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Κυριακή 26 Ιουνίου 2022

Severity of hearing loss after platinum chemotherapy in childhood cancer survivors

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Abstract

Background

Hearing loss is a potential side effect from childhood cancer treatment. We described the severity of hearing loss assessed by audiometry in a representative national cohort of childhood cancer survivors (CCS) and identified clinical risk factors.

Procedure

We included all CCS from the Swiss Childhood Cancer Registry who were diagnosed ≤18 age and treated with platinum-based chemotherapy between 1990 and 2014. We extracted audiograms, treatment-related information, and demographic data from medical records. Two reviewers independently assessed the severity of hearing loss at latest follow-up using the Münster Ototoxicity Scale. We used ordered logistic regression to identify clinical risk factors for severity of hearing loss.

Results

We analyzed data from 270 CCS. Median time from cancer diagnosis to last audiogram was 5 years (interquartile range 2.5–8.1 years). We found 53 (20%) CCS with mild, 78 (29%) with moderate, and 75 (28%) with severe hearing loss. Higher severity grades were associated with (a) younger age at cancer diagnosis (odds ratio [OR] 5.4, 95% confidence interval [CI]: 2.5–12.0 for <5 years); (b) treatment in earlier years (OR 4.8, 95% CI: 2.1–11.0 for 1990–1995); (c) higher cumulative cisplatin doses (OR 13.5, 95% CI: 4.7–38.8 for >450 mg/m2); (d) concomitant cranial radiation therapy (CRT) (OR 4.4, 95% CI: 2.5–7.8); and (e) hematopoietic stem cell transplantation (HSCT) (OR 2.7, 95% CI: 1.0–7.2).

Conclusion

Three of four CCS treated with platinum-based chemotherapy experienced some degree of hearing loss. We recommend closely monitoring patient's hearing function if treated at a young age with high cumulative cisplatin doses, and concomitant CRT as part of long-term care.

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The impact of pre‐transplant serum ferritin on haploidentical hematopoietic stem cell transplant for acquired severe aplastic anemia in children and adolescents

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Abstract

Haploidentical hematopoietic stem cell transplant (haplo-HSCT) provides an important alternative for children and adolescents with acquired severe aplastic anemia (SAA) lacking of matched donors. To test whether pre-transplant serum ferritin (SF) represents a candidate predictor for survival and a potential biomarker for graft-versus-host disease (GvHD) in pediatric haplo-HSCT, we retrospectively evaluated 147 eligible patients with SAA who underwent haplo-HSCT. The patients were divided into the low-SF group (< 1000 ng/ml) and the high-SF group (≥ 1000 ng/ml). We found that SF ≥1000 ng/ml independently increased the risk of grade II-IV aGvHD (HR = 2.596, 95% CI 1.304-5.167, p = .007) and grade III-IV aGvHD (HR = 3.350, 95% CI 1.162-9.658, p = .025). Similar probabilities of transplant-related mortality at 100 days were observed in the two groups (6.19 ± 2.45% vs 8.00 ± 3.84%, p = .168). The 2-year overall survival (85.29 ± 3.89% vs 92.00 ±3.84%, p = .746) and fai lure-free survival (83.23% ± 4.08% vs 83.37 ± 6.27%, p = .915) were comparable. GvHD-/failure-free survival were 60.06 ± 5.10% and 75.56 ± 6.87%, respectively (p = .056). In conclusion, the elevated pre-transplant SF level is associated with higher incidences of grade II-IV aGvHD and grade III-IV aGvHD. However, it is not associated with worse survival after haplo-HSCT for children and adolescent patients with SAA.

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Increased local concentrations of growth factors from leucocyte‐ and platelet‐rich fibrin do not translate into improved alveolar ridge preservation: an intraindividual mechanistic randomized controlled trial

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Abstract

Aims

Leucocyte- and platelet-rich fibrin (L-PRF) has been tested for enhancing alveolar ridge preservation (ARP), but little is known about the local release profile of growth factors (GF) and the clinical equipoise related to its efficacy remains. This study compared the patterns of GF release, early soft tissue healing and alveolar ridge resorption following unassisted healing and L-PRF application in non-molar extraction sockets.

