The aim of this study was to assess viewpoints of end-users concerning the purchasing process of high-risk medical devices and to discuss the relevance of health technology assessments (HTAs) at the hospital level and other potential areas for improvement of purchasing processes.; We used a cross-sectional study and assessed the attitudes and thoughts of orthopedic specialists. The study took place between June and October 2015 in Mexico.; We collected data from 187 orthopedic surgeons. Involvement of orthopedic specialists in purchasing was reported by 86 percent. However, clinical practice was perceived as negatively influenced by purchasing outcomes by 92 percent. The problems were described as: material failure; effectiveness of medical devices; obsolete medical device technology; incomplete provision of implant / instrument sets; delayed provision of implants and instruments.; To prevent sub-standard outcomes of purchasing decisions, this study and the current literature suggest that technologies should be assessed during the purchasing process, end-users should be adequately involved, and decisions should be based on multiple criteria including clinical impact in the short-term (e.g., primary stability of implant) and long-term (e.g., survival of implant). The focus on Mexico is particularly novel and provides insights into a health system where HTA is mainly present at the macro level and can be used for the listing of medical device technologies in the standard list. This study concludes that Mexican stakeholders of the purchasing process underestimate the contribution of HTAs at the level of purchasing decisions. HTA in Mexico has improved over the past years but still requires more advancement.
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Πέμπτη 19 Οκτωβρίου 2017
Attitudes of orthopedic specialists toward effects of medical device purchasing
Estimating particulate exposure from modern municipal waste incinerators in Great Britain
Municipal Waste Incineration (MWI) is regulated through the European Union Directive on Industrial Emissions (IED), but there is ongoing public concern regarding potential hazards to health. Using dispersion modeling, we estimated spatial variability in PM10 concentrations arising from MWIs at postcodes (average 12 households) within 10 km of MWIs in Great Britain (GB) in 2003-2010. We also investigated change points in PM10 emissions in relation to introduction of EU Waste Incineration Directive (EU-WID) (subsequently transposed into IED) and correlations of PM10 with SO2, NOx, heavy metals, polychlorinated dibenzo-p-dioxins/furan (PCDD/F), polycyclic aromatic hydrocarbon (PAH) and polychlorinated biphenyl (PCB) emissions. Yearly average modeled PM10 concentrations were 1.00 × 10(-5) to 5.53 × 10(-2) μg m(-3), a small contribution to ambient background levels which were typically 6.59-2.68 × 10(1) μg m(-3), 3-5 orders of magnitude higher. While low, concentration surfaces are likely to represent a spatial proxy of other relevant pollutants. There were statistically significant correlations between PM10 and heavy metal compounds (other heavy metals (r = 0.43, p = <0.001)), PAHs (r = 0.20, p = 0.050), and PCBs (r = 0.19, p = 0.022). No clear change points were detected following EU-WID implementation, possibly as incinerators were operating to EU-WID standards before the implementation date. Results will be used in an epidemiological analysis examining potential associations between MWIs and health outcomes.
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Drug Design Workshop: A Web-Based Educational Tool To Introduce Computer-Aided Drug Design to the General Public
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Antimalarial inhibitors rargeting serine hydroxymethyltransferase (SHMT) with in vivo efficacy and analysis of their binding mode based on X-ray cocrystal structures
Target-based approaches toward new antimalarial treatments are highly valuable to prevent resistance development. We report several series of pyrazolopyran-based inhibitors targeting the enzyme serine hydroxymethyltransferase (SHMT), designed to improve microsomal metabolic stability and to identify suitable candidates for in vivo efficacy evaluation. The best ligands inhibited Plasmodium falciparum (Pf) and Arabidopsis thaliana (At) SHMT in target assays and PfNF54 strains in cell-based assays with values in the low nanomolar range (3.2-55 nM). A set of carboxylate derivatives demonstrated markedly improved in vitro metabolic stability (t1/2 > 2 h). A selected ligand showed significant in vivo efficacy with 73% of parasitemia reduction in a mouse model. Five new cocrystal structures with PvSHMT were solved at 2.3-2.6 Å resolution, revealing a unique water-mediated interaction with Tyr63 at the end of the para-aminobenzoate channel. They also displayed the high degree of conformational flexibility of the Cys364-loop lining this channel.
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3-hydroxy-N'-arylidenepropanehydrazonamides with halo-substituted phenanthrene scaffolds cure P. berghei infected mice when administered perorally
Structural optimization of 3-hydroxy-N'-arylidenepropanehydrazonamides provided new analogs with nanomolar to subnanomolar antiplasmodial activity against asexual blood stages of Plasmodium falciparum, excellent parasite selectivity, and nanomolar activity against the earliest forms of gametocyte development. Particularly, derivatives with a 1,3-dihalo-6-trifluoromethylphenanthrene moiety showed outstanding in vivo properties and demonstrated in part curative activity in the Plasmodium berghei mouse model when administered perorally.
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Urinary Tract Infection: Which Conformation of the Bacterial Lectin FimH Is Therapeutically Relevant?
Frequent antibiotic treatment of urinary tract infections has resulted in the emergence of antimicrobial resistance, necessitating alternative treatment options. One such approach centers around FimH antagonists that block the bacterial adhesin FimH, which would otherwise mediate binding of uropathogenic Escherichia coli to the host urothelium to trigger the infection. Although the FimH lectin can adopt three distinct conformations, the evaluation of FimH antagonists has mainly been performed with a truncated construct of FimH locked in one particular conformation. For a successful therapeutic application, however, FimH antagonists should be efficacious against all physiologically relevant conformations. Therefore, FimH constructs with the capacity to adopt various conformations were applied. By examining the binding properties of a series of FimH antagonists in terms of binding affinity and thermodynamics, we demonstrate that depending on the FimH construct, affinities may be overestimated by a constant factor of 2 orders of magnitude. In addition, we report several antagonists with excellent affinities for all FimH conformations.
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Antischistosomal activity of pyrido[1,2-a]benzimidazole derivatives and correlation with inhibition of beta-hematin formation
The extensive use of praziquantel against schistosomiasis raises concerns about drug resistance. New therapeutic alternatives targeting critical pathways within the parasite are therefore urgently needed. Hemozoin formation in Schistosoma presents one such target. We assessed the in vitro antischistosomal activity of pyrido[1,2-a]benzimidazoles (PBIs) and investigated correlations with their ability to inhibit β-hematin formation. We further evaluated the in vivo efficacy of representative compounds in experimental mice and conducted pharmacokinetic analysis on the most potent. At 10 μM, 48/57 compounds resulted in >70% mortality of newly transformed schistosomula, whereas 37 of these maintained >60% mortality of adult S. mansoni. No correlations were observed between β-hematin inhibitory and antischistosomal activities against both larval and adult parasites, suggesting possible presence of other target(s) or a mode of inhibition of crystal formation that is not adequately modeled by the assay. The most active compound in vivo showed 58.7 and 61.3% total and female worm burden reduction, respectively. Pharmacokinetic analysis suggested solubility-limited absorption and high hepatic clearance as possible contributors to the modest efficacy despite good in vitro activity. The PBIs evaluated in this report thus merit further optimization to improve their efficacy and to elucidate their possible mode of action.
