organization.Results18 unique articles were identified. Overall mean reading grade level was a 12.89 ± 2.9. The highest reading level among these articles was 15.47–approximately the level of a college senior. Articles from "velopharyngeal dysfunction" had the highest mean reading level (13.73 ± 2.11), above "velopharyngeal insufficiency" (12.30 ± 1.56) and "VPI" (11.66 ± 1.70). Articles from peer-reviewed journals had the highest mean reading level (15.35 ± 2.79), while articles from academic hospitals had the lowest (12.81 ± 1.66). There were statistically significant differences in reading levels between the different search terms (P < 0.01) and article source types (P < 0.05). Only one mobile application was identified with VPI information, with a readability of 10.68.ConclusionDespite published reading level guidelines, online patient education materials for VPI are disseminated with language too complex for most readers. There is also a lack of VPI-related mobile application data available for patients. Patients will benefit if future updates to websites and disseminated patient information are undertaken with health literacy in mind. Future studies will investigate patient comprehension of these materials.



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A novel technique for unilateral supraglottoplasty

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Harry H. Ching, Alycia G. Spinner, Nathaniel H. Reeve, T.J. O-Lee
ObjectivesTraditional supraglottoplasty for pediatric laryngomalacia is most commonly conducted with either CO2 laser or cold steel instruments. While the procedure enjoys high success rates, serious complications such as excessive bleeding, supraglottic stenosis and aspiration can occur. Unilateral coblation supraglottoplasty may reduce this risk, but data on respiratory and swallowing outcomes are lacking. This study reports our experiences with unilateral coblation supraglottoplasty.MethodsPediatric patients with severe congenital laryngomalacia who underwent unilateral supraglottoplasty at a single institution from 2013 to 2016 were retrospectively reviewed. Bipolar radiofrequency ablation (Coblation) was utilized with partial arytenoidectomy, aryepiglottoplasty, and advancement of mucosal flaps. Outcome measures included apnea-hypopnea index (AHI), weight-by-age percentile, and decannulation rate.ResultsTwelve patients were included with an average age of 13.1 months (range 2–28 months). In patients without tracheostomy, 88% had complete resolution of respiratory symptoms, while the remainder had significant improvement. In patients without gastrostomy tubes, there was an average increase in weight-age percentile of 6.1, 7.8, and 15.3 points at 1, 3, and 6 months postoperatively, respectively. Three patients had complete polysomnography data with a mean preoperative AHI of 19.3 and postoperative AHI of 4.0. Three of four patients with tracheostomy have been decannulated at a mean follow-up of 1.5 years. There were no early or late postoperative complications and no revision supraglottoplasty.ConclusionUnilateral supraglottoplasty with bipolar radiofrequency ablation can improve respiratory symptoms and decrease OSA severity in severe congenital laryngomalacia. This technique is safe and can lead to substantial improvement in AHI in patients with OSA.



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Total serum bilirubin levels and sensorineural hearing loss in the US adolescents: NHANES 2007–2010

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Guoli Zhou, Wenjiang Fu
ObjectiveWe aimed to investigate whether current levels of total serum bilirubin are associated with different subtypes of sensorineural hearing loss (SNHL) in adolescents.MethodsA set of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) (2007–2010) was used. A subset of 1404 adolescents was sampled for measurements of total serum bilirubin, tympanometry, and average pure tone threshold at low-frequencies (LPTA: 500, 1000, 2000 Hz) or high-frequencies (HPTA: 3000, 4000, 6000, and 8000 Hz). SNHL was defined as the hearing loss that had type A tympanograms with a peak admittance of 0.3 ml or greater. Associations between serum bilirubin (square-root transformed) and different subtypes of SNHL were evaluated using binary or multinomial logistic regression models with 4-year sampling weights. The bootstrap method was used for estimation of variance and 10-fold cross-validation for assessment of overfitting issue.ResultsTotal serum bilirubin levels were found to be associated with any high-frequency (HPTA>15 dB in at least one ear, adjusted odds-ratio (ORa)(bootstrap 95% confidence interval) = 3.29(1.31–8.19), p = 0.011), but not with any low-frequency (LPTA>15 dB in at least one ear), SNHL in the US adolescents. Furthermore, high-frequency SNHL with HPTA>15 dB in both ears (bilateral) or HPTA≥25 dB in at least one ear, compared to that with HPTA>15 dB in one ear only (unilateral) or HPTA = 15–25 dB in at least one ear, had a stronger association with total serum bilirubin levels (ORa = 5.37(1.27–22.65), p = 0.022 for bilateral; ORa = 2.64(0.84–8.25), p = 0.094 for unilateral; ORa = 5.00(0.95–26.58), p = 0.058 for HPTA≥25 dB in at least one ear; as well as ORa = 3.06(1.15–8.25), p = 0.025 for HPTA = 15–25 dB in at least one ear). No severe overfitting problems were found.ConclusionOur findings suggest that current levels of total serum bilirubin may be informative in predicting and/or targeting high-frequency SNHL in the US adolescents.



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Postoperative bradycardia following adenotonsillectomy in children: Does intraoperative administration of dexmedetomidine play a role?

