Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B

alexandrossfakianakis shared this article with you from Inoreader Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B via Journal of Medical Virology Abstract Background/Aims Nucleos(t)ide analogs (NA) cannot completely suppress the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This study aimed to identify the risk factors for HCC development in naïve CHB patients treated with current NA. Methods Patients receiving NA (n = 905) were recruited retrospectively from the 17 hospitals of the Japanese Red Cross Liver Study Group. All treatment-naïve patients had been receiving current NA continuously for more than one year until the end of the follow-up. We analyzed the accuracy of predictive risk score using area under receiver operating characteristic curve. Results The albumin–bilirubin (ALBI) score was significantly improved by NA therapy (−0.171 ± 0.396; p < 0.001 at week 48). A total of 72 (8.0%) patients developed HCC over a median follow-up of 6.2 (1.03–15.7) years. An independent predictive factor of HCC development was older age, cirrhosis, lower pl atelet counts at baseline and ALBI score, and alpha-fetoprotein (AFP) at 1 year after NA therapy according to multivariate analysis. The accuracy was assessed using the PAGE-B, mPAGE-B, aMAP, APA-B, and REAL-B scores that included these factors. Discrimination was generally acceptable for these models. aMAP and REAL-B demonstrated high discrimination with 0.866/0.862 and 0.833/0.859 for 3- and 5- years prediction from the status of one year after NA therapy, respectively. Conclusion Baseline age and platelet count, as well as ALBI and AFP one year after NA, were useful for stratifying carcinogenesis risk. The aMAP and REAL-B scores were validated with high accuracy in Japanese CHB patients. This article is protected by copyright. All rights reserved. View on Web

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Heparin‐induced persistent hyperthermia with recurrent hyponatremia in hip fracture: Case report and review of literature

alexandrossfakianakis shared this article with you from Inoreader Heparin‐induced persistent hyperthermia with recurrent hyponatremia in hip fracture: Case report and review of literature via Journal of Clinical Pharmacy and Therapeutics Heparin is a commonly used anticoagulant in clinical practice. Few reports have been published of drug fever or hyponatremia caused by heparin, whose mechanism is still unclear. Here, we report a case of femoral neck fracture with persistent hyperthermia and recurrent hyponatremia caused by heparin, which was analyzed to provide novel insights and further reference for the clinical diagnosis of drug fever. Abstract What is Known and Objective Heparin is a commonly used anticoagulant in clinic. Persistent hyperthermia with recurrent hyponatremia caused by heparin is an extremely rare drug fever, which is difficult to judge in the early stage and is often misdiagnosed. Case Summary A 74-year-old elderly woman was admitted to our hospital due to left hip pain with limited mobility for 9 h. She was diagnosed with a femoral neck fracture, and continuous heparin anticoagulation was initiated. On the night of surgery, the patient developed high fever with a drop in the serum sodium concentration. Based on the patient's symptoms, signs, and results of the laboratory tests, postoperative absorptive heat and infectious fever were ruled out. After heparin discontinuation, her temperature and serum sodium concentration returned to the baseline levels. What is New and Conclusion Heparin can cause persistent or recurrent hyponatremia and should be considered in the identification of the aetiology this condition. View on Web

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Phytomedicine ELOM‐080 in Acute Viral Rhinosinusitis: A Randomized, Placebo‐Controlled, Blinded Clinical Trial

alexandrossfakianakis shared this article with you from Inoreader Phytomedicine ELOM‐080 in Acute Viral Rhinosinusitis: A Randomized, Placebo‐Controlled, Blinded Clinical Trial via The Laryngoscope This state-of-the-art DBPC-trial demonstrates significant superiority of herbal phytomedicine treatment in the reduction of Acute Viral Rhinosinusitis symptom severity and earlier improvement of symptoms when compared to placebo. Furthermore, this is the first RCT conducted with a herbal medicinal product that additionally investigated the influence of treatment on the viral load within samples from affected patients. Background ELOM-080 is a phytomedicine approved for the treatment of acute and chronic inflammatory diseases of the respiratory tract, sinusitis, and bronchitis in particular. This prospective, randomized, placebo-controlled, double-blind clinical trial was conducted to assess efficacy and safety of ELOM-080 in the treatment of acute viral rhinosinusitis (AVRS). Methods Patients with AVRS received oral treatment (4 × 1 capsule per day) with either ELOM-080 or matching placebo. Primary endpoints were the change in major symptom score (MSS) after 7 and 14 days of treatment assessed by the investigator (MSSINV). Secondary endpoints were changes in MSS assessed by the patients (MSSPAT), olfactory function (12-item Sniffin' Sticks), 20-Item Sino-Nasal Outcome Test (SNOT-20 GAV; German adapted version), influence of treatment on viral load, and safety. Results Four hundred and sixty-three patients were randomized. At day 4, subjective burden of disease (MSS) was significantly ameliorated compared to placebo (p = 0.012). During the first treatment week MSS scores improved about 1 day earlier, and 3 days earlier in the second week. Effect with ELOM-080 on mean MSSINV was statistically significantly superior to placebo at visit 3 (p = 0.016) and visit 4 (p = 0.014). In chemosensory testing identification scores improved comparably in both treatments. The improvement of the SNOT-20 GAV was more pronounced in ELOM-080 patients. Treatment with ELOM-080 indicated a potential for decreasing viral load. Both treatments were well tolerated. Conclusion ELOM-080 improves the burden of AVRS significantly in comparison to placebo, remission of symptoms occurred 3 days earlier. The results confirm the efficacy and safety of ELOM-080 for treatment of AVRS. Level of Evidence 1 Laryngoscope, 2022 View on Web