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Public antibodies to malaria antigens generated by two LAIR1 insertion modalities
In two previously described donors, the extracellular domain of LAIR1, a collagen-binding inhibitory receptor encoded on chromosome 19 (ref. 1), was inserted between the V and DJ segments of an antibody. This insertion generated, through somatic mutations, broadly reactive antibodies against RIFINs, a type of variant antigen expressed on the surface of Plasmodium falciparum-infected erythrocytes. To investigate how frequently such antibodies are produced in response to malaria infection, we screened plasma from two large cohorts of individuals living in malaria-endemic regions. Here we report that 5-10% of malaria-exposed individuals, but none of the European blood donors tested, have high levels of LAIR1-containing antibodies that dominate the response to infected erythrocytes without conferring enhanced protection against febrile malaria. By analysing the antibody-producing B cell clones at the protein, cDNA and gDNA levels, we characterized additional LAIR1 insertions between the V and DJ segments and discovered a second insertion modality whereby the LAIR1 exon encoding the extracellular domain and flanking intronic sequences are inserted into the switch region. By exon shuffling, this mechanism leads to the production of bispecific antibodies in which the LAIR1 domain is precisely positioned at the elbow between the VH and CH1 domains. Additionally, in one donor the genomic DNA encoding the VH and CH1 domains was deleted, leading to the production of a camel-like LAIR1-containing antibody. Sequencing of the switch regions of memory B cells from European blood donors revealed frequent templated inserts originating from transcribed genes that, in rare cases, comprised exons with orientations and frames compatible with expression. These results reveal different modalities of LAIR1 insertion that lead to public and dominant antibodies against infected erythrocytes and suggest that insertion of templated DNA represents an additional mechanism of antibody diversification that can be selected in the immune response against pathogens and exploited for B cell engineering.
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Francisella requires dynamic type VI secretion system and ClpB to deliver effectors for phagosomal escape
Francisella tularensis is an intracellular pathogen that causes the fatal zoonotic disease tularaemia. Critical for its pathogenesis is the ability of the phagocytosed bacteria to escape into the cell cytosol. For this, the bacteria use a non-canonical type VI secretion system (T6SS) encoded on the Francisella pathogenicity island (FPI). Here we show that in F. novicida T6SS assembly initiates at the bacterial poles both in vitro and within infected macrophages. T6SS dynamics and function depends on the general purpose ClpB unfoldase, which specifically colocalizes with contracted sheaths and is required for their disassembly. T6SS assembly depends on iglF, iglG, iglI and iglJ, whereas pdpC, pdpD, pdpE and anmK are dispensable. Importantly, strains lacking pdpC and pdpD are unable to escape from phagosome, activate AIM2 inflammasome or cause disease in mice. This suggests that PdpC and PdpD are T6SS effectors involved in phagosome rupture.
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Jansen-MIDAS: A multi-level photomicrograph segmentation software based on isotropic undecimated wavelets
Abstract
Image segmentation, the process of separating the elements within a picture, is frequently used for obtaining information from photomicrographs. Segmentation methods should be used with reservations, since incorrect results can mislead when interpreting regions of interest (ROI). This decreases the success rate of extra procedures. Multi-Level Starlet Segmentation (MLSS) and Multi-Level Starlet Optimal Segmentation (MLSOS) were developed to be an alternative for general segmentation tools. These methods gave rise to Jansen-MIDAS, an open-source software. A scientist can use it to obtain several segmentations of hers/his photomicrographs. It is a reliable alternative to process different types of photomicrographs: previous versions of Jansen-MIDAS were used to segment ROI in photomicrographs of two different materials, with an accuracy superior to 89%.
Here we present Jansen-MIDAS, an open source segmentation software. Using ground truth images, one can train it to obtain high accuracy segmentations for an image dataset. Scientists can use it to acquire several segmentations of their photomicrographs.
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The story continues: an overview of the ‘Dissertations into practice’ feature
Abstract
The 'Dissertations into practice' feature began life in March 2012 with a dual aim: to encourage students, recent graduates and new professionals to write for publication and to highlight the impact of student research on policy and practice. This article reflects on the initiative and demonstrates that it has been extremely successful in achieving both aims. It highlights the diverse range of contributions to the feature so far and proves that student research can and does influence policy and practice. It also demonstrates that, with the right encouragement and support, students are willing and able to write for academic publication and that they gain a lot from the experience.
A. M.
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Ask the Expert: I grind my teeth. What should I do?
Dr. Jinu Kurian is a general dentist at Hamburg Family and Cosmetic Dental Group LLC. The office can be reached at 973-209-6252. A: First and foremost, you need to be evaluated by a dentist.
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Titanium or resorbable plates for orthognathic surgery
This Cochrane review compared titanium & bioresorbable fixation systems for orthognathic surgery. Only 2 RCTS were identified providing insufficient evidence to determine if titanium plates or resorbable plates are superior.
The post Titanium or resorbable plates for orthognathic surgery appeared first on National Elf Service.
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Vértigo posicional paroxístico benigno: criterios diagnósticos. Documento de consenso del Comité para la Clasificación de los Trastornos Vestibulares de la Bárány Society
Source:Acta Otorrinolaringológica Española
Author(s): Michael von Brevern, Pierre Bertholon, Thomas Brandt, Terry Fife, Takao Imai, Daniele Nuti, David Newman-Toker
Este artículo presenta los criterios diagnósticos para el vértigo posicional paroxístico benigno (VPPB) formulados por el Comité para la Clasificación de los Trastornos Vestibulares de la Bárány Society. La clasificación refleja el estado actual del conocimiento acerca de los aspectos clínicos y los mecanismos patogénicos del VPPB e incluye tanto los síndromes bien establecidos como los emergentes. Se presupone que el conocimiento progresivo de la enfermedad conducirá a un desarrollo adicional de esta clasificación.This article presents operational diagnostic criteria for benign paroxysmal positional vertigo (BPPV), formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society. The classification reflects current knowledge of clinical aspects and pathomechanisms of BPPV and includes both established and emerging syndromes of BPPV. It is anticipated that growing understanding of the disease will lead to further development of this classification.
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Acute-onset diplopia in a case of nephrotic syndrome
Description
A 12-year-old boy was evaluated in our emergency services for complaints of diplopia and mild generalised headache since past 4 days. The patient was a known case of frequently relapsing idiopathic nephrotic syndrome and was currently in remission since 5 days. He was normal and oriented on general physical and systemic examination. Urine microscopy had revealed only traces of protein on repeated evaluation, and serum albumin was 2.2 g/dL on presentation. Visual acuity was 6/6 in both eyes, and the pupillary reflexes were brisk. The ocular motility examination revealed an esotropia of 20 prism dioptres (figure 1A) along with limitation of the abduction movements in both eyes (figure 1B,C). However, right eye showed a greater limitation compared with left eye. Anterior segment of both the eyes were normal, but the fundus examination revealed bilateral severe established optic disc oedema (figure 2A,B). The...
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A case of autosplenectomy associated with T-cell checkpoint inhibitor treatment
Description
A 77-year-old Caucasian man presented to the oncology service with de novo v-raf murine sarcoma viral oncogene homolog B (BRAF), wild-type metastatic melanoma and widespread disease involving; subcutaneous fat, lymph nodes, bone and spleen with no history of autoimmunity. At diagnosis, the spleen was measured within normal limits on CT. In November 2013, he commenced treatment on a phase-III randomised double-blinded clinical trial (CA209-067) and received combination checkpoint inhibitor therapy with ipilimumab and nivolumab.
Radiological mixed response was observed after three months, with a partial response in all target lesions (RECIST V.1.1 criteria) but an increase in the size of the non-target splenic metastasis consistent with pseudoprogression. In conjunction, splenic enlargement was demonstrated (figure 1).
Figure 1
Subsequent restaging coronal abdominopelvic CT demonstrating an increased splenic length of 11.8 cm.
After seven months of immunotherapy, he achieved a complete radiological response to treatment with an...