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Benjamin Bush, Joseph D. Tobias, Chen Lin, James Ruda, Kris R. Jatana, Garth Essig, Jennifer Cooper, Dmitry Tumin, Charles A. Elmaraghy
IntroductionDexmedetomidine is a novel pharmacologic agent that has become a frequently used adjunct during care of pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy. While generally safe and effective, dexmedetomidine is associated with adverse effects of hypotension and bradycardia from its central sympatholytic effects. Due to safety concerns, our institution routinely admits patients with OSA for overnight cardiorespiratory monitoring following tonsillectomy. With such monitoring, we have anecdotally noted bradycardia in our patients and sought to investigate whether this was related to the increased use of intra-operative dexmedetomidine.MethodsWe retrospectively reviewed records over an 11-month period to compare the incidence of postoperative bradycardia following hospital admission for tonsillectomy in patients who received dexmedetomidine versus those who did not.ResultsThe study cohort included 921 patients (371 received dexmedetomidine and 550 did not). Bradycardia was asymptomatically noted in 66 patients (7.2%). No patient required medical intervention for the bradycardia or developed clinical symptoms. There was no association of bradycardia with the intra-operative administration of dexmedetomidine (8.9% of patients who received dexmetomidine vs. 9.4% who did not). In multivariable analysis, bradycardia was more common among older patients, with the administration of topical or injected lidocaine, and with specific associated procedures (inferior turbinate coblation with out-fracture or direct laryngoscopy and bronchoscopy).ConclusionThe increased incidence of asymptomatic bradycardia in our post-adenotonsillectomy patients seemed to relate more to increased utilization of postoperative cardiac telemetry, and did not appear associated with the use of dexmedetomidine use intra-operatively.



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Clinical role of vitamin D in prognosis of otitis media with effusion

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Fatih Alper Akcan, Yusuf Dündar, Hümeyra Bayram Akcan, Ahmet Uluat, Derya Cebeci, Mehmet Ali Sungur, İlhan Ünlü
ObjectiveTo investigate the clinical role of Vitamin D in prognosis of Otitis media with effusion.MethodsThis prospective-controlled study was conducted at otolaryngology department in Duzce University, Turkey. The study group comprised children who were diagnosed with Otitis media with effusion between September 2016 and February 2017. Control group was conducted with children underwent circumcision or inguinal hernia repair operations that confirmed with ENT examination they do not have any sign of otitis media. After 3 months of follow-up without any treatment, unresolved cases who were accepted as chronic otitis media with effusion were operated under general anesthesia for ventilation tube application. Study and control groups were assessed depending on the serum 25(OH)Vitamin D levels at the end of 3 months; < 15 ng/mL was accepted as vitamin D deficiency. The results were compared with the control group in terms of vitamin D levels. Also, subgroup analysis was performed addressing to the complete recovery otitis media with effusion and chronic otitis media with effusion.ResultsOne-hundred-seventy-four children with otitis media with effusion and 80 control patients were included to the study. One-hundred-eight (62%) out of 174 patients with otitis media with effusion was completely recovered after a 3-months follow up. Of those 66 out of 174 children, they had persistent diseases, underwent ventilation tube insertion after a 3-months follow-up. The mean 25(OH)Vitamin D level was 18.98 ± 10.60 in otitis media with effusion group and 28.07 ± 14.10 in control group and the difference was statistically significant between the study and control group (p < 0.001). Vitamin D deficiency was observed in 33 out of 66 patients (50.0%) in chronic otitis media with effusion group whilst 35 out of 108 patients (32.4%) in complete recovery otitis media with effusion group (p = 0.021). The rate of 25(OH)Vitamin D deficiency was 25% in control group which was statistically different from chronic otitis media with effusion and recovery chronic otitis media with effusion groups (p = 0.006).ConclusionsThis study not only shows the relationship between Vitamin D and otitis media with effusion development, but also demonstrates the effects of Vitamin D on otitis media with effusion prognosis. There is a significant association between 25(OH)Vitamin D deficiency and follow-up outcomes of otitis media with effusion.



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Germinal mosaicism of PAX3 mutation caused Waardenburg syndrome type I

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Kaitian Chen, Yuan Zhan, Xuan Wu, Ling Zong, Hongyan Jiang
ObjectivesWaardenburg syndrome mutations are most often recurrent or de novo. The rate of familial recurrence is low and families with several affected children are extremely rare. In this study, we aimed to clarify the underlying hereditary cause of Waardenburg syndrome type I in two siblings in a Chinese family, with a mother affected by prelingual mild hearing loss and a father who was negative for clinical symptoms of Waardenburg syndrome and had a normal hearing threshold.MethodsComplete characteristic features of the family members were recorded and genetic sequencing and parent-child relationship analyses were performed.ResultsThe two probands were found to share double mutations in the PAX3/GJB2 genes that caused concurrent hearing loss in Waardenburg syndrome type I. Their mother carried the GJB2 c.109G > A homozygous mutation; however, neither the novel PAX3 c.592delG mutation, nor the Waardenburg syndrome phenotype, was observed in either parent.ConclusionThese previously unreported digenic mutations in PAX3/GJB2 resulted in deafness associated with Waardenburg syndrome type I in this family. To our knowledge, this is the first report describing germinal mosaicism in Waardenburg syndrome. This concept is important because it complicates genetic counseling of this family regarding the risk of recurrence of the mutations in subsequent pregnancies.



