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Τετάρτη 3 Αυγούστου 2022

Combination therapy with remdesivir and immunomodulators improves respiratory status in COVID‐19: A retrospective study

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Abstract

Immunomodulators (tocilizumab/baricitinib) improve outcomes of coronavirus disease (COVID-19) patients, but the synergistic effect of remdesivir is unknown. The effect of combination therapy with remdesivir, immunomodulators, and standard treatment in COVID-19 patients was investigated. This retrospective, single-center study included COVID-19 patients who were treated with tocilizumab or baricitinib. The severity of respiratory status in the two groups on day 14 and day 28 and the duration to respiratory recovery in both groups were compared, and the effect of remdesivir use on respiratory status was examined in a multivariate analysis. Ninety-eight patients received tocilizumab or baricitinib; among them, 72 used remdesivir (remdesivir group) and 26 did not (control group). The remdesivir group achieved faster respiratory recovery than the control group (median 11 days vs. 21 days, p=0.033), faster weaning from supplemental oxygen (HR 2.54, 95% CI 1 .14–5.66, p=0.021). Age, body mass index, diabetes mellitus, and time from onset to oxygen administration were independent prognostic factors. The remdesivir group achieved better severity level at days 14 and 28 (p=0.033 and 0.003, respectively) and greater improvement from baseline severity (p=0.047 and 0.018, respectively). Remdesivir combination therapy did not prolong survival (HR 0.31, 95% CI 0.04–2.16, p=0.23). Among severely ill COVID-19 patients who received immunomodulator, remdesivir contributed to a shorter respiratory recovery time and better respiratory status at days 14 and 28. Concomitant remdesivir with immunomodulators and standard treatment may provide additional benefit in improving respiratory status of COVID-19 patients.

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Clinical characteristics, outcomes, and seasonality of acute respiratory infection associated with single and co‐detected rhinovirus species among hospitalized children in Amman, Jordan

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Abstract

Background

Rhinovirus (RV)-specific surveillance studies in the Middle East are limited. Therefore, we aimed to study the clinical characteristics, outcomes, and seasonality of RV-associated acute respiratory infection among hospitalized young children in Jordan.

Methods

We conducted a prospective viral surveillance study and enrolled children <2 years old admitted to a large public hospital in Amman, Jordan (2010–2013). Demographic and clinical data were collected by structured interviews and chart abstractions. Nasal and/or throat swabs were collected and tested for a panel of respiratory viruses, and RV genotyping and speciation was performed.

Results

At least one virus was detected in 2,641/3,168 children (83.4%). RV was the second most common virus detected (n=1,238; 46.9%) and was co-detected with another respiratory virus in 730 cases (59.0%). Children with RV co-detection were more likely than those with RV-only detection to have respiratory distress but had similar outcomes. RV-A accounted for about half of RV-positive cases (54.7%), while children with RV-C had a higher frequency of wheezing and reactive airway disease. RV was detected year-round and peaked during winter.

Conclusions

Though children with RV co-detection had worse clinical findings, neither co-detection nor species affected most clinical outcomes.

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The diagnostic yield of head and neck imaging in symptomatic patients with a normal clinical examination

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Abstract

Aim

Nationally, concern has been raised about the overuse of diagnostic testing. In patients with unilateral otalgia and no history of Head and Neck Cancer (HNC), 1% had a malignancy detected on imaging that was not detected on clinical examination.

Methods

We performed a retrospective review of "MRI soft tissue neck" scans performed at our hospital from May 2020 to May 2021. Patients were excluded if their scan was not ordered for HNC symptoms. Previous HNC patients undergoing follow-up imaging were also included.

Results

In total, 326 scan requests were analyzed. Of the 132 patients without clinical features of overt disease, only one received a new diagnosis of HNC. This patient had previously had a HNC and was undergoing routine follow-up imaging.

Conclusion

Our data demonstrate that performing MRI scans in symptomatic patients with a normal examination, FNE, and no history of HNC does not benefit the diagnosis or management of these patients.

