Changes in the occlusal function of orthognathic patients with vertical malformations after combined orthodontic surgical therapy: a prospective clinical study

alexandrossfakianakis shared this article with you from Inoreader Changes in the occlusal function of orthognathic patients with vertical malformations after combined orthodontic surgical therapy: a prospective clinical study via International Journal of Oral and Maxillofacial Surgery via MedWorm.com The aim of this study was to assess the changes in occlusal patterns during combined surgical and orthodontic therapy in patients with vertical jaw malformations. Twenty-six orthognathic patients (18 female, eight male; median age 25 years, interquartile range 11.5 years) and 10 control patients (five female, five male; median age 29.8 years, interquartile range 13.5 years) recruited from neutral configured patients attending the Department of Orthodontics, were investigated. Based on cephalometry, the patients were grouped into vertical skeletal configurations of either open, deep, or natural bite cases. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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“Inhaled Zanamivir versus Oral Oseltamivir to Prevent Influenza-related Hospitalization or Death: A Nationwide Population-based Quasi-experimental Study”

alexandrossfakianakis shared this article with you from Inoreader Response to "Inhaled Zanamivir versus Oral Oseltamivir to Prevent Influenza-related Hospitalization or Death: A Nationwide Population-based Quasi-experimental Study" via Clinical Infectious Diseases Advance Access to the editor—In their recent article, Su et al compared the effectiveness of inhaled zanamivir and oral oseltamivir for influenza patients in a quasi-experimental cohort study using population-based National Health Insurance Research Database [1]. They found that prescribing zanamivir for clinically diagnosed influenza patients within 48 hours was not inferior to oseltamivir in terms of the risk of subsequent influenza-related hospitalization and death. In addition to the limitations mentioned by the authors, we would like to share some ideas regarding the study design as well as further investigations that would be of interest to the readers. View on Web

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‘Reduced Cell Surface Levels of C-C Chemokine Receptor 5 and Immunosuppression in Long Coronavirus Disease 2019 Syndrome’

alexandrossfakianakis shared this article with you from Inoreader Response to 'Reduced Cell Surface Levels of C-C Chemokine Receptor 5 and Immunosuppression in Long Coronavirus Disease 2019 Syndrome' via Clinical Infectious Diseases Advance Access to the editor—Gaylis et al offer "an unexpected mechanism of abnormal immune downmodulation in some persons that is normalized by leronlimab" [1]. The disclosure of a public statement [2] and a Warning Letter [3] on leronlimab (PubChem SID 384585377) by the Food and Drug Administration (FDA) is appropriate. Gaylis et al offer no biostatistical methods but cite the clinical trial record. Using the Supplementary Data provided by Gaylis et al [1] with nonparametric Wilcoxon signed ranked test for change (Weeks 8–0), the 2-sided P-values for Figure 1A are .003 (leronlimab) and .0139 (placebo) and for Figure 1B are .0002 (leronlimab, Improving), .7344 (leronlimab, not improving), .0640 (placebo, not improving), and .1272 (placebo, not improving). Paired t-test results were not meaningfully different. Reporting nonsignificance (NS) for the latter 2 P-values with the given sample sizes is not advised, but the NS for placebo (Figure 1A) is significant and affects the conclusion. They do not define "responder" or state if the definition was made a priori. Some of the symptoms may not be independent (eg, cough/sore throat, headache/sleep disturbance) so using them all to generate a "responder" score should be explained. They fail to provide a mechanism of action or gene expression results to explain how a monoclonal antibody to CCR5, a G-protein-coupled receptor (GPCR), might increase the proportion of CD45+/CCR5+ T cells relative to total cell counts or increase expression of CCR5 in T cells. The authors should report the time between positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test and enrollment, duration of COVID-19 infection, re-exposure to SARS-CoV-2, especially to variants different from the original infecting viruses, other factors that affect immune responses, distribution of severity of COVID-19 among the treatment groups, the results by age and sex, the receptor occupancy, and the potential effects of the half-life of leronlimab. Galanti and Shaman [4] report multiple (re-)infections per year in the same subjects with other coronaviruses. Lee et al [5] reported that "granulocyte macrophage colony-stimulating factor caused a marked decrease of CXCR4 (from ∼5000 ABS to <500) while up-regulating CCR5 expression (from ∼5000 to ∼20 000 ABS)." Jacobson et al [6] reported 'mean terminal half-lives (PRO 140 Serum Concentration) were 3.4 and 3.7 days, but Yang et al [7] suggested an "estimated half-life of about 10 days." With T-cell proliferation and the potential increase in CCR5 expression, the half-life and receptor occupancy need to be appropri ately addressed in different patient populations. Roche and Futura state that "plasma membrane of eukaryotic cells is constantly being internalized" [8]; how long a 146.7 kDa [9] antibody bound to the 62 kDa [10] transmembrane CCR5 (NP_001381712.1) remains at the surface or, when it is internalized, whether it is trafficked back to surface or to the lysosomes is of interest. T-cell exhaustion [11] could help explain the results; with small sample sizes, imbalances can occur so duration, sev erity, and time from PCR test for each patient is important. Finally, genotypes of CCR5, which may affect binding of leronlimab, and of the ligands of CCR5, such as CCL3L1 with copy number variants [12], and any antidrug antibodies (ADA) against leronlimab would help elucidate this finding. View on Web