Materials and Methods

Atraumatic tooth extraction of two hopeless teeth per patient was followed by unassisted healing or L-PRF placement to fill the socket in 18 systemically healthy, nonsmoking subjects. This intraindividual trial was powered to assess changes in horizontal alveolar ridge dimensions 1 mm below the crest of alveolar bone. GF concentrations in wound fluid were assessed with a multiplex assay at 6, 24, 72 and 168 hours. Early healing was evaluated with the wound-healing index and changes in soft tissue volumes on serial digital scans. Hard tissue changes were measured on superimposed CBCT images after 5 months of healing.

Results

L-PRF resulted in higher GF concentrations in WF as compared to the control, but no differences in release patterns or time of peak were observed. No intergroup differences in early healing parameters were observed. Alveolar bone resorption was observed in both groups. No significant intergroup differences were observed in hard tissue healing 1, 3 or 5 mm apical to the original bone crest, or in ability to digitally plan a prosthetically guided implant with or without bone augmentation.

Conclusions

L-PRF increased the GF concentrations in wound fluid of extraction sockets without shifting the pattern observed in unassisted healing, while the increased delivery did not translate into clinical benefits in early wound healing or ARP. The current findings question the assumption that increased local concentrations of GF by L-PRF translate into improved clinical outcomes. Additional definitive studies are needed to establish the benefits of L-PRF in ARP. (clinicaltrials.gov NCT03985033)

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When Effects Cannot be Estimated: Redefining Estimands to Understand the Effects of Naloxone Access Laws

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Violations of the positivity assumption (also called the common support condition) challenge health policy research and can result in significant bias, large variance, and invalid inference. We define positivity in the single- and multiple-timepoint (i.e., longitudinal) health policy evaluation setting, and discuss real-world thr eats to positivity. We show empirical evidence of the practical positivity violations that can result when attempting to estimate the effects of health policies (in this case, Naloxone Access Laws). In such scenarios, an alternative is to estimate the effect of a shift in law enactment (e.g., the effect if enactment had been delayed by some number of years). Such an effect corresponds to what is called a modified treatment policy, and dramatically weakens the required positivity assumption, thereby offering a means to estimate policy effects even in scenarios with serious positivity problems. We apply the approach to define and estimate the longitudinal effects of Naloxone Access Laws on opioid overdose rates. Violations of the positivity assumption (also called the common support condition) challenge health policy research and can result in significant bias, large variance, and invalid inference. We define positivity in the single- and multiple-timepoint (i.e., longitudinal) health policy evaluation setting, and discuss real-world threats to positivity. We show empirical evidence of the practical positivity violations that can result when attempting to estimate the effects of health policies (in this case, Naloxone Access Laws). In such scenarios, an alternative is to estimate the effect of a shift in law enactment (e.g., the effect if enactment had been delayed by some number of years). Such an effect corresponds to what is called a modified treatment policy, and dramatically weakens the required positivity assumption, thereby offering a means to estimate policy effects even in scenarios with serious positivity problems. We apply the approach to define and estimate the longitudinal effec ts of Naloxone Access Laws on opioid overdose rates. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Complications of sinus floor elevation procedure and management strategies: A systematic review

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Abstract

Aim

This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management strategies.

Materials and methods

Electronic database and hand search were conducted to screen the literature published from January 1960 to June 2021. The selected studies had to report well-described SFE techniques, complications during, and post-SFE. Data extraction included types of SFE techniques, complications, and their treatment strategies.

Results

A total of 74 studies with 4411 SFE procedures met the inclusion criteria. Different SFE techniques demonstrated varying patterns for both complications and complication rates. Postoperative pain, swelling, and edema were widely reported. The most common complications that required intervention following Lateral SFE (LSFE) were sinus membrane perforation (SMP), wound dehiscence, graft exposure and failure, and sinusitis. LSFE had more SMPs and sinusitis cases compared with a transcrestal SFE (TSFE). The presence of benign paroxysmal positional vertigo following TSFE was significant in certain selected studies.

Conclusion

Given the inherent limitations, this systematic review showed distinct features of complications in SFE using varying techniques. Treatment planning for these procedures should incorporate strategies to avoid complication occurrence.