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Symptom Localization May Differentiate Subtypes of Eustachian Tube Dysfunction

alexandrossfakianakis shared this article with you from Inoreader Symptom Localization May Differentiate Subtypes of Eustachian Tube Dysfunction via The Laryngoscope A cross-sectional study evaluating the use of patient-localizing symptoms in the diagnosis of eustachian salpingitis (ES) and obstructive eustachian tube dysfunction (OETD) was performed. Patients with symptoms localizing to the infratemporal fossa were more likely to have ES compared to those localizing to the external auditory canal, which had OETD. These exam findings may be helpful to screen patients with vague aural symptoms and prompt appropriate work up for underlying pathology of the eustachian tube. Objective To evaluate the predictive ability of symptom self-localization to distinguish obstructive eustachian tube dysfunction from non-obstructive salpingitis. Methods Adult (age ≥18 years) patients with a primary complaint of aural discomfort who underwent diagnostic nasal endoscopy and tympanometry at a tertiary academic center were enrolled. Symptoms were self-localized by using a single finger on the affected side. All patients completed the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and underwent scoring of eustachian tube inflammation using the Endoscopic Evaluation of the Eustachian Tube (3ET) system. Results Seventy-three patients were included in the study. Symptoms were localized to the external auditory canal (EAC) in 28 (38.4%), to the infratemporal fossa (ITF) below the lobule in 37 (50.7%), and to the preauricular region in 8 (11.0%). Demographics and medical history were similar between groups. The EAC group had significantly more negative tympanometric peak pressure (TPP) (median, −92.0 daPa; IQR, 95.5) and higher 3ET scores. In contrast, the ITF group had normal TPP (median, −2.0 daPa; IQR, 7.0) and higher 3ET scores. The preauricular group was more likely to have temporomandibular joint or pterygoid muscle pain. ETDQ-7 scores did not differ significantly between groups. Conclusion Symptom localization is associated with specific objective findings in the evaluation of aural discomfort. Patients with pain localizing to the ITF are more likely to have findings of eustachian tube salpingitis without obstruction whereas patients with symptoms deep in the EAC are more likely to have findings consistent with obstructive eustachian tube dysfunction. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Blood eosinophil count in the diagnosis of allergic‐like rhinitis with chronic rhinosinusitis

alexandrossfakianakis shared this article with you from Inoreader Blood eosinophil count in the diagnosis of allergic‐like rhinitis with chronic rhinosinusitis via Clinical Otolaryngology Abstract Background Allergic rhinitis (AR) and nonallergic rhinitis (NAR) often are comorbid with chronic rhinosinusitis (CRS). Finding a convenient test that distinguishes these complex conditions is helpful for effective treatment. We aimed to analyze blood parameter differences between AR and NAR patients with/without CRS. Methods Eight hundred thirteen patients, including AR and NAR with different conditions (CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP)) were analyzed in this retrospective study. Patients with a nasal deviation alone were included as healthy controls (HC). ROC analysis was used to assess the value of blood parameters for diagnosing AR or NAR with/without CRS. Results Compared to nonallergic-like rhinitis (HC, CRSwNP and CRSsNP), the blood eosinophil count was significantly increased in the allergic-like rhinitis groups, except for NAR-CRSsNP (AR, AR-CRSwNP, AR-CRSsNP, NAR and NAR-CRSwNP). The NAR-CRSsNP group had a higher level of eosinophils than the HC and CRSsNP groups. Among allergic-like rhinitis patients, eosinophils were higher in allergic-like rhinitis patients with CRSwNP (AR-CRSwNP and NAR-CRSwNP) than in allergic-like rhinitis patients without CRSwNP (AR, AR-CRSsNP, NAR and NAR-CRSsNP). However, no difference in blood eosinophils was observed between AR and NAR. There was also no difference among nonallergic-like rhinitis patients. Similar findings were found for the blood eosinophil proportion. Furthermore, the blood eosinophil count was a good predictor of allergic-like rhinitis, especially allergic-like rhinitis with CRSwNP. Conclusion The blood eosinophil count and proportion may be good diagnostic predictors of allergic-like rhinitis but cannot differentiate between AR and NAR. This indicator may be much better in predicting allergic-like rhinitis with CRSwNP. This article is protected by copyright. All rights reserved. View on Web