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Pediatric Button Battery Injuries—Current State and What’s Next?

alexandrossfakianakis shared this article with you from Inoreader Pediatric Button Battery Injuries—Current State and What's Next? via JAMA Otolaryngology–Head & Neck Surgery Current Issue The study by Philteos et al in this issue of JAMA Otolaryngology–Head & Neck Surgery is a systematic review of published cases of airway injury among pediatric patients who ingested button batteries (BBs). Although these types of severe complications associated with BB ingestion have been previously reported, to date this is the largest review focused on airway injuries. Given the direct proximity of the esophagus and the trachea, airway injury is a possible risk in cases of BB ingestion. The authors' review of the literature and data from the National Capital Poison Center (NCPC) database yielded 195 cases total. The mean age at BB ingestion was 17.8 months, and the mean time between ingestion and removal was 5.8 days. The duration of impaction is difficult to precisely determine because many ingestions are unwitnessed and have a delayed diagnosis. Button batteries at least 20 mm in diameter (with lithium chemistry) are more likely to become impacted in the pediatric esophagus, but smaller BBs (including those with nonlithium chemistry) also pose a substantial risk; 11% of the injury cases with known BB diameters in this report involved BBs smaller than 20 mm, with the smallest diameter being 10 mm. Tracheoesophageal fistula (TEF), a life-threatening complication of BB ingestion, was found to be the most common airway injury (79%). Most TEFs required surgical management, and all 14 deaths reported TEF involvement. Other airway complications found included unilateral and bilateral vocal cord paralysis, subglottic stenosis, tracheal stenosis, and tracheomalacia. The use of injury mitigation strategies before or after BB removal was not assessed in this study, which is limited by the known underreporting of these cases to any data source. This review by Philteos et al describes complications from BB ingestion s associated with airway injury, invaluably highlighting a significant source of pediatric morbidity and mortality. View on Web

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Thyroid Surgeries in Asymptomatic Patients

alexandrossfakianakis shared this article with you from Inoreader Thyroid Surgeries in Asymptomatic Patients via JAMA Otolaryngology–Head & Neck Surgery Online First In this issue of JAMA Otolaryngology−Head & Neck Surgery, Dr Sajisevi and colleagues report the findings of a retrospective analysis of 1328 patients in 16 centers in 4 countries who underwent thyroid surgery for thyroid pathology in 2019. Patients were classified by the mode of detection of the thyroid findings that led to surgery: endocrinopathic condition, patient-requested screening, clinician-screening physical examination, radiologic serendipity, diagnostic cascade, symptomatic thyroid disease, and under surveillance. The primary outcomes were the mode of detection and the proportion and size of thyroid cancers discovered in patients who were asymptomatic. The authors found that 41% of patients were asymptomatic at the time of the detection of the thyroid condition, while 34% of patients had structural thyroid symptoms at the time of detection. The remaining 25% of patients were either under surveillance for known thyroid pathology, such as thyroid nodules, or had an endocrinopathic condition, such as hyperthyroidism, hyperparathyroidism, or multiple endocrine neoplasia syndrome. Of the 1328 cases, 613 (46%) revealed thyroid cancer. The authors also found that 51% of these cancers were in asymptomatic patients, while only 30% were in symptomatic patients. Finally, the mean tumor size was significantly larger in symptomatic compared with asymptomatic patients (3.2 cm vs 2.1 cm). View on Web

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Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery

alexandrossfakianakis shared this article with you from Inoreader Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery via The Laryngoscope Objective This study investigates the impact of postoperative gabapentin on opioid consumption and pain control following endoscopic sinus surgery (ESS) and/or septoplasty. Methods Patients who underwent ESS and/or septoplasty at a single institution from 2021 to 2022 were enrolled. All patients received postoperative hydrocodone-acetaminophen for pain control. Half of the patients were also prescribed gabapentin for the first postoperative day in addition to hydrocodone-acetaminophen. Subjects completed the Revised American Pain Society Patient Outcome Questionnaire 24 h and 7 days after surgery. We conducted a multivariable regression analysis to assess opioid consumption and improvement in pain scores in the first week between gabapentin and non-gabapentin groups. Results A total of 102 subjects, 51 in each arm, were enrolled. The mean age was 52 years and 53% of participants were female. Controlling for important baseline demographic, clinical, and surgically related variables, the addition of postoperative gabapentin was associated with a 44% (9.5 mg from 21.6 mg) reduction in opioids consumed in the first postoperative week (B = −9.54, 95% C.I. = [−17.84, −1.24], p = 0.025). In addition, patients in both arms exhibited similar improvement in pain severity and sleep interference in the first 7 days (B = −1.59, 95% C.I. = [−5.03, 1.84], p = 0.36). Conclusion To the best of our knowledge, this is the first study to investigate the impact of postoperative gabapentin on opioid consumption and pain control following ESS and/or septoplasty. Our analysis demonstrated that postoperative gabapentin effectively reduced opioid use during the first postoperative week without compromising pain control. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Systematic review of head and neck lymphedema assessment