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Non-infectious aortitis in an immunosuppressed renal transplant recipient with IgA nephropathy
A 54-year-old woman presented with atypical chest pain, fever and malaise. She was immunosuppressed with three agents following a living-donor kidney transplant 1 year previously. Her native kidney failure was secondary to biopsy-demonstrated crescentic IgA nephropathy, with systemic involvement. A CT pulmonary angiogram revealed an inflammatory cuff of soft tissue around the descending thoracic aorta suggesting aortitis. Inflammatory markers were elevated. Given her immunosuppression, the patient was screened extensively for infective causes and was empirically commenced on intravenous meropenem. After 72 hours of no clinical or serological response to antibiotic therapy, negative microbiological investigations and worsening inflammation on serial imaging, she was commenced on high-dose methylprednisolone for presumed inflammatory aortitis. Symptoms and inflammatory markers rapidly normalisedand the patient was discharged home on oral prednisolone. A clinical diagnosis of IgA-related aortitis was made. Imaging 3 months later showed complete resolution of the aortitis.
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Learning from errors: unnecessary intensive care unit admissions
An elderly man was transferred to our emergency department with reported ventricular tachycardia requiring intravenous amiodarone and intensive care unit admission. Device interrogation, the following day, revealed only frequent premature ventricular contractions and non-sustained ventricular tachycardia in a patient with a known history of these conditions. The patient underwent unnecessary invasive monitoring after being emergently transferred to our facility and admitted to the intensive care unit. Fortunately, our patient did not suffer any unwarranted side effects from intravenous amiodarone. This case reports on some negative consequences of inappropriate intensive care unit admissions and how they could have been avoided.
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Giant meningioma in skull radiograph
Description
A 35-year-old woman presented to peripheral hospital with loss of consciousness, urine incontinence and behavioural changes. The family noticed her impulsiveness and irritability 2 months prior to her presentation to the emergency department. No history of fever, vomiting, trauma or seizures. She was transferred to our hospital and on arrival, she was confused, with normal cranial nerve examination and equally reactive pupils. She had marked weakness in right upper and lower limbs. Because intracranial lesion was suspected, a lateral skull X-ray and a CT scan were done which revealed a large left frontal extra-axial calcified lesion with enlarged meningeal artery grooves (see figure 1 for the X-ray and figure 2 for the sagittal MRI). The patient underwent craniotomy and total removal of the meningioma with total weight of 347 g with pathological feature of psammomatous meningioma, WHO grade 1 (figure 3).1 She tolerated...
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Result of Health Illiteracy and Cultural Stigma: Fourniers Gangrene, a Urological Emergency
A 63-year-old Caucasian man presents to his regional hospital 8 days postinsertion of beads in his urethra, causing Fournier's gangrene of the penis and delayed surgical management of his gangrene. The reasons for his delay are cultural stigma associated with sexual practices and health illiteracy.
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Anaesthesia and orphan disease: airway and anaesthetic management in Huntingtons disease
We present a case that highlights the issues surrounding the delivery of a safe general anaesthetic to a patient with Huntington's disease (HD) and bulbar dysfunction. In the case of a 46-year-old patient undergoing laparoscopic percutaneous endoscopic gastrostomy tube insertion, we discuss the rationale behind our chosen method and anaesthetic agents as well as airway issues specific to HD. In a patient whose condition would not allow for an awake fibreoptic intubation, we opted for a modified rapid sequence induction. Special considerations were made with regard to muscle relaxation given the complications associated with inadequate paralysis and reversal in patients with HD. The technique we describe may also apply to other patient categories, such as patients with movement disorders, bulbar dysfunction and dementia.
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Rare presentation of an old bug
We highlight a rare presentation of Legionella infection in a 77-year-old woman with a clinical diagnosis of giant cell arteritis 2 months prior to presentation. She was started on 60 mg prednisone that was tapered to 10 mg after 4 weeks following her diagnosis. She presented with a 1-month progressive dyspnoea in the absence of any other symptoms. Her exposure history was significant only for a recent trip to Florida where she stayed at a hotel. Initial laboratory workup was significant for hyponatraemia (127 mmol/L). Workup including bronchoalveolar lavage (BAL) and induced sputum for gram stain, acid fast stain and bacterial culture were negative for Pneumocystis jirovecii pneumonia and other opportunistic infectious agents. However, BAL was positive for Legionella pneumophila via PCR that was confirmed by a positive urinary Legionella antigen. The patient received treatment with levofloxacin that led to full resolution of her symptoms.
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Unusual cause of saddle nose
Description
A 53-year-old female presented with a 2-week history of shortness of breath, cough and fever. Over the past 6 months, she reported painful tongue ulcers and pain in her nose, accompanied with nasal crusting and yellowish discharge. She had a history of pulmonary coccidioidomycosis, diagnosed 10 years ago, and she was treated with antifungal regimen. Physical examination revealed rhonchi bilaterally, multiple shallow ulcerative lesions on her tongue and a saddle nose deformity (figure 1A). CT of the chest demonstrated extensive ground-glass opacities with areas of nodular consolidation. Given her symptoms and history of coccidioidomycosis, nasal cavity biopsy was performed that revealed focal ulceration, non-specific inflammation with many cocci spherules, confirmed by Grocott's methenamine silver stain (figure 1B). Cultures from the lesions and the sputum grew Coccidioides immitis. Treatment with fluconazole 400 mg daily was initiated, and after several days her symptoms improved.
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Gentamicin-vancomycin-colistin local antibiotherapy in a cement spacer in a 54-year-old haemophilic patient with relapsing plurimicrobial severe prosthetic joint infection
Description
A 54-year-old patient with haemophilia and hepatitis C virus infection experienced acute left prosthetic joint infection due to Klebsiella pneumoniae and Staphylococcus aureus following unipolar exchange in September 2015. As the outcome was not favourable with bloody discharge despite haemophilic factor substitution, a new local debridement was performed in May 2016 and multidrug-resistant Enterobacter asburiae (only susceptible to imipenem, colistin, amikacin and fosfomycin) and Corynebacterium striatum (only susceptible to vancomycin, rifampin and linezolid) grew in cultures. As explantation was considered too risky due to the potential bleeding, systemic intravenous treatment was proposed with imipenem (3 g/day), vancomycin (2.5 g/day) and fosfomycin (12 g/day). After 3 months of therapy, the bloody discharge persisted. One month after discontinuation of antibiotics, the patient presented a large 'bourgeon charnu' with impressive bloody discharge (figure 1A). X-ray revealed trochanter osteolysis, without prosthesis loosening (figure 1B). Prosthesis explantation was performed, and a...
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Primary hepatic hemangioendothelioma in a patient with Budd-Chiari syndrome
A 36-year-old woman was diagnosed with compensated cirrhosis of liver secondary to Budd-Chiari syndrome (BCS) and had undergone stenting of a thrombosed left hepatic vein. Eight months later, she presented with jaundice and right upper quadrant pain. CT revealed multiple focal lesions in the liver, which on biopsy proved to be hepatic hemangioendothelioma (HHE). Her liver disease and ascites progressively increased. Four months later, magnetic resonance cholangiopancreatography showed an advanced stage of HHE with infiltration of the common bile duct and vascular invasion with a blocked stent, with metastasis to the spleen and dorsolumbar vertebrae. We believe this is the first reported case of an HHE developing in the background of BCS.
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Amyands hernia detected incidentally in two patients
The appendix is rarely present inside the inguinal hernia sac. The risk of appendicitis increases in these patients since the blood supply to the appendix can be impaired. The condition is frequently asymptomatic, and even if symptomatic it gives rise to non-specific symptoms. There is no specific laboratory finding. Diagnosis is frequently made with radiological imaging. We report two cases diagnosed as Amyand's hernia with CT.
