Αρχειοθήκη ιστολογίου

Κυριακή 15 Ιανουαρίου 2023

Spontaneous Recovery Rate of Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta‐analysis

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Abstract

Purpose

Steroids comprise the mainstay of treatment for idiopathic sudden sensorineural hearing loss (ISSNHL). Since steroidal treatment was integrated to clinical practice guidelines, newly published no-treatment or placebo arms in clinical trials are scarce. To evaluate the effectiveness of steroidal treatment ± hyperbaric oxygen therapy, the data should be compared to spontaneous recovery. The aim of this paper is to find the most accurate spontaneous recovery rate, in the light of which, other treatment modalities should be judged.

Materials and Methods

Eligible studies published until July 2021 were identified through systematic searches of "PubMed", "Web of Science" and "Google Scholar". Retrospective studies and randomized/non-randomized control trials involving only adult participants (≥18 years) with ISSNHL, and placebo/no treatment were included. Only articles that used the American Academy of Otolaryngology–Head and Neck Surgery's diagnostic criteria for ISSNHL were included.

Results

942 records initially identified, 166 duplicates and 753 articles were excluded based on article subject, title, and abstract. The full texts of 13 articles were reviewed. 7 studies were included for qualitative synthesis, 5 papers included in quantitative synthesis. 180 ears were included in pooled statistics. The pooled spontaneous recovery was 60.28% (95% CI = 38.88–79.94%) with a heterogeneity of 86.0% (95% CI = 69.4–93.6%).

Conclusions

Spontaneous recovery of ISSNHL should not be over-looked, as it may be close to 60%. This may have both clinical and research implications.

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Pharmacokinetic and pharmacodynamic study of 3 products of epoetin alfa as single subcutaneous dose in healthy volunteers

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Abstract

Background

Hemax® is an epoetin alfa product developed by Biosidus S.A. in Argentina at the end of the 1980's and has been present in that market since 1991. The initial presentation was a lyophilized powder containing albumin as stabilizer, to best adapt to environmental conditions in developing countries; more recently, a prefilled syringe, albumin-free presentation was developed, since this presentation has become the preferred standard in many markets.

Objective

The primary objective was to compare the pharmacokinetic profile of different formulations of epoetin alfa after a single subcutaneous administration to healthy volunteers of 40,000 IU of Eprex/Erypo® and Hemax® PFS.

Methods

This clinical trial was conceived following an open label, randomized, 3-way 3-period cross-over balanced, and sequential design. The study was conducted on 24 healthy volunteers.

Results

To analyze similarity between Hemax® PFS and the innovator product, Eprex®, AUC and Cmax of both products have been compared. The 90%CI lower limit for the geometric mean ratios was higher than 80% for any comparisons and the 90%CI upper limit for these geometric ratios was below 125% for all the comparisons made, thus demonstrating equivalence between both products.

Conclusion

The comparison between Hemax® PFS and Eprex® resulted in similar 90%CI for Cmax, AUC(0-120 h) and AUC(0-inf) ratios, all of them within the 80-125% interval, with a power above 95% for each ratio. These findings suggest biosimilar patterns for absorption velocity (with Tmax close to 15 h), absorption extent and elimination (with an elimination half-life close to 25-30 h for each formulation)

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Defining the Optimal Duration of Therapy for Hospitalized Patients with Complicated Urinary Tract Infections and Associated Bacteremia

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Abstract
Objective
Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTI).
Methods
We conducted an observational study of patients ≥18 years at 24 United States hospitals to identify the optimal treatment duration for patients with cUTI. To increase the likelihood patients experienced true infection, eligibility was limited to those with associated bacteremia. Propensity sco res were generated for an inverse probability of treatment weighted analysis. The primary outcome was recurrent infection with the same species within 30 days of completing therapy.
Results
1,099 patients met eligibility criteria and received 7, 10, or 14 days of therapy. There was no difference in the odds of recurrent infection for 382 (46%) patients receiving 10 days and 452 (54%) patients receiving 14 days of therapy (aOR 0.99, 95% CI, 0.52-1.87). An increased odds of recurrence was observed in 265 (37%) patients receiving 7 days versus 452 (63%) patients receiving 14 days of treatment (aOR 2.54, 95% CI, 1.40-4.60). When limiting the 7-day versus 14-day analysis to the 627 patients who remained on intravenous beta-lactam therapy or were transitioned to highly bioavailable oral agents, differences in outcomes no longer persisted; aOR 0.76, 95% CI, 0.38-1.52. Of 76 patients with recurrent infections, 2 (11%), 2 (10%), and 10 (36%) in the 7, 10, and 14-day groups, respecti vely, had drug-resistant infections (p=0.10).
Conclusion
Seven days of antibiotics appears effective for hospitalized patients with cUTI when antibiotics with comparable IV and oral bioavailability are administered; 10 days may be needed for all other patients.
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Isolation and characterization of mammalian orthoreovirus from bats

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Abstract

Mammalian orthoreovirus (MRV) infects many mammalian species including humans, bats, and domestic animals. To determine the prevalence of MRV in bats in the United States, we screened more than 900 bats of different species collected during 2015 to 2019 by a real-time RT-PCR assay; 4.4% bats tested MRV-positive and 13 MRVs were isolated. Sequence and phylogenetic analysis revealed that these isolates belonged to four different strains/genotypes of viruses in serotypes 1 or 2, which contain genes similar to those of MRVs detected in humans, bats, bovine, and deer. Further characterization showed that these four MRV strains replicated efficiently on human, canine, monkey, ferret and swine cell lines. The 40/Bat/USA/2018 strain belonging to the serotype 1 demonstrated the ability to infect and transmit in pigs without prior adaptation. Taken together, this is evidence for different genotypes and serotypes of MRVs circulating in U.S. bats, which can be a mixing vessel of MRVs that may spread to other species, including humans, resulting in cross-species infections.