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Systematic review of knowledge of, attitudes towards, and practices for newborn hearing screening among healthcare professionals

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Rohit Ravi, Dhanshree R. Gunjawate, Krishna Yerraguntla, Bellur Rajashekhar
IntroductionThe success of newborn hearing screening programs lies in the timely identification, diagnosis, and management of children with hearing loss accomplished via a multidisciplinary newborn hearing screening (NHS) team. The team is typically comprised of various healthcare professionals who act as decision makers as well as facilitators for different stages in the screening process. Team members' knowledge of, attitudes towards, and practices for early hearing detection and intervention programs are critical for success and prevention of loss to follow up. In this context, it becomes crucial to understand their knowledge of, attitudes towards, and practices for towards newborn hearing screening.MethodsA systematic review was conducted on the following databases; PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, Science Direct and Cochrane Library. This search was carried out using various keywords such as practitioners, newborn hearing screening, knowledge, attitudes, and practices in different combinations. The review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines.ResultsA total of 271 hits were obtained of which 20 articles were found suitable for inclusion in the final review. Overall, similar results were found regarding team members' knowledge of NHS programs, regardless of country of origin. Similarly, attitudes toward NHS programs were positive. Team members' experiences with NHS programs varied from country-to-country and across healthcare professionals. Results consistently showed gaps in team members' knowledge suggesting the need for outreach and professional education programs on NHS.ConclusionNHS teams members from different countries, healthcare systems, and early hearing detection and intervention programs show gaps in critical knowledge warranting outreach and educational programs.



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Identification of two novel pathogenic compound heterozygous MYO7A mutations in Usher syndrome by whole exome sequencing

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Ying Jia, Xiaoge Li, Dong Yang, Yi Xu, Ying Guo, Xin Li
The current study aims to identify the pathogenic sites in a core pedigree of Usher syndrome (USH). A core pedigree of USH was analyzed by whole exome sequencing (WES). Mutations were verified by polymerase chain reaction (PCR) amplification and Sanger sequencing. Two pathogenic variations (c.849+2T>C and c.5994G>A) in MYO7A were successfully identified and individually separated from parents. One variant (c.849+2T>C) was nonsense mutation, causing the protein terminated in advance, and the other one (c.5994G>A) located near the boundary of exon could cause aberrant splicing. This study provides a meaningful exploration for identification of clinical core genetic pedigrees.



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The anatomic applicability of transcanal endoscopic ear surgery in children

Publication date: Available online 15 December 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Wan-Hsuan Sun, Chin-Lung Kuo, Tzu-Chin Huang
ObjectiveThe feasibility of TEES in dealing with pediatric middle ear disease is still under investigation. The goal of this study was to compare anatomical dimensions of the EAC between children and adults, and to analyze the anatomic applicability of TEES in children.MethodsForty pediatric (18 years old and younger) and 20 adult patients who received TB-HRCT to evaluate middle ear conditions were enrolled from December 2010 to December 2015. Dimensions including the diameters of the EAC orifice, isthmus and tympanic membrane annulus, the length of EAC, the height of the middle ear, and the angle between tympanic membrane and EAC axis were determined according to the TB-HRCT data.ResultsThe diameters of the EAC orifice and isthmus and length of EAC in the pediatric patients were slightly smaller than those in the adult patients. The anatomical dimensions of middle ear were similar in both groups. Simple regression analysis indicated that the diameters of the EAC orifice and isthmus and the length of the EAC were positively correlated with the age of the pediatric patients. In the pediatric patients, 67 ears (83.75%) had an EAC isthmus diameter larger than 4 mm and are sufficient with a 3-mm endoscope manipulation.ConclusionTEES is applicable for most pediatric patients using an endoscope with a diameter of 3 mm or smaller. With an appropriate endoscope and instruments, TEES is a safe and effective alternative to treat pediatric middle ear disease.



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Designing a tissue-engineered tracheal scaffold for preclinical evaluation

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Cameron A. Best, Victoria K. Pepper, Devan Ohst, Kyle Bodnyk, Eric Heuer, Ekene A. Onwuka, Nakesha King, Robert Strouse, Jonathan Grischkan, Christopher K. Breuer, Jed Johnson, Tendy Chiang
ObjectiveRecent efforts to tissue engineer long-segment tracheal grafts have been complicated by stenosis and malacia. It has been proposed that both the mechanical characteristics and cell seeding capacity of TETG scaffolds are integral to graft performance. Our aim was to design a tracheal construct that approximates the biomechanical properties of native sheep trachea and optimizes seeding with bone marrow derived mononuclear cells prior to preclinical evaluation in an ovine model.MethodsA solution of 8% polyethylene terephthalate (PET) and 3% polyurethane (PU) was prepared at a ratio of either 8:2 or 2:8 and electrospun onto a custom stainless steel mandrel designed to match the dimensional measurements of the juvenile sheep trachea. 3D-printed porous or solid polycarbonate C-shaped rings were embedded within the scaffolds during electrospinning. The scaffolds underwent compression testing in the anterior-posterior and lateral-medial axes and the biomechanical profiles compared to that of a juvenile ovine trachea. The most biomimetic constructs then underwent vacuum seeding with ovine bone marrow derived mononuclear cells. Fluorometric DNA assay was used to quantify scaffold seeding.ResultsBoth porous and solid rings approximated the biomechanics of the native ovine trachea, but the porous rings were most biomimetic. The load-displacement curve of scaffolds fabricated from a ratio of 2:8 PET:PU most closely mimicked that of native trachea in the anterior-posterior and medial-lateral axes. Solid C-ringed scaffolds had a greater cell seeding efficiency when compared to porous ringed scaffolds (Solid: 19 × 10⁴ vs. Porous: 9.6 × 10⁴ cells/mm³, p = 0.0098).ConclusionA long segment tracheal graft composed of 2:8 PET:PU with solid C-rings approximates the biomechanics of the native ovine trachea and demonstrates superior cell seeding capacity of the two prototypes tested. Further preclinical studies using this graft design in vivo would inform the rational design of an optimal TETG scaffold.