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Re-correction osteotomy with osteophyte graft for correction loss with non-union after high tibial osteotomy
A 68-year-old man with right knee varus osteoarthritis was treated by lateral closed-wedge high tibial osteotomy. A correction loss with non-union occurred 6 months after surgery and a re-correction osteotomy was performed. Removing the proximal screws of the lateral plate, a medial opening-wedge re-osteotomy was performed. Arthroscopically harvested osteophytes were used to fill the gap after opening. An additional medial locking plate was installed on the medial side. Finally, the proximal lateral screws were reinserted and locked again. Mature trabecular continuity was obtained in the gap by 6 months, and there was no varus deformity 4 years after re-correction. Re-correction osteotomy could be a viable treatment when lateral compartment osteoarthritis has not progressed and good range of motion still exists. Osteophyte grafting may be an effective option not only to avoid iliac bone grafting but also to promote bone healing in re-osteotomy.
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Vancomycin-associated drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: masquerading under the guise of sepsis
A patient presented with what appeared to be severe urosepsis. After admission and antibiotic administration, a newly developed rash and subsequent facial swelling appeared to be a reaction to penicillin class antibiotics. However, despite changing class of therapy with continued antimicrobial coverage, end organ damage continued, the rash worsened and facial oedema developed. Drug reaction with eosinophilia and systemic symptoms was ultimately diagnosed and was consistent with clinical and histopathological findings, as well as meeting all criteria for scoring systems. The patient was started on intravenous methylprednisolone 125 mg per 8 hours with rapid improvement of rash, swelling and end organ damage. Initial challenge to decrease dose failed, but the patient was ultimately able to be discharged on an extended taper.
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Memory of World War II with loud atypical friction rub due to pulmonary asbestosis
Description
An 87-year-old healthy woman was admitted to our hospital with progressive dyspnoea on effort since the preceding 6 months. She had a history of total gastrectomy, performed 5 years earlier. She was a non-smoker and worked as a business manager.
She did not abuse drugs. During World War II, when she was 15 years old, she worked for a year in a factory manufacturing the brake pads of fighter planes using copious amounts of asbestos. Physical examination revealed the presence of a 'hard and high-pitched knocking sound during the early inspiratory phase', in the right middle to lower lung fields, anteriorly (online ).
A chest radiograph showed massive calcifications in both lungs, including at the level of the diaphragm (figure 1A). Thoracic CT confirmed that these calcifications corresponded to the deposition of massive pleural plaques (figure 1B, C), especially in the visceral pleura (figure...
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Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences
Summary
Peripheral nerve blocks are popular as a mode of anaesthesia for limb surgery and their beneficial effects are well documented in elective surgery. However, concerns have been raised about potential rebound pain outweighing the benefits in acute ankle fracture surgery. Furthermore, pain scores and morphine consumption do not provide a full picture, as pain is subjective. To evaluate the clinical usefulness of peripheral nerve blocks, we explored patients' expectations and experiences by means of semi-structured interviews analysed with systematic text condensation. We obtained ethical approval and informed consent and sampled purposively among adult patients scheduled for ankle surgery with nerve blocks as the primary mode of anaesthesia. Patients were interviewed within 48 h postoperatively. Data saturation was reached after 13 interviews. We found that, despite pre-emptive ibuprofen and paracetamol, some patients did experience excruciating rebound pain for up to 2 h, although most had little or no pain. The patients had doubts about what to do when the block wore off, which led to a risk of unnecessary pain levels or morphine overuse. Patients had difficulty understanding the effect and course of the nerve blocks. They had misunderstandings regarding the blocks' effect on sensation, resulting in fear of feeling pain during surgery and of permanent nerve damage after surgery. However, patients valued the mental alertness, ability to ambulate and efficient pain relief provided by the blocks. We recommend that patients be given thorough and repeated information as we feel this is crucial in preventing undesirable responses from patients, and is likely to increase the overall clinical usefulness of nerve blocks in acute limb surgery.
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Clinicopathologic implications of CD8 + /Foxp3 + ratio and miR-574-3p/PD-L1 axis in spinal chordoma patients
Abstract
Currently, little is known about the interactions between microRNAs (miRNAs) and the PD-1/PD-L1 signaling pathway in chordoma, and data discussing the role of the immune milieu in chordoma prognosis are limited. We aimed to analyze the relationship between PD-L1, miR-574-3p, microenvironmental tumor-infiltrating lymphocytes (TILs) and clinicopathological features of spinal chordoma patients. PD-L1 expression and TILs (including Foxp3+, CD8+, PD-1+ and PD-L1+) were assessed by immunohistochemistry in tumor specimens of 54 spinal chordoma patients. MiRNAs microarray and bioinformatical analysis were used to identify miRNAs potentially regulating PD-L1 expression, which were further validated by quantitative RT-PCR. miR-574-3p was identified to potentially regulate PD-L1 expression in chordoma, which inversely correlated with PD-L1. Positive PD-L1 expression on tumor cells was associated with advanced stages (P = 0.041) and TILs infiltration (P = 0.005), whereas decreased miR-574-3p level correlated with higher muscle invasion (P = 0.012), more severe tumor necrosis (P = 0.022) and poor patient survival. Importantly, a patient subgroup with PD-L1+/miR-574-3plow chordoma phenotype was significantly associated with worse local recurrence-free survival (LRFS) (P = 0.026). PD-1+ TILs density was associated with surrounding muscle invasion (P = 0.014), and independently portended poor LRFS (P = 0.040), while PD-L1+ TILs showed tendencies of less aggressive clinical outcomes. Multivariate analysis of OS only found CD8+/Foxp3+ ratio to be independent prognostic factor (P = 0.022). These findings may be useful to stratify patients into prognostic groups and provide a rationale for the use of checkpoint blockade therapy, possibly by administering miR-574-3p mimics, in spinal chordoma.
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Chlamydia
Chlamydia: The agent of a sexually transmitted disease, a type of bacteria found in the cervix, urethra, throat, or rectum that acts very much like gonorrhea in the way it is spread, the symptoms it produces, and its long-term consequences. Chlamydia is destructive to the Fallopian tubes, causing infertility, tubal pregnancy, and severe pelvic infection. It is common for infected women to have no symptoms. Chlamydia is associated with an increased incidence of preterm births. Also, an infant can acquire the disease during passage through the birth canal, leading to eye problems or pneumonia. Chlamydia is one of the reasons newborns are routinely treated with antibiotic eyedrops. Chlamydia can also cause inflammation of the urethra, epididymis, and rectum in men. A chronic form of arthritis, called reactive arthritis, can develop after chlamydia infection.
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Cover Image
The cover image, by Ines Kapferer-Seebacher et al., is based on the Other Periodontal manifestations of Ehlers–Danlos syndromes: A systematic review, DOI: 10.1111/jcpe.12807.
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Automated MicroSPECT/MicroCT Image Analysis of the Mouse Thyroid Gland
Thyroid , Vol. 0, No. 0.
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Role of Krüppel-Like Factor 4 in the Maintenance of Chemoresistance of Anaplastic Thyroid Cancer
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Review of "Setting Performance Standards for Technical and Nontechnical Competence in General Surgery" by Szasz P, Bonrath EM, Louridas M, Fesco AB, Howe B, Fehr A, Ott M, Mack LA, Harris KA, Grantcharov TP in Ann Surg 266: 1-7, 2017 and "Beyond 'Measure Twice': New Performance Standards in Surgery" by Yule S in Ann Surg 266:8-9, 2017.
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13-93B3 Bioactive Glass: a New Scaffold for Transplantation of Stem Cell-Derived Chondrocytes.
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Hemodynamic Changes in Paramedian Forehead Flap.
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The Etiology of Neuronal Development in Craniosynostosis: A Working Hypothesis.
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Hydatid Cyst of the Parotid Gland: A Rare Location.