alexandrossfakianakis shared this article with you from Inoreader Systematic review of head and neck lymphedema assessment via Head & Neck Abstract Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer and its treatment. However, no consensus exists on the "gold-standard" assessment tool for the purposes of diagnosis, classification, or monitoring of HNL. We conducted a systematic review of the literature regarding HNL assessment to determine the optimal method/s of assessment for patients with HNL. A review of publications between January 2000 and September 2021 was undertaken on four electronic databases. Studies were excluded if no clear assessment method of HNL was documented. Sixty-seven articles were included in the study. A wide range of assessment methods for HNL have been reported in the literature. For the purposes of diagnosis and classification of physical findings, computed tomography (CT) appears the most promising tool available for both external and internal HNL. In terms of monitoring, ultrasound appears optimal for external HNL, while a clinician-reported ratin g scale on laryngoscopy is the gold standard for internal HNL. Patient-reported assessment must be considered alongside objective methods to classify symptom burden and monitor improvement with treatment. View on Web

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Acute toxicity in patients treated with concurrent chemoradiotherapy with proton versus intensity‐modulated radiation therapy for nonmetastatic head and neck cancers

alexandrossfakianakis shared this article with you from Inoreader Acute toxicity in patients treated with concurrent chemoradiotherapy with proton versus intensity‐modulated radiation therapy for nonmetastatic head and neck cancers via Head & Neck Abstract Background We evaluated if proton therapy is associated with decreased acute toxicities compared to intensity-modulated radiation therapy (IMRT) in patients receiving concurrent chemoradiotherapy for head and neck cancers. Methods We analyzed 580 patients with nonmetastatic head and neck cancers. Primary endpoint was any 90-day grade ≥3 toxicity, prospectively collected and graded per CTCAEv4. Modified Poisson regression models were used. Results Ninety-five patients received proton and 485 IMRT. The proton group had more HPV-positive tumors (65.6 vs. 58.0%, p = 0.049), postoperative treatment (76.8 vs. 62.1%, p = 0.008), unilateral neck treatment (18.9 vs. 6.6%, p < 0.001) and significantly lower doses to organs-at-risk compared to IMRT group. Adjusted for patient and treatment characteristics, the proton group had decreased grade 2 dysgeusia (RR0.67, 95%CI 0.53–0.84, p = 0.004) and a trend toward lower grade ≥3 toxicities (RR0.60, 95%CI 0.41–0.88, p = 0.06). Conclusions Proton therapy was associated with significantly reduced grade 2 dysgeusia and nonstatistically significant decrease in acute grade ≥3 toxicities compared to IMRT. View on Web

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Rhinovirus persistence during the COVID‐19 pandemic – impact on paediatric acute wheezing admissions

alexandrossfakianakis shared this article with you from Inoreader Rhinovirus persistence during the COVID‐19 pandemic – impact on paediatric acute wheezing admissions via Journal of Medical Virology Abstract Rhinoviruses have persisted throughout the COVID-19 pandemic, despite other seasonal respiratory viruses (influenza, parainfluenza, respiratory syncytial virus, adenoviruses, human metapneumovirus) being mostly suppressed by pandemic restrictions, such as masking and other forms social distancing, especially during the national lockdown periods. Rhinoviruses, as non-enveloped viruses, are known to transmit effectively via the airborne and fomite route, which has allowed infection amongst children and adults to continue despite pandemic restrictions. Rhinoviruses are also known to cause and exacerbate acute wheezing episodes in children predisposed to this condition. Non-infectious causes such as air pollutants (PM2.5, PM10) can also play a role. In this retrospective ecological study, we demonstrate the correlation between UK national sentinel rhinovirus surveillance, the level of airborne particulates and the changing patterns of paedi atric emergency department presentations for acute wheezing, before and during the COVID-19 pandemic (2018-2021) in a large UK teaching hospital. This article is protected by copyright. All rights reserved. View on Web

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Dynamics of nasopharyngeal tract phageome and association with disease severity and age of patients during three waves of COVID‐19

alexandrossfakianakis shared this article with you from Inoreader Dynamics of nasopharyngeal tract phageome and association with disease severity and age of patients during three waves of COVID‐19 via Journal of Medical Virology Abstract In December 2019, several patients were hospitalized and diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which subsequently led to a global pandemic. To date, there are no studies evaluating the relationship between the respiratory phageome and the SARS-CoV-2 infection. The current study investigated the phageome profiles in the nasopharyngeal swabs collected from 55 patients during the three different waves of COVID-19 in the Campania Region (Southern Italy). Data obtained from the taxonomic profiling show that phage families belonging to the order Caudovirales have a high abundance in the patient samples. Moreover, the severity of the COVID-19 infection seems to be correlated with the phage abundance. This article is protected by copyright. All rights reserved. View on Web

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