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Odontogenic tumors: Review of 127 cases in Marathwada region of Maharashtra

Atul Bhagwat, SR Barpande, JD Bhavthankar, MS Mandale, Jayanti Humbe, Preeti Singh

Journal of Oral and Maxillofacial Pathology 2017 21(3):457-458

Introduction: Odontogenic tumors (OTs) are a group of heterogeneous lesions derived from epithelial or ectomesenchymal tissues or both, which are part of the tooth-forming apparatus. They range from hamartomatous or nonneoplastic tissue proliferations to malignant neoplasms with metastatic capacity. OTs are comparatively rare, comprising about 4.79% of all oral and maxillofacial biopsy specimens diagnosed. Several retrospective studies carried out in Africa, Asia, Europe and America, show that differences exist in the relative frequency of the various histologic types. Very few studies are reported among Asians, especially from the Indian subcontinent. Hence, the present study is designed to determine the frequency of the OTs and compare them with reports of various other part of the world. Study Design: A retrospective study was carried out with the ethical clearance and permission from the authority. The histopathology records from the Department of Oral Pathology and Microbiology, within the period from January 1992 to June 2012 were obtained. A total number of OTs were analyzed for age, gender, site of the tumor and histopathological type. The odontogenic keratocyst now considered as kerato cysticodontogenic tumor (KCOT) was also included in the present study. Statistical analysis was carried out to find out the incidence of OTs according to their histopathological type, and also to find male: female ratio in various OTs. Results: Totally, 2652 tissue specimens were received for histopathologic examination out of which 127 were OTs. All these reported cases were benign except two cases of malignancy. Among these male: female ratio of 1.04:1 with an overall mandible: maxilla ratio of 1.01:1. The most common benign odontogenic tumor was KCOT (44.9%). Ameloblastomas were the second most common benign tumors (35.43%), followed by odontome (7.08%) and adenomatoid odontogenic tumor (4.72%). Age distribution showed a peak occurrence of the odontogenic tumor in the fourth decade (31.49%). Conclusion: OTs are rare lesions in the studied population and are represented mainly by the KCOT, ameloblastoma and odontoma. Data from the reviewed cases have shown a possible geographic variation of OTs. With the introduction of the KCOT in the 2005 WHO classification, this neoplasm is now one of the most prevalent OT types.

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Oral potentially malignant disorders: Revisited

Jay Gopal Ray

Journal of Oral and Maxillofacial Pathology 2017 21(3):326-327



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Screening of oral potentially malignant disorders: Need of the hour

Nadeem Jeddy, Shivani Ravi, T Radhika

Journal of Oral and Maxillofacial Pathology 2017 21(3):437-438

Oral potentially malignant disorders (OPMDs) include a variety of lesions and conditions which display an increased risk for malignant transformation to oral cancer. As the incidence and prevalence of OPMD are highly increasing in India, its early detection and prevention is the need of the hour. Early diagnosis of such disorders is necessary to prevent the malignant transformation. Many advanced diagnostic techniques are used to predict their progression and to assess the risk of malignant transformation. Management of symptoms of OPMDs is necessary for the overall well-being of the patient. This short communication provides an overview and the importance of early diagnosis and prevention of OPMDs.

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Dr. H. M. Dholakia

Rajiv S Desai

Journal of Oral and Maxillofacial Pathology 2017 21(3):328-329



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Cancer stem cells: An insight

Rohit Balwant Moharil, Alka Dive, Shubhangi Khandekar, Ashish Bodhade

Journal of Oral and Maxillofacial Pathology 2017 21(3):463-463

Cancer stem cells (CSCs) have the ability to self-renew and are present in most tissues including breast, brain, lung, head and neck, prostates, testis, ovary, esophagus, colon and liver. Their origin is yet to be discovered though a series of hypotheses have been proposed in this regard. CSCs play a role in not only the creation of cancer but also its evolution, metastasis and recurrence. CSCs have an important role in cancer therapy and the resistance toward chemotherapeutic agents. This article reviews the characteristics of CSCs in terms of origin, methods of isolation and cancer therapy.