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Outcomes of Titanium Mesh Cranioplasty in Pediatric Patients.
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Virtual Reality Model of the Three-Dimensional Anatomy of the Cavernous Sinus Based on a Cadaveric Image and Dissection.
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Skull Base Neuroendoscopic Training Model Using a Fibrous Injectable Tumor Polymer and the Nico Myriad.
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A Modification to the Nasal Septal Chain Suture Which Improves Its Application.
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Metopism: a Study of the Persistent Metopic Suture.
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Advanced glycation end products impair NLRP3 inflammasome-mediated innate immune responses in macrophages [Signal Transduction]
Advanced glycation end products (AGEs) are adducts formed on proteins by glycation with reducing sugars, such as glucose, and tend to form and accumulate under hyperglycemic conditions. AGE accumulation alters protein function and has been implicated in the pathogenesis of many degenerative diseases such as diabetic complications. AGEs have also been shown to promote the production of pro-inflammatory cytokines, but the roles of AGEs in inflammasome signaling have not been explored in detail. Here, we present evidence that AGEs attenuate activation of the NLRP3 inflammasome in bone marrow-derived macrophages (BMDMs) as determined by caspase-1 processing and interleukin-1β production. AGEs also dampened the assembly of the NLRP3 inflammasome, but did not affect the NLRC4 or AIM2 inflammasome activation. Moreover, our data indicated that AGE treatment inhibited toll-like receptor (TLR)-dependent production of pro-inflammatory cytokines in BMDMs. This immunosuppressive effect of AGE was not associated with a receptor for AGEs (RAGE)-mediated signaling. Instead, AGE treatment markedly suppressed lipopolysaccharide-induced M1 polarization of macrophages. Furthermore, AGEs significantly dampened innate immune responses including NLRP3 inflammasome activation and type-I interferon production in macrophages upon influenza virus infection. These observations collectively suggest that AGEs could impair host NLRP3 inflammasome-mediated innate immune defenses against RNA virus infection leading to an increased susceptibility to infection.
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CRISPR/Cas9-based screening of long noncoding RNAs (lncRNAs) in macrophages with an NF-kappa B reporter [RNA]
The innate immune system protects against infections by initiating an inducible inflammatory response. NF-kappa B (NF-KB) is one of the critical transcription factors controlling this complex response, but some aspects of its regulation remain unclear. For example, although long noncoding RNAs (lncRNAs) have been shown to critically regulate gene expression, only a fraction of these have been functionally characterized, and the extent to which lncRNAs control NF-KB expression is unknown. Here, we describe the generation of a GFP-based NF-KB reporter system in immortalized murine bone marrow-derived macrophages (iBMDMs). Activation of this reporter, using Toll-like receptor ligands, resulted in GFP expression, which could be monitored by flow cytometry. We also established a CRISPR/Cas9 gene deletion system in this NF-KB reporter line, enabling us to screen for genes that regulate NF-KB signaling. Our deletion-based approach identified two long intergenic noncoding (linc)RNAs, lincRNA-Cox2 and lincRNA-AK170409, that control NF-KB signaling. We demonstrate a potential novel role for lincRNA-Cox2 in promoting IkBA degradation in the cytoplasm. For lincRNA-AK170409, we provide evidence that this nuclear-localized lincRNA regulates a number of inflammation-related genes. In conclusion, we have established an NF-KB-GFP iBMDM reporter cell line and a line that stably expresses Cas9. Our approach enabled identification of lincRNA-Cox2 and lincRNA-AK170409 as NF-KB regulators and this tool will be useful for identifying additional genes involved in regulating this transcription factor critical for immune function.
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Repair of Calvarial Bone Defect Using Jarid1a-Knockdown Bone Mesenchymal Stem Cells in Rats
Tissue Engineering Part A , Vol. 0, No. 0.
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Exploration of Portal Activation by Patients in a Healthcare System.
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Experience and Compliance With Scanning Vaccines' Two-Dimensional Barcodes to Record Data.
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Question intonation contours as dynamic epistemic operators
Abstract
Although intonation has been traditionally claimed to be a strong indicator of the epistemic commitments of the participants in a discourse, very few empirical investigations have addressed specific semantic hypotheses related to the precise epistemic contribution of question intonation to utterance interpretation. The main aim of this paper is to test the claim that intonation in Catalan plays an important role in the specification of dynamic epistemic commitments in two complementary directions, i.e., speaker commitments to the speaker's own proposition and speaker agreement with the addressee's proposition. Following Krifka's commitment space semantics (Krifka 2015, 2017), we will test the claim that question intonation in Catalan encodes different levels of assert (commitment) and reject ((dis)agreement) epistemic operators. A total of 119 Central Catalan listeners participated in an acceptability judgment task and were asked to rate the perceived degree of acceptability between a set of interrogative utterances (variously produced with one of four intonational contours) and their previous discourse context (which was controlled for epistemic bias). Results showed that question intonation contours encode binary (and not degree) distinctions in speaker commitment and speaker agreement. That is, results showed that question intonation encodes fine-grained information about the epistemic stance of the speaker, not only in relation to the speaker's own propositions but also in relation to the addressee's propositions. From a crosslinguistic point of view, we argue that intonation closely parallels the function of modal markers in their encoding of speaker commitment and speaker agreement operators.
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Neutrophil–Particle Interactions in Blood Circulation Drive Particle Clearance and Alter Neutrophil Responses in Acute Inflammation
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Crystallinity of Double-Stranded RNA-Antimicrobial Peptide Complexes Modulates Toll-Like Receptor 3-Mediated Inflammation
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Direct Observation of Oxygen Vacancy Distribution across Yttria-Stabilized Zirconia Grain Boundaries
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Dasna jail dental clinic to be named after Aarushi
The near defunct dental clinic was revived by the Talwars during their imprisonment in the Aarushi-Hemraj double murder case. ALLAHABAD: UP minister of state for jail Jai Kumar Singh Jaiki on Wednesday said the state government has decided to name the dental clinic, operated by dentist couple Rajesh and Nupur Talwar in Dasna jail, after their daughter Aarushi .
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First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP),
Resumo Introdução: A traqueostomia é um procedimento que pode ser feito em qualquer faixa etária, inclusive em crianças abaixo de um ano. Infelizmente no Brasil existe uma enorme dificuldade dos profissionais de saúde em lidar com esta condição e uma falta de padronização dos cuidados. Objetivo: Este consenso clínico realizado pela Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) e Sociedade Brasileira de Pediatria (SBP) tem como objetivo gerar recomendações nacionais sobre os cuidados e condutas diante das crianças traqueostomizadas. Método: Foram selecionados um grupo de especialistas com experiência em traqueostomia na infância (otorrinolaringologistas, pediatras intensivistas, endoscopistas, pneumopediatras) que tivessem comprovada atuação prática no assunto, e que também contemplassem as diversas regiões do Brasil, de acordo com os critérios de inclusão e exclusão. Resultados: Os resultados gerados neste documento foram obtidos a partir da concordância da maioria dos participantes em relação as indicações, tipo de cânula, técnicas cirúrgicas, cuidados e orientações gerais e decanulação. Conclusão: Estas diretrizes poderão servir como norteadoras para os mais diversos profissionais de saúde em todo país que lidam com as dificuldades das crianças traqueostomizadas.