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Pediatric inflammatory myofibroblastic tumor of the bladder with ALK–FN1 fusion successfully treated by alectinib

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Abstract

An inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm characterized by the proliferation of myofibroblasts and inflammatory cell infiltration. Although radical resection is the only established treatment strategy for IMT, it can cause functional disorders when vital organs are affected. We describe a case of pediatric IMT of the bladder with FN1–ALK (fibronectin 1–anaplastic lymphoma kinase) fusion. Radical resection might lead to urinary disturbance due to the large tumor size at diagnosis. However, the tumor was successfully treated with alectinib, a second-generation ALK inhibitor, followed by transurethral resection of the bladder tumor without any complications.

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Automatic Dental Biofilm Detection Based on Deep Learning

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Abstract

Aim

To estimate the automated biofilm detection capacity of the U-Net neural network on tooth images.

Material and methods

Two datasets of intraoral photographs taken in the frontal and lateral views of permanent and deciduous dentitions were employed. The first dataset consisted of 96 photographs taken before and after applying a disclosing agent and was used to validate the domain's expert biofilm annotation (intraclass correlation coefficient = 0.93). The second dataset comprised 480 photos, with or without orthodontic appliances, without disclosing agents, and was used to train the neural network to segment the biofilm. Dental biofilm labeled by the dentist (without disclosing agents) was considered the ground-truth. Segmentation performance was measured using accuracy, F1 score, sensitivity, and specificity.

Results

The U-Net model achieved an accuracy of 91.8%, F1 score of 60.6%, specificity of 94.4%, and sensitivity of 67.2%. The accuracy was higher in the presence of orthodontic appliances (92.6%).

Conclusion

Visually segmenting dental biofilm employing a U-Net is feasible and can assist professionals and patients in identifying dental biofilm, thus improving oral hygiene and health.

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Baricitinib or imatinib in hospitalized COVID‐19 patients: results from COVINIB, an exploratory randomized clinical trial.

alexandrossfakianakis shared this article with you from Inoreader

ABSTRACT

Background

Baricitinib and imatinib are considered therapies for COVID-19, but their ultimate clinical impact remains to be elucidated, so our objective is to determine whether these kinase inhibitors provide benefit when added to standard care in hospitalized COVID-19 patients.

Methods

Phase-2, open-label, randomized trial with a pick-the-winner design conducted from September 2020 to June 2021 in a single Spanish center. Hospitalized adults with COVID-19 pneumonia and a symptom duration ≤ 10 days were assigned to 3 arms: imatinib (400 mg qd, 7 days) plus standard-care, baricitinib (4 mg qd, 7 days) plus standard-care, or standard-care alone. Primary outcome was time to clinical improvement (discharge alive or a reduction of 2 points in an ordinal scale of clinical status) compared on a day-by-day basis in order to identify differences ≥ 15% between the most and least favorable groups. Secondary outcomes included oxygenation and ventilatory support requirements, additional therapies administered all-cause mortality and safety.

Results

165 patients analyzed. Predefined criteria for selection of the most advantageous arm were met for baricitinib, but not for imatinib. However, no statistically significant differences were observed in formal analysis, but a trend towards better results in patients receiving baricitinib was found compared to standard care alone (HR for clinical improvement 1.41, 95%CI 0.96-2.06; HR for discontinuing oxygen 1.46, 95%CI 0.94-2.28). No differences were found regarding additional therapies administered or safety.

Conclusions

Baricitinib plus standard care showed better results for hospitalized COVID-19 patients, being the most advantageous therapeutic strategy among those proposed in this exploratory clinical trial.

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Dentine thickness in maxillary fused molars depends on the fusion type: An ex vivo micro‐CT study

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Aim

The present study aimed to determine and compare the dentine thickness around the root canals of maxillary molars with fusion using micro-computed tomography (micro-CT).

Methodology

A total of 120 fused maxillary molars having more than a single canal with distinct canal orifices near the cementoenamel junction were selected from a pool of extracted maxillary molars, which were scanned on a micro-CT device (SkyScan 1172, Bruker-microCT, Kontich, Belgium). The minimum dentine thickness around the root canals in furcal direction was measured using CTAn software (v.1.18.8 Bruker-microCT) at each millimetre. The specimens were grouped according to their fusion type, and dentine thickness around the canals was compared. The data were statistically analysed using ANOVA and post hoc Tukey-Kramer tests following an assessment of the normality of their distribution with the Kolmogorov-Smirnov test (p .05).

Results

Dentine thickness showed a statistically significant decrease at 2 mm below the orifice irrespective of fusion type. The minimum dentine thickness values were detected around the second mesiobuccal canal as 0.30 mm at 6 mm below orifice. Dentine thickness around the mesiobuccal canal significantly greater in fusion type 1 than those of types 2 and 3 (p < .05), while those of distobuccal and palatal canals were significantly thinner in type 3 fusion compared to type 1 or 6 (p < .05).

Conclusion

Minimum dentine thickness values at the danger zone of distobuccal and palatal canals change according to the fusion type in fused maxillary second molars.

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