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Oral submucous fibrosis: An update

Jay Gopal Ray, T Smitha

Journal of Oral and Maxillofacial Pathology 2017 21(3):330-331



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Estimation of silver nucleolar organizer regions in oral lichen planus, oral lichenoid reactions and oral lichenoid dysplasia

J Chandrakala, M Vidya, S Hemavathy, Sahana Srinath, T Suresh, T Satish Yadav

Journal of Oral and Maxillofacial Pathology 2017 21(3):454-454

Aims and Objective: (1) To study the clinical and histological features of oral lichen planus, oral lichenoid reaction (OLR) and oral lichenoid dysplasia (OLD). (2) To estimate and compare the silver nucleolar organizer regions in OLR and OLD. Materials and Methods: A total of 40 biopsies were studied; sections were divided as study group, which consists of OLP, OLR and OLD each of 10 cases and 10 biopsies of normal oral mucosa as control group. Sections were stained by silver staining technique and total number of silver stained nucleolar organizer regions (AgNORs ) were counted in nucleoli of 100 cells in each section under x100 objective (oil immersion). Results: Our study revealed that the difference between the (AgNOR) count of OLP (2.272 ± 0.09) and OLR (2.27 ± 0.073) is not statistically significant (P = 0.81). The mean AgNOR count of OLD (2.388 ± 0.043) compared to that of OLP (2.272 ± 0.09) and OLR (2.27 ± 0.073) showed an increase and it is statistically highly significant (P = 0.002 and P = 0.003, respectively). Conclusion: AgNOR count is an objective test, which has stronger biological basis for diagnosing epithelial dysplasia. It is easy to perform, inexpensive and is performed on biopsied specimen. However, this technique cannot differentiate OLP and OLR, as there is no much difference in the proliferative activity of cells in these two lesions. It is reasonable to suggest that all biopsy tissues from lichenoid lesions where dysplastic features are observed in routine histopathological sections should be additionally stained by silver technique to ascertain dysplastic status of the lesion. Clinical Significance: This is an improved diagnostic parameter, which will help pathologists to formulate more definitive final histopathological diagnosis and will in turn facilitate the formulation of patient treatment and follow-up care by clinicians.

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Natural killer cell: An immuno-oncology novel target for cancer therapy?

HR Shwetha, T Smitha

Journal of Oral and Maxillofacial Pathology 2017 21(3):332-333



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Quantitative assessment of silver-stained nucleolar organizer region in odontogenic cysts to correlate the growth and malignant potentiality

Sailendra Nath Biswas, RR Paul, Jay Gopal Ray, Sumit Majumdar, Divya Uppala

Journal of Oral and Maxillofacial Pathology 2017 21(3):460-461

Context: The most common and important odontogenic cyst involving jaws is the odontogenic keratocyst (OKC) or primordial cyst, the dentigerous cyst and the radicular cyst. These cysts all though do not show similar behavior, they all have the potentiality to recur. Silver nitrate staining of the nucleolar organizer regions (AgNORs) of the benign and malignant lesions is becoming very useful as a diagnostic indicator. Thus, the aim of this study is to assess the diagnostic potential of AgNORs in the cystic epithelium of common odontogenic cysts. Materials and Methods: Archived specimens of odontogenic cysts were stained with hematoxylin and eosin stain and AgNOR stain. Results: The comparative evaluation of the AgNOR counts was done among the three varieties of odontogenic cysts, i.e., radicular cysts, dentigerous cysts and OKC and were observed that the mean for OKC was significantly higher than that of radicular cyst. Conclusion: Therefore, AgNor could be used as an efficient tool for comparative evaluation of microscopic features such as epithelial thickness, surface keratinization and mural proliferation in dentigerous cyst to that of the AgNOR count.

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Correlation of salivary glucose level with blood glucose level in diabetes mellitus

Shreya Gupta, Meghanand T Nayak, JD Sunitha, Geetanshu Dawar, Nidhi Sinha, Neelakshi Singh Rallan

Journal of Oral and Maxillofacial Pathology 2017 21(3):334-339

Background: Saliva is a unique fluid, which is important for normal functioning of the oral cavity. Diabetes mellitus (DM) is a disease of absolute or relative insulin deficiency characterized by insufficient secretion of insulin by pancreatic beta-cells. The diagnosis of diabetes through blood is difficult in children, older adults, debilitated and chronically ill patients, so diagnosis by analysis of saliva can be potentially valuable as collection of saliva is noninvasive, easier and technically insensitive, unlike blood. The aim of the study was to correlate blood glucose level (BGL) and salivary glucose level (SGL) in DM patients. Methodology: A cross-sectional study was conducted in 120 patients, who were categorized as 40 controlled diabetics, 40 uncontrolled diabetics and 40 healthy, age- and sex-matched individuals constituted the controls. The blood and unstimulated saliva samples were collected from the patients at the different intervals for fasting, random and postprandial levels. These samples were then subjected for analysis of glucose in blood and saliva using glucose oxidase/peroxidase reagent in HITACHI 902(R) Automatic analyzer, and the results were recorded. Results: The mean SGLs were higher in uncontrolled and controlled diabetic groups than in nondiabetic group. A highly statistically significant correlation was found between fasting saliva glucose and fasting blood glucose in all the groups. Conclusion: With increase in BGL, increase in SGL was observed in patients with diabetes suggesting that SGL can be used for monitoring glycemic level in DM.