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Impact of cartilage graft size on success of tympanoplasty
Resumo Introdução: Na última década, tem havido um interesse crescente no uso de enxertos de cartilagem como opção para o reparo de perfurações primárias de membrana timpânica. As principais vantagens da cartilagem são a sua rigidez e o metabolismo braditrófico, o que a torna particularmente adequada para condições difíceis, tais como perfurações subtotais, otite adesiva e reoperações. Objetivo: Analisar o impacto de diferentes tamanhos de perfuração, portanto diferentes tamanhos de cartilagem, sobre o desfecho anatômico e funcional da timpanoplastia. Método: Através deste estudo prospectivo, não controlado, não randomizado, 50 pacientes foram submetidos a timpanoplastia de cartilagem tipo 1 (20 mulheres e 30 homens), com idade média de 19,3 ± 9,8 anos. De acordo com o tamanho da perfuração, os pacientes foram subdivididos em três grupos, Grupo I com perfuração > 50% da área da membrana timpânica, Grupo II com perfuração de 25%-50% da área da membrana timpânica, Grupo III com perfuração ≤ 25% da membrana timpânica. Todos apresentavam Audiometria tonal pura pré e pós-operatório - gap Aéreo-Ósseo para frequências testadas (0,5, 1, 2, 4 kHz). Todos os pacientes foram acompanhados por pelo menos 12 meses após a cirurgia. Resultados: A taxa de sucesso anatômico entre todos os pacientes foi de 92%, todos os grupos apresentaram melhoria estatisticamente significante entre pré e pós-operatório nos três grupos, não houve correlação significante entre o tamanho do enxerto de cartilagem e observou-se algum grau de melhoria do gap nos 3 grupos. Conclusão: O tamanho do enxerto de cartilagem não tem impacto sobre o grau de melhoria da audição ou na taxa de sucesso anatômico após timpanoplastia.
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Encoding of speech sounds at auditory brainstem level in good and poor hearing aid performers
Abstract Introduction: Hearing aids are prescribed to alleviate loss of audibility. It has been reported that about 31% of hearing aid users reject their own hearing aid because of annoyance towards background noise. The reason for dissatisfaction can be located anywhere from the hearing aid microphone till the integrity of neurons along the auditory pathway. Objectives: To measure spectra from the output of hearing aid at the ear canal level and frequency following response recorded at the auditory brainstem from individuals with hearing impairment. Methods: A total of sixty participants having moderate sensorineural hearing impairment with age range from 15 to 65 years were involved. Each participant was classified as either Good or Poor Hearing aid Performers based on acceptable noise level measure. Stimuli /da/ and /si/ were presented through loudspeaker at 65 dB SPL. At the ear canal, the spectra were measured in the unaided and aided conditions. At auditory brainstem, frequency following response were recorded to the same stimuli from the participants. Results: Spectrum measured in each condition at ear canal was same in good hearing aid performers and poor hearing aid performers. At brainstem level, better F0 encoding; F0 and F1 energies were significantly higher in good hearing aid performers than in poor hearing aid performers. Though the hearing aid spectra were almost same between good hearing aid performers and poor hearing aid performers, subtle physiological variations exist at the auditory brainstem. Conclusion: The result of the present study suggests that neural encoding of speech sound at the brainstem level might be mediated distinctly in good hearing aid performers from that of poor hearing aid performers. Thus, it can be inferred that subtle physiological changes are evident at the auditory brainstem in a person who is willing to accept noise from those who are not willing to accept noise.
Resumo Introdução: Os aparelhos auditivos são prescritos para aliviar a perda de audibilidade. Tem sido relatado que 31% dos usuários rejeitam seu aparelho auditivo devido ao desconforto com o ruído de fundo. A razão para a insatisfação pode estar situada em qualquer local desde o microfone do aparelho auditivo até a integridade de neurônios ao longo da via auditiva. Objetivos: Medir espectros desde a saída do aparelho auditivo no nível do meato acústico externo e frequência de resposta (FFR) registrada no tronco encefálico de indivíduos com deficiência auditiva. Método: Foram selecionados 60 participantes com deficiência auditiva neurossensorial moderada, de 15 a 65 anos. Cada participante foi classificado como usuário bom ou mau de prótese auditiva (GHP ou PHP) com base na medida de nível de ruído aceitável (ANL). Estímulos/da/e/si/foram apresentados em alto-falante a 65 dB SPL. No meato acústico externo, os espectros foram medidos nas condições sem aparelho e com aparelho. No tronco encefálico auditivo, FFR foram registradas para os mesmos estímulos dos participantes. Resultados: Os espectros medidos em cada condição no meato acústico externo foram os mesmos em GHP e PHP. No nível do tronco cerebral, melhor codificação F0; energias de F0 e F1 foram significativamente maiores em GHP do que em PHP. Embora os espectros do aparelho auditivo fossem quase os mesmos entre GHP e PHP, existem variações fisiológicas sutis no tronco encefálico auditivo. Conclusão: O resultado do presente estudo sugere que a codificação neural do som da fala no nível do tronco encefálico pode ser mediada distintamente em GHP em comparação com PHP. Assim, pode-se inferir que mudanças fisiológicas sutis são evidentes no tronco encefálico em uma pessoa que está disposta a aceitar o ruído em comparação com aqueles que não estão dispostos a aceitar o ruído.
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Profile and prevalence of hearing complaints in the elderly
Abstract Introduction: Hearing is essential for the processing of acoustic information and the understanding of speech signals. Hearing loss may be associated with cognitive decline, depression and reduced functionality. Objective: To analyze the prevalence of hearing complaints in elderly individuals from Rio Grande do Sul and describe the profile of the study participants with and without hearing complaints. Methods: 7315 elderly individuals interviewed in their homes, in 59 cities in the state of Rio Grande do Sul, Brazil, participated in the study. Inclusion criteria were age 60 years or older and answering the question on auditory self-perception. For statistical purposes, the chi-square test and logistic regression were performed to assess the correlations between variables. Results: 139 elderly individuals who did not answer the question on auditory self-perception and 9 who self-reported hearing loss were excluded, totaling 7167 elderly participants. Hearing loss complaint rate was 28% (2011) among the elderly, showing differences between genders, ethnicity, income, and social participation. The mean age of the elderly without hearing complaints was 69.44 (±6.91) and among those with complaint, 72.8 (±7.75) years. Elderly individuals without hearing complaints had 5.10 (±3.78) years of formal education compared to 4.48 (±3.49) years among those who had complaints. Multiple logistic regression observed that protective factors for hearing complaints were: higher level of schooling, contributing to the family income and having received health care in the last six months. Risk factors for hearing complaints were: older age, male gender, experiencing difficulty in leaving home and carrying out social activities. Conclusions: Among the elderly population of the state of Rio Grande do Sul, the prevalence of hearing complaints reached 28%. The complaint is more often present in elderly men who did not participate in the generation of family income, who did not receive health care, performed social and community activities, had a lower level of schooling and were older.
Resumo Introdução: A audição é essencial para o processamento de eventos acústicos e emissão e compreensão dos sinais de fala. A perda auditiva pode estar associada ao declínio cognitivo, à depressão e à redução da funcionalidade. Objetivo: Analisar a prevalência de queixa auditiva em idosos do Rio Grande do Sul e descrever o perfil dos participantes com e sem queixa auditiva. Método: Participaram do estudo 7.315 idosos entrevistados em suas residências, em 59 cidades gaúchas. Os critérios de inclusão adotados foram ter 60 anos ou mais e terem respondido à questão sobre autopercepção auditiva. Para fins estatísticos foi realizado o teste Qui-quadrado e regressão logística para avaliar as correlações entre as variáveis. Resultados: Foram excluídos 139 idosos sem resposta à autopercepção auditiva e nove por autorreferirem surdez (7.167 participantes). A frequência de queixa de perda auditiva foi de 28% (2011) dos idosos, apresentou diferença entre gêneros, etnia, renda, participação social. A média de idade dos idosos sem queixa auditiva foi de 69,44 (± 6,91) e com queixa 72,8 (± 7,75) anos. Os idosos sem queixa auditiva apresentaram 5,10 (± 3,78) anos de estudo comparados com 4,48 (± 3,49) anos dos com queixa. A regressão logística múltipla observou que foram fatores protetores para a queixa auditiva maior escolaridade, contribuir na renda familiar e ter recebido atendimento de saúde nos últimos seis meses. Fatores de risco para a queixa auditiva foram idade mais avançada, sexo masculino, apresentar dificuldade de sair de casa e realizar atividades sociais. Conclusões Na população idosa do Rio Grande do Sul a prevalência de queixa auditiva atingiu 28%. A queixa está mais presente em idosos homens, sem participação na renda familiar, não receberam atendimento de saúde, tinham atividade social e comunitária, com menor escolaridade e maior idade.