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Wastewater Surveillance for Infectious Disease: A Systematic Review

alexandrossfakianakis shared this article with you from Inoreader Wastewater Surveillance for Infectious Disease: A Systematic Review via American Journal of Epidemiology - Advance Access Abstract Wastewater surveillance of SARS-CoV-2 has been shown to be a valuable source of information regarding SARS-CoV-2 transmission and COVID-19 cases. Though the method has been used for several decades to track other infectious diseases, there has not been a comprehensive review outlining all of the pathogens that have been surveilled through wastewater. Herein we identify what infectious diseases have been previously studied via wastewater surveillance prior to the COVID-19 pandemic. Infectious diseases and pathogens were identified in 100 studies of wastewater surveillance across 38 countries, as well as themes of how wastewater surveillance and other measures of disease transmission were linked. Twenty-five separate pathogen families were identified in the included studies, with the majority of studies examining pathogens from the family Picornaviridae, including polio and non-polio enteroviruses. Most studies of wastewater surveillance did not li nk what was found in the wastewater to other measures of disease transmission. Among those studies that did, the value reported varied by study. Wastewater surveillance should be considered as a potential tool for many infectious diseases. Wastewater surveillance studies can be improved by incorporating other measures of disease transmission at the population-level including disease incidence and hospitalizations. View on Web

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Hypermitotic meningiomas harbor DNA methylation subgroups with distinct biological and clinical features

alexandrossfakianakis shared this article with you from Inoreader Hypermitotic meningiomas harbor DNA methylation subgroups with distinct biological and clinical features via Neuro-Oncology Advance Access Abstract Background Meningiomas, the most common primary intracranial tumors, can be separated into 3 DNA methylation groups with distinct biological drivers, clinical outcomes, and therapeutic vulnerabilities. Alternative meningioma grouping schemes using copy number variants, gene expression profiles, somatic short variants, or integrated molecular models have been proposed. These data suggest meningioma DNA methylation groups may harbor subgroups unifying contrasting theories of meningioma biology. Methods 565 meningioma DNA methylation profiles from patients with comprehensive clinical follow-up at independent discovery (n=200) or validation (n=365) institutions were re-analyzed and classified into Merlin-intact, Immune-enriched, or Hypermitotic DNA methylation groups. RNA sequencing from the discovery (n=200) or validation (n=302) cohort were analyzed in the context of DNA methylation groups to identify subgroups. Biological featur es and clinical outcomes were analyzed across meningioma grouping schemes. Results RNA sequencing revealed differential enrichment of FOXM1 target genes across 2 subgroups of Hypermitotic meningiomas. Differential expression and ontology analyses showed the subgroup of Hypermitotic meningiomas without FOXM1 target gene enrichment was distinguished by gene expression programs driving macromolecular metabolism. Analysis of genetic, epigenetic, gene expression, or cellular features revealed Hypermitotic meningioma subgroups were concordant with Proliferative or Hypermetabolic meningiomas, which were previously reported alongside Merlin-intact and Immune-enriched tumors using an integrated molecular model. The addition of DNA methylation subgroups to clinical models refined prediction of postoperative outcomes compared to the addition of DNA methylation groups. Conclusions Meningiomas can be separated into 3 DNA methylation groups and Hypermitotic meningiomas can be su bdivided into Proliferative and Hypermetabolic subgroups, each with distinct biological and clinical features. View on Web

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Sociodemographic Disparities in the Diagnostic Management of Pediatric Thyroid Nodules

alexandrossfakianakis shared this article with you from Inoreader Sociodemographic Disparities in the Diagnostic Management of Pediatric Thyroid Nodules via JAMA Otolaryngology–Head & Neck Surgery Online First This cross-sectional study assesses the association of sociode mographic factors with the odds of receiving a biopsy, timeliness of the procedure, and risk of nodule malignancy. View on Web

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Use of Tumor Bed Frozen Section to Assess Final Tumor Margin in Oral Cavity Carcinoma

alexandrossfakianakis shared this article with you from Inoreader Use of Tumor Bed Frozen Section to Assess Final Tumor Margin in Oral Cavity Carcinoma via JAMA Otolaryngology–Head & Neck Surgery Current Issue This cross-sectional study evaluates the accuracy and imp lications of using intraoperative frozen section histopathology samples to assess tumor bed margins in patients undergoing surgery for oral cavity squamous cell carcinoma. View on Web

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Association of Stapedotomy Volume and Patient Sex With Better Outcome

alexandrossfakianakis shared this article with you from Inoreader Association of Stapedotomy Volume and Patient Sex With Better Outcome via JAMA Otolaryngology–Head & Neck Surgery Current Issue This cross-sectional study evaluates demographic characte ristics, surgical characteristics, and audiometric data associated with closure of the air-bone gap to less than 10 dB or 15 dB. View on Web

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