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Giant-cell fibroma: Understanding the nature of the melanin-laden cells

Spoorti Kulkarni, Chetana Chandrashekar, Ranjani Kudva, Raghu Radhakrishnan

Journal of Oral and Maxillofacial Pathology 2017 21(3):429-433

Giant-cell fibroma is a localized, benign fibrous mucosal mass, which clinically mimics any other fibroepithelial growth, and its distinction from other lesions is on the basis of its peculiar histopathology. A case of giant-cell fibroma with stroma strewn with brown pigment-laden cells is presented herewith. Immunohistochemical staining aided with histochemical reaction to understand the origin of these cells was carried out. Various mechanisms that explain the presence of melanin granules in reactive lesions of giant-cell fibroma is discussed in the present report.

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Curcuma longa extract – Haldi: A safe, eco-friendly natural cytoplasmic stain

Hema Suryawanshi, Rupali Naik, Pramod Kumar, Rolly Gupta

Journal of Oral and Maxillofacial Pathology 2017 21(3):340-344

Background: Eosin is most widely used synthetic dye belonging to the xanthene group. These dyes are efficient but are hazardous to human and animal health. With the increasing awareness of a green earth, it is advisable to use more of eco-friendly and biodegradable material which can be effectively achieved by the use of natural dyes obtained from plants and other natural sources. Turmeric, available as Curcuma longa (domestic), has long been in use in the subcontinent as a spice and flavoring agent in most food preparations. Its health benefit as a natural antibiotic and anti-inflammatory has been successfully established by several researchers. The intense yellow color imparted by turmeric inspired us to explore its efficacy as a potential alternative for eosin in routine histopathological procedures. Aim: The aim of this was to explore the efficacy of turmeric extract as a stand-alone counterstain for hematoxylin and its comparative assessment with routine H and E staining. Materials and Methods: The rhizomes of C. longa were cut into small pieces, dried and milled. This powder was dissolved into alcohol and centrifuged using a centrifugal machine. The supernatant was then collected with the help of micropipette. This supernatant was used as a counterstain for hematoxylin. Results: The data were analyzed using Mann–Whitney U test with Statistical Package for the Social Sciences version 15.0 (SPSS Inc.,). The P value obtained was statistically insignificant (P > 0.05). Conclusion: Although eosin is the most efficient counterstain for hematoxylin, turmeric can also be used as an alternative for eosin.

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A comparative study of three commonly used two-dimensional overlay generation methods in bite mark analysis

Nilufer Gev Pajnigara, Apeksha S Balpande, Mukta B Motwani, Anuraag Choudhary, Samantha Thakur, Natasha G Pajnigara

Journal of Oral and Maxillofacial Pathology 2017 21(3):442-446

Aim: The present study attempts to compare the bite mark overlays generated by three different methods. The objectives of the study were to compare the three commonly used techniques for overlay generation and to evaluate the interobserver reliability in assessing bite marks by these methods. Materials and Methods: Overlays were produced from the biting surfaces of six upper and six lower anterior teeth of 30 dental study models using the following three methods: (a) Hand tracing from wax impressions, (b) radiopaque impression method and (c) computer-based method. Results: The computer-based method was found to be the most accurate method. Of the two hand tracing methods, radiopaque wax impression method was better than the wax impression method for overlay generation. Conclusions: It is recommended that forensic odontologists use computerized method, but the use of hand tracing overlays in bite mark comparison cases using radiopaque wax impression method can also be done where sophisticated software and trained persons in forensic odontology are not available.

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The effect of fluorosis on human teeth under light microscopy: A cross-sectional study

Maya Ramesh, Malathi Narasimhan, Ramesh Krishnan, Rita Mary Aruna, Sarah Kuruvilla

Journal of Oral and Maxillofacial Pathology 2017 21(3):345-350

Background: Fluoride is needed for the normal development of bone and teeth; in high levels, it affects developing teeth and bone. Dental fluorosis (DF) is caused by ingestion of excess fluoride mainly through drinking water. Aim: The present study aims to observe and understand the histological changes of fluorosed teeth under light microscope (LM). Materials and Methods: Teeth which were indicated for extractions for orthodontic or periodontal problems were selected. Thirty extracted teeth were selected with varying degrees of DF based on modified Dean's fluorosis index. Ground sections of these teeth were prepared and the sections were studied under binocular LM. Photomicrographs were taken under high power objective using 15 megapixels Nikon camera. Results and Conclusion: Qualitative histologic changes in different grades of fluorosed teeth were evaluated in enamel, dentin, cementum and between their junctions. Fluoride interacts with enamel in both mineral phases and organic macromolecules by strong ionic and hydrogen bonds resulting in incomplete crystal growth at prism peripheries. This presents as hypomineralization of enamel and dentin, increased interglobular dentin, increased secondary curvatures and changes in cementum such as diffuse cementodentinal junction and increased thickness of Tomes' granular layer. Changes in the structure of the teeth with Dean's index below 2 and teeth with Dean's index of 2 and above were compared using Chi-square test. P value was found to be highly significant being 0.00047. Many of the features of dental fluorosis seen in the present study under light microscope are comparable to those results studied under specialized microscopes.