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Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study
Resumo Introdução: Os implantes cocleares (IC) são indiscutivelmente um método eficaz de recuperação da função auditiva de pacientes surdos. Objetivo: Descrever o protocolo de avaliação vestibular pré-operatória em sujeitos que serão submetidos ao IC. Método: Nosso protocolo institucional prevê o diagnóstico vestibular por meio de seis testes simples: testes de Romberg e Fukuda, nistagmo espontâneo, Head Impulse Test, Head Shaking Nistagmus, prova calórica. Resultados: Foram avaliados 21 pacientes com média de 42,75 ± 14,38 anos. Apenas 28% da amostra apresentaram todos os testes normais. A presença de informação vestibular assimétrica foi documentada pela prova calórica em 32% da amostra e o nistagmo espontâneo mostrou-se pista importante para seu diagnóstico. A arreflexia vestibular bilateral foi diagnosticada em quatro sujeitos; arreflexia unilateral em três e hiporreflexia bilateral em dois. O Head Impulse Test mostrou-se indicador significante (p = 0,0001) para diagnosticar arreflexia da orelha testada. O teste de Romberg sensibilizado em almofada foi capaz de diagnosticar os comprometimentos severos da função vestibular (p = 0,003). Conclusão: Os seis testes clínicos foram capazes de identificar a presença ou não de função vestibular e assimetria da função entre as orelhas de um mesmo indivíduo.
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Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings
Resumo Introdução: Fístulas traqueoesofágicas persistentes podem ser resolvidas através da redução do tamanho da fístula ou substituição da prótese; no entanto, mesmo com técnicas conservadoras, o pertuito em torno da fístula pode continuar em pacientes com laringectomia total. Além disso, várias técnicas têm sido desenvolvidas para superar esse problema, inclusive injeções ao redor da fístula, fechamento da fístula com retalhos locais, retalhos miofasciais ou retalhos livres e fechamento da fístula com um botão septal de silicone. Objetivo: Apresentar os resultados da aplicação de anel de silicone para expansão da prótese vocal em pacientes com grandes fístulas periprotéticas persistentes. Método: Prótese vocal foi colocada em 42 pacientes após laringectomia total, e fístula foi detectada ao redor da prótese em 18 desses 42 pacientes. Quatro pacientes obtiveram melhora com métodos conservadores. Oito dos 18 pacientes que não obtiveram sucesso com métodos conservadores foram tratados usando sutura primária e quatro pacientes foram tratados com retalhos locais. Um anel de silicone foi aplicado inicialmente nos dois pacientes restantes e, também, aplicado a dois pacientes que tiveram recorrência após a técnica de sutura e a dois pacientes que tiveram recorrência após a utilização de retalho local. No total, seis pacientes receberam anéis de silicone em decorrência da fístula traqueoesofágica secundária. Os pacientes haviam sido tratados com provox-1 inicialmente e posteriormente com provox-2. No momento da detecção da fístula em torno do estoma, seis pacientes haviam recebido provox-2. Resultados: A fístula foi tratada com sucesso em seis pacientes. Além disso, após o tratamento a fala foi mantida de forma eficaz. Não houve problema de adaptação. O tempo de troca da prótese expandida com os anéis de silicone não foi diferente do tempo que se leva para a colocação da prótese normal. O anel de silicone combinado com a prótese vocal foi usado 26 vezes em pacientes na época da troca de prótese e não houve recorrência da fístula durante os 29 ± 6 meses de acompanhamento. Conclusão: Os resultados sugerem que em casos de grandes fístulas peri-prostéticas persistentes, anéis expandidos de silicone e prótese vocal modificada são eficazes tanto para o fechamento da fístula como para a manutenção da fala do paciente.
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The effect of melatonin and vitamin C treatment on the experimentally induced tympanosclerosis: study in rats
Abstract Introduction: The ethiopathogenesis of tympanosclerosis has not been completely under- stood yet. Recent studies have shown that free oxygen radicals are important in the formation of tympanosclerosis. Melatonin and Vitamin C are known to be a powerful antioxidant, interacts directly with Reactive Oxygen Species and controls free radical-mediated tissue damage. Objective: To demonstrate the possible preventative effects of melatonin and Vitamin C on tympanosclerosis in rats by using histopathology and determination of total antioxidant status total antioxidant status. Methods: Standard myringotomy and standard injury were performed in the middle ear of 24 rats. The animals were divided into three groups: Group 1 received melatonin, Group 2 received vitamin C, and Group 3 received saline solution. Results: The mean values of total antioxidant status were similar in the all study groups before the treatment period. The mean values of total antioxidant status were significantly higher in the melatonin and vitamin C groups compared to control group but vitamin C with melatonin groups were similar after the treatment period (p < 0.001). Minimum and maximum wall thicknesses were lower in the melatonin and vitamin C groups compared to the control group but the differences were insignificant. Conclusion: Melatonin increases total antioxidant status level and might have some effect on tympanosclerosis that develops after myringotomy.
Resumo Introdução: A etiopatogênese da timpanoesclerose (TE) não foi ainda totalmente esclarecida. Estudos recentes têm demonstrado que os radicais livres de oxigênio são importantes na formação de TE. Melatonina e vitamina C são conhecidas por serem poderosos antioxidantes, interagir diretamente com espécies reativas de oxigênio (ROS) e controlar danos em tecidos mediados por radicais livres. Objetivo: Demonstrar os possíveis efeitos preventivos da melatonina e da vitamina C na TE em ratos com histopatologia e determinação da capacidade antioxidante total (CAT). Método: Miringotomias padronizadas foram feitas na orelha média de 24 ratos. Os animais foram divididos em três grupos: o Grupo 1 recebeu melatonina, o Grupo 2 vitamina C e o grupo 3 solução salina. Resultados: Os valores médios de CAT foram semelhantes em todos os grupos de estudo antes do período de tratamento. Os valores médios de CAT foram significativamente maiores nos grupos que receberam melatonina e vitamina C em comparação com o grupo de controle, mas os grupos vitamina C e melatonina foram semelhantes após o período de tratamento (p < 0,001). As espessuras mínimas e máximas de parede foram menores nos grupos melatonina e vitamina C, em comparação com o grupo controle, mas as diferenças não foram significativas. Conclusão: A melatonina aumenta os níveis de CAT e pode ter algum efeito sobre a TE que se desenvolve após a miringotomia.