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Dose of deferasirox correlates with its effects, which differ between low‐risk myelodysplastic syndrome and aplastic anaemia

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Dose of deferasirox correlates with its effects, which differ between low-risk myelodysplastic syndrome and aplastic anaemia

This study retrospectively evaluated the efficacy, safety and dose–effect relationships of deferasirox (DFX) in patients with low-risk myelodysplastic syndrome (MDS) and aplastic anaemia (AA) who were refractory to regular treatment in a real-world setting. We found that a significant decrease in serum ferritin (SF) and an improvement in haematologic parameters, organ function and even overall survival (OS) can be achieved if the accumulated DFX dose reaches a certain level. Patients with low-risk MDS need a higher dose than those with AA.


Abstract

What is known and objective

Patients with low-risk myelodysplastic syndrome (MDS) and aplastic anaemia (AA) often need transfusions, which may accelerate iron overload. The aim of this study was to evaluate the efficacy, safety and dose–effect relationships of deferasirox (DFX) in patients with low-risk MDS and AA who were refractory to regular treatment in a real-world setting.

Methods

Patient data were recorded, and dose–effect relationships of DFX were calculated after the first 6 months. Total annual exposure to DFX was calculated after 12 months and expressed as the accumulated exposure time at a dosage of 20 mg/kg/day.

Results and discussion

Sixty-one patients with low-risk MDS and 51 with AA were enrolled. The minimum dosage of DFX needed for a significant serum ferritin (SF) decrease was 20 mg/kg/day at 6 months, and the minimum accumulation of DFX had to reach 9 months at 20 mg/kg/day by 12 months for patients with low-risk MDS. For patients with AA, the minimum dosage was 10 mg/kg/day at 6 months, and the minimum accumulation had to reach 3 months at 20 mg/kg/day by 12 months. With the same exposure, significant improvements in haematological parameters were also observed in AA. Lower liver enzymes compared with baseline were observed. Gastrointestinal disorders and elevated serum creatinine were the most common side effects. Higher exposure to DFX correlated with longer overall survival (OS).

What is new and conclusion

A significant decrease in SF and an improvement in haematologic parameters, organ function and even OS can be achieved if the accumulated DFX dose reaches a certain level. Patients with low-risk MDS need a higher dose than those with AA.

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Effect of body weight on bleeding events of aspirin in ischemic stroke or transient ischemic attack patients

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Effect of body weight on bleeding events of aspirin in ischemic stroke or transient ischemic attack patients

Bodyweight and combination with SSRIs are related to bleeding adverse reaction of aspirin. Patients weighted less than 60 kg will be at a higher risk of adverse bleeding events.


Abstract

What is Known and Objectives

Bleeding is the most common adverse reaction to aspirin and can lead to drug discontinuation or even be life-threatening in the secondary prevention of stroke or transient ischemic attack. The aim of this study was to evaluate risk factors for bleeding adverse reaction of aspirin in ischemic stroke or transient ischemic attack.

Methods

This retrospective analysis included patients treated with aspirin (100 mg) as a secondary prevention for ischemic stroke or transient ischemic attack. The bleeding events that occurred during the first year were collected, including gastrointestinal, skin, nasal cavity, gum, and urinary tract bleeding events. Then, univariate and multivariate logistic regression analyses were used to identify independent factors associated with bleeding events of aspirin.

Results and Discussion

A total of 578 patients were enrolled in this study, and 58 patients developed bleeding during the first year of secondary prevention. Body weight and combination with selective serotonin reuptake inhibitors were found to be significant risk factors for overall bleeding (p = 0.025 and 0.012). Body weight below 60 kg was a risk factor for overall bleeding and gastrointestinal bleeding events.

What is new and conclusion

Patients weighing less than 60 kg were at increased risk of bleeding with 100 mg aspirin for secondary prevention of cerebral infarction transient ischemic attack.

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The role of gastrointestinal pathogen PCR testing in liver transplant recipients hospitalized with diarrhea

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

Diarrhea is a common symptom among liver transplant (LT) recipients and can result in significant morbidity. The utility of PCR-based multiplex gastrointestinal (GI) pathogen panels in this population is unknown.

Methods

We assessed incidence, predictors, and outcomes of GI PCR positivity among inpatients who underwent stool pathogen testing with the FilmArray multiplex GI PCR panel at our institution within 1 year following LT from April 2015 to December 2019.