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Influence of risk factors on patients suffering from potentially malignant disorders and oral cancer: A case–control study

Vidya Kadashetti, KM Shivakumar, Minal Chaudhary, Swati Patil, Madhuri Gawande, Alka Hande

Journal of Oral and Maxillofacial Pathology 2017 21(3):455-456

Background: Tobacco use can alone lead to death worldwide, especially in developing and underdeveloped countries. China and Brazil are the world's largest producer of tobacco. India holds the third place in producing, and it is the fourth largest consumer of tobacco and its products in the world. Objectives: A case–control study was carried out to assess the influence of risk factors on patients with potentially malignant disorders (PMD) and oral cancer. Materials and Methods: Fifty cases diagnosed with PMD and oral cancer patients were selected for the study. An equal number 50 healthy controls who were also selected after age and gender matching. Multivariate logistic regression analysis was used to estimate the suspected risk factors for PMD and oral cancers. Chi-square test, Adjusted odd's ratios with 95% confidence interval were also used for the statistical analysis. Results: There is a statistically significant difference between the different age group, duration, frequency, exposure time, and synergistic effect of tobacco chewing, smoking and alcohol drinking. Conclusions: Chewing tobacco is one of the major risk factors in the initiation of PMD which can lead to oral cancer.

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Oral candidiasis: A retrospective study of 276 Brazilian patients

Henrique Cortes Meira, Bruna Mascarenhas De Oliveira, Igor Figueiredo Pereira, Marcelo Drumond Naves, Ricardo Alves Mesquita, Vagner Rodrigues Santos

Journal of Oral and Maxillofacial Pathology 2017 21(3):351-355

Background: Although oral candidiasis (OC) is a very common fungal infection of oral cavity, clinical features of affected patients and their demographic profile are not well documented. Objective: The objective of the study was to assess the demographic profile of patients diagnosed with OC and its clinical features in an import Brazilian center of oral and maxillofacial pathology. Materials and Methods: A retrospective study consisted of 276 patients diagnosed with OC by cytopathology Periodic Acid-Schiff (PAS) staining, during the period of 20 years. The variables related to patients were gender, age and skin color. Regarding infection, the data collected were location, color, symptoms, early manifestation, or recurrent and associated factors. Results: Male and female were equally affected, and the median age was 43 years. The majority of lesions were of primitive origin, asymptomatic and affecting only one site of oral cavity. The most affected site was the palate followed by tongue. More than a half of the patients (56.2%) had red lesions. The main associated factors related were the use of removable prostheses, bone marrow transplantation and AIDS. Conclusions: OC affects predominantly adults and elderly, without difference between sex and skin color. Although clinical findings are crucial, cytopathology tests are important complementary examinations to reach a definitive diagnosis. PAS staining seems to be more used in cases of erythematous candidiasis since white lesions are easier to diagnose clinically.

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A comparative study of odontogenic keratocyst and orthokeratinized odontogenic cyst using Ki67 and α smooth muscle actin

Vinay Kumar Dandena, Satish Yadava Thimmaiah, Mohammad Asif Kiresur, Prahlad Hunsigi, Swathi Roy, M Rashmi

Journal of Oral and Maxillofacial Pathology 2017 21(3):458-459

Aim: This study aimed to demonstrate and evaluate the expression of stromal myofibroblasts (MFs) and epithelial cell proliferation using α-smooth muscle actin (α-SMA) and Ki67 markers, respectively, in odontogenic keratocyst (OKC) and orthokeratinized odontogenic cyst (OOC) to correlate their aggressive behavior. Materials and Methods: Twenty cases of OKC and twenty cases of OOC were stained with α-SMA and Ki67 markers for demonstration of stromal MFs and epithelial cell proliferation, respectively, and ten cases of well-differentiated squamous cell carcinoma were used as positive control. Assessment of the number of α-SMA-positive stromal cells and Ki67-positive epithelial cells determined by MFs and proliferative epithelial cell frequency in 10 high-power fields (×400) was presented as the mean number of positive cells per field. Statistical Analysis: Kruskal–Wallis and Mann–Whitney test were used to analyze the difference in the mean number of α-SMA- and Ki67-positive cells per field between OKC and OOC. Results: The mean number of positively stained cells for α-SMA and Ki67 is significantly higher in OKC compared to OOC. Conclusion: Impression is that, the different behaviors of these two entities are compatible with their immunohistochemical view. The high value of stromal MFs and proliferative epithelial cells in OKC in comparison to OOC indicates its aggressiveness and potential for recurrence.

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Prevalence of nasal carriers of methicillin-resistant Staphylococcus aureus among dental students: An in vivo study

N Hema, N Sunil Raj, ED Chaithanya, Rashmi Chincholi, M Iswariya, KN Hema

Journal of Oral and Maxillofacial Pathology 2017 21(3):356-359

Aim: The aim of this study is to evaluate the prevalence of nasal carriage of coagulase positive methicillin-resistant Staphylococcus aureus (MRSA) among dental students. Materials and Methods: Four hundred dental students, divided into two groups – undergraduates (200) and postgraduates (200), were screened using sterile cotton swabs for carriage of MRSA in anterior nares. The samples were inoculated on HiCrome MeReSa Agar Base-with cefoxitin supplement. Further confirmatory tests were done by Gram-staining, Tube coagulase and Cefoxitin disc diffusion test on Mueller–Hinton agar. Results: MRSA was positive among 25 (12.50%) undergraduates and 49 (24.50%) postgraduates students. Further confirmatory test also showed the same results. MRSA colonization was significantly more in postgraduate students, who are exposed to more number of patients and have put in more clinical hours as compared to undergraduate students who have just entered clinics and have limited clinical exposure. Conclusion: The present study concluded that rate of MRSA colonization was 18.5% in the dental school population. The colonization rate was significantly (P = 0.002%) higher in postgraduate students as compared to undergraduate students emphasizing the need to follow infection control protocols stringently. Clinical Significance: Awareness about MRSA among dental doctors is mandatory so as to prevent transmission of MRSA in dental settings.