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Overexpression of circFNDC3B promotes the progression of oral tongue squamous cell carcinoma through the miR‐1322/MED1 axis

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Abstract

Background

The potential role of circFNDC3B in regulating oral tongue squamous cell carcinoma development (OTSCC) remains unknown.

Methods

The level of circFNDC3B in OTSCC tissues or cell lines was measured and its function in vitro and in vivo was analyzed. Interactions among circFNDC3B, miR-1322, and MED1 were verified by luciferase reporter and RNA pull-down assays.

Results

The level of circFNDC3B in tissues or cell lines of OTSCC was higher than that in control groups. siRNA-mediated circFNDC3B inhibition resulted in weakened proliferation, migration, and invasion, which was reversed by miR-1322. Overexpression of MED1 in OTSCC cells partially reversed the tumor suppression functions of si-circFNDC3B or miR-1322 mimics in vitro. circFNDC3B overexpression dramatically promoted tumor growth in vivo. circFNDC3B directly bound with miR-1322 and consequently promoted the MED1 expression in OTSCC cells.

Conclusions

The circFNDC3B/miR-1322/MED1 axis participates in OTSCC progression, which may provide novel therapeutic targets for OTSCC.

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Particular body odors matter: Disgust sensitivity differs across attachment groups

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Abstract

Extensive research has highlighted how one's attachment style influences the development and maintenance of romantic relationships. Disgust is a construct that conceptually overlaps with attachment style given both include elements of behavioral avoidance. However, no previous study has examined how one's attachment style may influence disgust-based avoidance of intimacy in romantic relationships. Therefore, the aim of the current study is to determine if adult attachment style is associated with olfactory disgust ratings towards eight body odor (BO) sources from their partner, previous partner, or others. The results revealed that disgust ratings of a partner's BO differed depending on attachment style. Specifically, the participants with a dismissing-avoidant attachment style rated their partner's BO as more disgusting than the secure, fearful-avoidant, or preoccupied styles. Moreover, participants with a dismissing-avoidant attachment style rated their partner's and strangers' BO equally disgusting whereas those in the other attachment groups rated strangers' BO as more disgusting than their partner's.

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Posttreatment FDG‐PET/CT Hopkins criteria predict locoregional recurrence after definitive radiotherapy for oropharyngeal squamous cell carcinoma

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Abstract

Background

Metabolic response assessment for oropharyngeal squamous cell carcinoma (OPSCC) aids in identifying locoregional persistence/recurrence (LRR). The Hopkins Criteria are a standardized qualitative response assessment system using posttreatment FDG-PET/CT.

Methods

We conducted a retrospective cohort study of patients with node-positive OPSCC treated with definitive (chemo)radiotherapy. We assessed Hopkins Criteria performance for LRR, then developed and validated a competing-risks model.

Results

Between 2004 and 2018, 259 patients were included with median follow-up of 43 months. The Hopkins Criteria sensitivity, specificity, negative predictive value, and accuracy were 68%, 88%, 95%, and 85%. The 36-month cumulative incidence of LRR was greater with positive scores (45% vs. 5%, HR 12.60, p < 0.001). PET/CTs performed ≤10 weeks after radiotherapy were associated with a four-fold increase in pathologically negative biopsies/surgeries (36% vs. 9%, p = 0.03). The AUC for LRR was 0.89 using a model integrating the Hopkins score.

Conclusions

The Hopkins Criteria predict LRR with high accuracy for OPSCC response assessment.

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A systematic review of the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with obstructive sleep apnoea

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Abstract

Introduction

Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA.

Methods

We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was done. The protocol of this systematic review was registered with PROSPERO (CRD42021273451).

Results

A total of 1836 patients from ten observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported.

Conclusion

Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria.