Results

112 patients were identified. 14 (12.5%) had a positive PCR for any pathogen. Escherichia coli (= 9) and Norovirus (= 5) were the most common pathogens detected. Recipients with a positive PCR were significantly further from LT (median 74.5 vs 15.5 days, p < 0.01) and tested earlier during hospitalization (median 1.0 vs 9.0 days, p < 0.01). C. difficile was positive in 20.0% of patients with a positive PCR and 11.4% with a negative PCR. CMV viremia was observed in 11.6% of patients, all in the negative PCR group. Following a positive PCR, patients were more likely to have a change in antimicrobial regimen (71.4% vs 28.6%, p = 0.02), a shorter length of stay (median 7.5 vs. 17.5 days, p < 0.01), and a trend toward lower rates of readmission and colonoscopy within 30 days.

Conclusions

In hospitalized LT recipients with diarrhea, GI PCR pathogen identification was associated with the use of targeted antimicrobial therapy and a shorter length of stay. GI PCR testing should be considered early during admission and later in the post-LT period.

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Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: a controlled clinical study

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Abstract

Background

Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion.

Objectives

To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study.

Methods

73 adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n=34) followed-up during a 6-months dietary program, and Gastroplasty group (GG; n=39) evaluated immediately before, 3, and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the 4 basic tastes were assessed. Two-way mixed model and sign test were applied.

Results

Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p<0.001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein, and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p<0.05).

Conclusion

After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed.

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Nanobots to eliminate bacteria in root canals – Nano Dentistry

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Nanobots in Root Canal Treatment

With millions of Root Canal Treatments being performed every day across the globe, it is important to make sure that Root Canal Treatment is successful in clearing out the bacteria form the Root canals to achieve the purpose of saving an infected tooth using root canal treatment. Disinfection protocol being used today includes mechanical preparation along with use of chemicals such as Sodium Hypochlorite, Hydrogen Peroxide, Chlorhexidine, etc along with Lasers a nd Ultrasonic devices. If these chemicals fail to penetrate the dentinal tubules, accessory canals, etc, proper disinfection cannot be achieved. This is where Nanobots have come into action in eliminating Bacteria in Root Canals which is being termed as - "Nano Dentistry" According to American association of endodontics over 25 millions of root canals are performed annually, over 90% are successful, remaining 10% failures are due to inadequate decontamination of root canal treatment. The dentinal tubules are very small, and the bacteria reside deep in the tissue. correct techniques are not efficient enough to go all the way inside and kill the bacteria. To address these treatment failures, researchers from the "Indian institute of science and nano robotics" company "Theranautilus"  have demonstrated that nano sized robots (nanobots) can effectively kill bacteria in the dentinal tubules. [caption id="attachment_6922" align="alignnone" width="549"]
Nanobots in Root Canal Treatment

Source - https://www.indiatoday.in/science/story/tiny-nanobots-in-teeth-can-kill-bacteria-help-better-dental-treatment-1950064-2022-05-16[/caption] How do Dental Nanobots work in Root Canal Treatment?  Dental Nanobots work by heating up their surface and in turn killing the bacteria in the canals with which they come in contact. So Nanobots use heat to disinfect the canals without the need for chemicals. According to the findings, nanobots were able to penetrate up to 2000um into dentinal tubules, thus achieving a vast improvement in penetration depth compared to laser activation and ultrasonic devices, researchers believe that using the heat to kill the bacteria is the safe alternative to using harsh chemicals agents or antibiotics to decontaminate a root canal. When the nanobots were injected into extracted tooth samples, the nanobots are penetrated deep inside the the dentinal tubules under the control of device that generates a low intensity magnetic field. By manipulating magnetic field, the researches were able to cause the surface of nanobots to generate heat to kill the bacteria nearby. To this end, researchers are currently developing a novel medical device that can be easily placed inside the patient mouth and allow the dentist to inject and manipulate the nanobots inside the teeth during the root canal therapy. Nanobots Or magnetically controlled nanoparticles have been used to trap and move objects using light, which pass through blood and tend to adhere to cancer cells. Researchers at Theranautilus, have used the dental nanoparticles on mice and have concluded them to be safe for use in Biological tissue. The study, titled "Mobile nanobots for prevention of root canal treatment failure", was published online on 28 April 2022 in Advanced Healthcare Materials, ahead of inclusion in an issue. References - Researchers use nanobots to eliminate bacteria in Root canals - Dental Tribune
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