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Efficacy of syringe-irrigation topical therapy and the influence of the middle turbinate in sinus penetration of solutions
Resumo Introdução: Terapias tópicas são a melhor opção de tratamento pós-operatório da rinossinusite crônica, principalmente com alto volume e pressão, como os squeeze bottles. Porém, não são opções disponíveis na realidade brasileira, na qual frequentemente são usados seringas para a irrigação. Objetivo: Averiguar a eficácia da terapia tópica nasossinusal com seringa e a influência da concha média nesse processo. Método: Estudo de intervenção em modelos de treinamento (S.I.M.O.N.T.). Após dissecção padronizada, três intervenções foram feitas (spray nasal 4 puffs, seringa de 60 mL e squeeze bottle de 240 mL) com a concha média normal e suturada. Foram capturadas imagens de cada seio após as intervenções, totalizando 144 imagens. As imagens foram classificadas por 10 avaliadores de acordo com a quantidade de volume residual de zero a 3, sendo zero e 1 considerados penetração ruim e 2 e 3, penetração boa. As 1.440 avaliações foram utilizadas neste estudo. Resultados: Considerando todas as situações de concha média, a quantidade de penetrações boas foi de 8,1% para spray; 68,3% para seringa e 78,3% para squeeze (p < 0,0001). Considerando todos os tipos de intervenção, a concha média normal obteve 48,2% de penetrações boas e a concha média suturada, 55% (p = 0,01). Considerando apenas concha média suturada, não houve diferença entre as intervenções seringa e squeeze (76,3% vs. 80,4%; p = 0,27). Conclusão: A terapia tópica de irrigação com seringa de 60 mL foi mais eficaz do que com spray nasal. O status da concha média mostrou-se fundamental e influenciou a terapia tópica. A irrigação com seringa foi tão eficaz quanto a com squeeze bottle quando a concha média foi suturada ao septo nasal.
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Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study
Resumo Introdução: A avaliação do desfecho de cirurgia medido pela satisfação ou qualidade de vida do paciente é muito importante, especialmente em cirurgia plástica. Existe um interesse crescente na autoavaliação de desfechos nesta especialidade cirúrgica. Objetivo: O objetivo deste estudo foi determinar a satisfação do paciente em relação à aparência e função do nariz com o uso de um questionário validado, antes e depois da cirurgia de rinoplastia. Método: Estudo prospectivo realizado em um centro terciário. Todas as cirurgias de rinoplastia feitas em adultos entre fevereiro de 2013 e agosto de 2014 foram incluídas. Muitos pacientes foram submetidos à cirurgia nasal adicional, como septoplastia ou turbinoplastia. Os procedimentos cirúrgicos e as características dos pacientes também foram registrados. Resultados: Entre 113 pacientes, 107 completaram os questionários e o período de acompanhamento. A análise da avaliação do desfecho de rinoplastia (ADR) no pré-operatório e pós-operatório mostrou uma melhoria significativa após 3 e 6 meses em questões funcionais e estéticas (p < 0,01). No pré-operatório, os pacientes ansiosos e inseguros apresentaram um escore pior (p < 0,05). A diferença na melhoria dos escores não foi significativa quando os grupos foram divididos com base em outros procedimentos nasais, cirurgia primária ou revisão e abordagem aberta versus fechada. Conclusão: Verificou-se que pacientes com menor grau de alfabetização estavam mais satisfeitos com o procedimento. A cirurgia de rinoplastia melhorou significativamente a qualidade de vida do paciente quanto à função e ao aspecto do nariz.
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Medical adherence to intranasal corticosteroids in adult patients
Abstract Introduction: The adherence to medical treatment in allergic rhinitis is poorly evaluated in clinical practice. Objectives: To evaluate adherence to intranasal corticosteroids in the treatment of allergic rhinitis patients. Methods: This prospective study was conducted on adult patients who were admitted to the outpatient clinic of the otolaryngology department tertiary hospital. Patients diagnosed with moderate to severe persistent AR and who had not used any nasal sprays were enrolled in the study. The patients were provided with mometasone furoate nasal sprays. On the 30th day, all participants filled out a questionnaire regarding the factors that may have influenced their adherence to the treatment. Afterwards, each patient filled out the Turkish-language-validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor that may have affected adherence to the prescribed medication was evaluated according to the MMAS-8 score and all variables were analyzed statistically. Results: Fifty-nine adult patients with a mean age of 32.5 years (range 21-52 years) were included in the study. The mean overall MMAS-8 score was 3.64. Two factors were significantly related to low adherence: number of dependent children (p = 0.001) and benefit from the medication (p = 0.001). In addition, patients with higher education levels seemed to be more adherent than the rest of the group. Conclusion: Clinicians must keep in mind the factors related to non-adherence in order to achieve better treatment outcomes. Therefore, based on our results, patients must be informed that medications should be taken properly regardless of the benefit, and the treatment should be scheduled with respect to daily activities, particularly for patients caring for more than two children.
Resumo Introdução: A adesão ao tratamento clínico de rinite alérgica é mal avaliada na prática clínica. Objetivos: Avaliar a adesão aos corticosteroides intranasais no tratamento de pacientes com rinite alérgica. Método: Este estudo prospectivo foi realizado com pacientes adultos admitidos no ambulatório do setor de otorrinolaringologia de um hospital terciário. Os pacientes diagnosticados com rinite alérgica moderada a persistente grave que não haviam ainda usado spray nasal foram incluídos no estudo. Os pacientes receberam sprays nasais de furoato de mometasona. No 30° dia, todos preencheram um questionário sobre os fatores que podem ter influenciado a sua adesão ao tratamento. Depois disso, cada paciente preencheu o formulário da Escala de Adesão Clínica Morisky validado para a língua turca (MMAS-8). Cada fator que pode ter afetado a adesão à medicação prescrita foi avaliado de acordo com o escore de MMAS-8 e todas as variáveis foram analisadas estatisticamente. Resultados: Foram incluídos no estudo 59 pacientes adultos com média de 32,5 anos (variação de 21-52). O escore total médio de MMAS-8 foi de 3,64. Dois fatores foram significantemente relacionados com a baixa adesão: número de dependentes infantis (p = 0,001) e benefício da medicação (p = 0,001). Além disso, os pacientes com níveis de ensino mais elevados pareceram ser mais adesistas do que o restante do grupo. Conclusão: Os médicos devem estar cientes dos fatores relacionados à falta de adesão, a fim de alcançar melhores resultados do tratamento. Portanto, com base em nossos resultados, os pacientes devem ser informados de que os medicamentos devem ser usados adequadamente independentemente do benefício, e o tratamento deve ser programado com relação às atividades diárias, especialmente para os pacientes que cuidam de mais de dois filhos.
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An often neglected area in crooked nose: middle turbinate pneumatization
Resumo Introdução: O nariz torto ou o nariz com desvio é um nariz com um desvio da posição vertical reta da face. A pneumatização extensa da concha média, também chamada de concha bolhosa ou concha média bolhosa (CMB), é conhecida por ser um dos possíveis fatores etiológicos da obstrução nasal, sinusite recorrente e cefaleia. Não há estudo relativo a uma associação entre CMB e nariz torto. Objetivo: Investigar a associação entre o nariz torto e a presença de CMB. Método: Foram analisados retrospectivamente 199 pacientes que se submeteram a septorrinoplastia aberta. Achados pré-operatórios paranasais à tomografia computadorizada (TC), fotodocumentação pré-operatória e exame rinoscópico anterior foram registrados. Dos 199 pacientes, observou-se que 169 atendiam aos critérios e foram incluídos no estudo. As TC foram examinadas para observar a presença de CMB, hipertrofia de conchas inferiores e desvio de septo (DS). Os DS e narizes tortos foram então classificados. Resultados: Dos 169 pacientes, 94 (56%) apresentavam uma deformidade de nariz e 75 (44%) apresentavam nariz reto. Enquanto 49 (52%) pacientes com nariz torto tinham CMB extensa, 20 pacientes com nariz reto (26,6%) tinham CMB. Uma relação estatisticamente significativa foi encontrada entre a presença de nariz torto e CMB, independentemente do lado da doença (p = 0,011). Conclusão: Este estudo revelou uma relação entre o nariz torto e CMB.
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