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Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes

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Impact of Socioeconomic Demographics and Race on Laryngotracheal Stenosis Etiology and Outcomes

Our retrospective cohort study identified that Black patients comprised the greatest proportion of patients with iatrogenic laryngotracheal stenosis. Of all etiologies, the iatrogenic form of stenosis had the highest incidence of temporary tracheostomy and tracheostomy dependence.


Objective

Certain sociodemographic variables are known to result in health care disparities. This study investigates potential differences in outcomes for patients with laryngotracheal stenosis (LTS) based on racial backgrounds and socioeconomic variables including insurance status and English language-Proficiency.

Methods

Patients with LTS from 2016 to 2021were identified by relevant ICD codes. Variables including race, age, gender, language preference and insurance status were collected from medical records. Risk factors for LTS including COPD, smoking history, diabetes, GERD, and BMI were obtained. Etiology of LTS was categorized as autoimmune, traumatic, iatrogenic, or idiopathic. Need for temporary tracheostomy and tracheostomy dependence were determined at last follow-up visit.

Results

129 patients were included for review. 70% of Black patients had iatrogenic LTS, whereas 65% of the White patient cohort had autoimmune or idiopathic LTS. Black patients were more strongly associated with temporary tracheostomy and tracheostomy dependence compared to White patients. Public health insurance and co-morbid GERD were associated with tracheostomy dependence for White patients only.

Conclusion

This study identified a disproportionate representation of Black patients in the iatrogenic etiology of LTS. Although controlling for risk factors of LTS, this cohort had an increased need for temporary tracheostomy and tracheostomy dependence compared to White and Latinx cohorts. This finding merits further study.

Level of Evidence

III Laryngoscope, 2022

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Extrarenal Wilms tumor with hypertension and dilated cardiomyopathy in an infant: A report of an unusual case

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Abstract

While Wilms tumors are the most frequently detected kidney cancer type in children, extrarenal Wilms tumors (ERWTs) remain rare. This report is the first to describe hypertension and dilated cardiomyopathy in a patient with an ERWT. A 6-month-old male infant presented with an abdominal mass and paroxysmal hypertension; echocardiography revealed dilated cardiomyopathy with an ejection fraction of 34%, as well as substantially increased plasma renin activity. Pathology yielded a definitive diagnosis of ERWT. Cardiac function and blood pressure gradually returned to normal after tumorectomy. The early diagnosis of such a tumor together with efficient oncologic treatment are vital to optimal patient outcomes.

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Perception of orbital epitheses evaluated with eye tracker

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Abstract

Purpose

Orbital epitheses replace a missing eyeball and surrounding soft tissue. Perception of epithesis in public gaze and the attention areas on the face are of interest. This study aimed to examine the differences in perception of orbital epitheses by prosthodontists, dentistry students, and laypeople with an objective evaluation tool that utilized eye-tracking technology.

Materials and methods

Twenty-four frontal facial images of 12 patients who had orbital epitheses were viewed by 81 observers (prosthodontists, dentistry students, laypeople) in random order for 5 seconds each. Gaze data were analyzed. Kruskal-Wallis H test with Bonferroni correction was used to compare parameters in groups and areas of interest.

Results

First fixation duration at the mouth for symmetrical images were 0.30, 0.28, and 0.25 seconds for prosthodontists, students, and laypeople, respectively. Fixation duration at mouth for the laypeople (0.27s) was shorter than students (0.29s) and prosthodontists (0.31s) at symmetrical images. Time to the first fixation to epithesis, nose, and eye was significantly lower than the forehead and mouth for all groups. Fixation count at epithesis was 6.36 for prosthodontists, 5.64 for students, and 5.34 for laypeople.

Conclusion

Eyes were of most significant interest for all observer groups in symmetrical images. Individuals dealing with dentistry, especially prosthodontists, paid more attention to the mouth region along with the eyes in symmetrical images, considering fixation duration and fixation count. Attention directed to epithesis by all groups was verified with objective and measurable criteria. Prosthodontists' attention to epithesis and mouth was evident considering the four parameters measured.

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