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Immunoexpression of programmed cell death 4 protein in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma

Karishma M Desai, Alka D Kale

Journal of Oral and Maxillofacial Pathology 2017 21(3):462-462

Background: Oral squamous cell carcinoma (OSCC) is the frequently reported cancer of the head and neck. Recent studies are being conducted to evaluate the role of potential markers for diagnosing the stages of development of OSCC from normal cells. Aim: The aim of this study is to evaluate and compare the immunoexpression of programmed cell death 4 (PDCD4) protein in normal oral mucosa, oral epithelial dysplasia (OED) and OSCC. Materials and Methods: Histologically diagnosed, formalin-fixed paraffin-embedded archived cases (n = 100) of normal mucosa (n = 10), OED (n = 60) and OSCC (n = 30) were analyzed immunohistochemically in the present retrospective study using monoclonal rabbit antihuman PDCD4. OED and squamous cell carcinoma were graded according to the World Health Organization and Broder's histological grading criteria, respectively. Clinical parameters and immunohistochemical results were analyzed by Fisher exact test using SPSS software. P <0.05 was indicative of significant differences. Results: PDCD4 expression was observed in the normal oral mucosa, OED and OSCC. The maximum expression was observed in the normal oral mucosa, which reduced significantly in OED and OSCC (P = 0.017). With the increase in the transformation from normal cells to cancer cells, a shift from nuclear to cytoplasmic staining was observed indicating predominant cytoplasmic localization of stain as a feature of altered cells. Conclusion: The present study delineates the molecular difference between the normal, dysplastic and carcinomatous cells; and points toward the role of PDCD4 localization in the proliferation of cells. This study thus highlights the need for further research with inclusion of long follow-up period and other pathological criteria such as inflammation and microenvironment, immune status of patient and tumor stage, which could aid in the development of prospective diagnostic options.

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Quantitative and qualitative assessment of argyrophilic nucleolar organizer regions in normal, premalignant and malignant oral lesions

Buddhdev P Khushbu, Monali Chalishazar, Hemant Kale, Malay Baranwal, Tapan Modi

Journal of Oral and Maxillofacial Pathology 2017 21(3):360-366

Aim: The aim of the study was to assess the cell proliferation and biologic aggressiveness of the lesions by evaluating the significance of number and dispersal pattern of Argyrophillic Nucleolar organizing Regions (AgNORs) using silver colloid technique in normal mucosa, premalignant and malignant lesions. Settings and Design: In-vitro study, lab setting Methods and Material: The study sample consisted of five groups each with a sample size of 10 and a control group. Group I (Control), Group II (Oral Submucous Fibrosis - Mild dysplasia), Group III (Oral Submucous Fibrosis - Moderate dysplasia), Group IV (Leukoplakia - Mild dysplasia), Group V (Leukoplakia - Moderate dysplasia) and Group VI (Squamous cell carcinoma). Two sections were cut, of which one was stained with H/E stain for histopathological analysis and the second one with Silver nitrate for AgNOR counting and grading. The data obtained were analyzed both qualitatively and qualititavely. Statistical Analysis Used: Student's Unpaired T test and One- way ANOVA Results: The Mean AgNOR count increased in the following ascending order: i.e OSMF with mild dysplasia, leukoplakia with mild dysplasia, OSMF with moderate dysplasia, leukoplakia with moderate dysplasia and squamous cell carcinoma. Qualititatively, Type II AgNOR pattern was found to be the predominant one in all the samples. Type III AgNOR pattern was found to be increasing with the increase in the grade of dysplasia. Conclusions: AgNOR quantity is proportional to the proliferative activity of the cell and does not necessarily always indicate malignancy. It is the qualitative characteristics of AgNOR that help to differentiate the premalignant and malignant lesions.

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Tonal and morphophonological effects on the location of perceptual centers (p-centers): Evidence from a Bantu language

Publication date: March 2018
Source:Journal of Phonetics, Volume 67
Author(s): Kathryn Franich
Perceptual centers (or 'p-centers') correspond to the perceptual moment of occurrence of a syllable or word, and are crucial in the perception of speech rhythm. A metronome alignment task was used to investigate how tone and prenasalization—two elements which affect speech timing and which also interact acoustically—influenced p-center location in Medʉmba, a Grassfields Bantu language. Plain CV words bearing low tones were found to have p-centers which were later (farther from consonant releases and closer to vowel onsets) than those bearing high tones, but the observed effect was not present in prenasalized words. We attribute this difference to the effects of tone depression and slope leveling in prenasalized forms. While prenasalization generally led to earlier p-centers (mirroring effects found for onset clusters in other languages), forms with morphologically-derived prenasal onsets behaved more like plain CV forms, suggesting that nasal prefixes do not contribute to p-center timing. Our findings for derived prenasal sequences parallel similar articulatory findings for languages with simplex onset coordination, where consonant 'clusters' actually behave as separate timing units.



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