Long‐term Outcomes of Vocal Fold Paralysis Following Patent Ductus Arteriosus Ligation in Neonates

alexandrossfakianakis shared this article with you from Inoreader Long‐term Outcomes of Vocal Fold Paralysis Following Patent Ductus Arteriosus Ligation in Neonates via The Laryngoscope Premature infants undergoing patent ductus arteriosus ligation are at risk for vocal fold paralysis leading to long term voice and swallowing complications. In this study, we review risk factors for vocal fold paralysis and offer insight into long term outcomes and further treatment needs in this unique patient population. Introduction In patients undergoing patent ductus arteriosus (PDA) ligation there is a significant risk of left vocal fold paralysis (LVFP) particularly in premature neonates who are small for gestational age. The objective of this study is to determine the incidence of LVFP in infants following PDA ligation and report on long-term outcomes in patients with LVFP. Methods We performed a prospective study of patients undergoing PDA ligation in the newborn intensive care unit (NICU) between April 2004 and May 2014. Following PDA ligation, flexible laryngoscopy was performed to assess vocal fold mobility. Patients were then followed longitudinally to determine long-term outcomes. Results A total of 163 infants underwent PDA ligation. Thirty-six patients (22%) developed LVFP following the procedure. Twenty-five percent of neonates <1500 g experienced LVFP versus 5% of patients >1500 g (p = 0.033). Patients with LVFP were more likely to require a feeding tube (64% vs. 19.6%; p < 0.05) and spent more time in the NICU (135 days vs. 106 days; p < 0.05). Twenty-four patients received long-term follow-up. Six (25%) had complete resolution of LVFP, 10 (42%) were compensated, and 8 (33%) demonstrated persistent LVFP with no improvement. Conclusions The incidence of LVFP after PDA ligation is high especially in extremely low birth weight children. The majority of patients recovered well with time, but further surgical intervention was required in uncompensated cases. Long-term follow-up of these patients is needed to ensure improvement. Laryngoscope, 2022 View on Web

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Development and validation of prognostic nomograms in patients with ascending type of nasopharyngeal carcinoma: A retrospective study based on SEER database

alexandrossfakianakis shared this article with you from Inoreader Development and validation of prognostic nomograms in patients with ascending type of nasopharyngeal carcinoma: A retrospective study based on SEER database via Head & Neck Abstract Background Nomograms specifically used to predict the prognosis of ascending type nasopharyngeal carcinoma (NPC) have not been constructed. Methods Data of ascending type (T3-4N0-1M0) NPC from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 were extracted. Results Altogether 862 patients with ascending type NPC were enrolled, including 603 in training cohort and 259 in validation cohort. Age, marital status, pathology, grade, tumor size, T classification, and chemotherapy were the independent prognostic factors for overall survival (OS). Age, marital status, pathology, grade, and chemotherapy were the independent prognostic factors for cancer-specific survival (CSS). In training cohort, the concordance index of the OS and CSS nomograms were 0.694 (95% confidence interval [CI], 0.677–0.711) and 0.678 (95%CI, 0.659–0.697), respectively, while those in validation cohort were 0.740 (95%CI, 0.715–0.765) and 0.708 (95%CI, 0.679–0.737), separately. Conclusion The as-constructed nomograms for ascending type NPC could provide accurate prognostic predictions of OS and CSS. View on Web

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Humoral response to heterologous prime‐booster vaccination in heart transplant recipients aged 18 to 70 years primed with a viral vector SARS‐CoV‐2 vaccine

alexandrossfakianakis shared this article with you from Inoreader Humoral response to heterologous prime‐booster vaccination in heart transplant recipients aged 18 to 70 years primed with a viral vector SARS‐CoV‐2 vaccine via Transplant Infectious Disease Abstract Background Solid organ transplant recipients have demonstrated a blunted immune response to standard 2-dose vaccination against SARS-CoV-2. This study sought to determine the humoral response to heterologous booster vaccination (viral vector vaccine dose 1 and 2 + mRNA booster). Methods Heart transplant recipients, aged 18 to 70 years of age who initially received two doses of the viral vector ChAdOx1 nCoV-19 vaccine followed by a BNT162b2 mRNA booster were recruited. A detectable antibody response in the absence of prior SARS-CoV-2 was the primary outcome measured. This was defined as an anti-spike titre of ≥0.8 U/mL on the Elecsys anti-SARS-CoV-2 S immunoassay. Results A total of 80 heart transplant patients (mean age 49±13 years, 28% female) were included. Blood samples were drawn at a median of 30 (IQR 28–33) days after the BNT162b2 mRNA booster. The frequency of a detectable antibody response increased from 37.5% (n = 30) after dose 2 to 56% (n = 45) post dose 3 (p<0.001). A non-detectable antibody response was significantly more common in recipients with a shorter time interval from transplantation (p<0.001), lower likelihood of cardiac allograft vasculopathy (p = 0.003) and in those prescribed a triple versus dual immunosuppressant regime (p = 0.009) and a tacrolimus versus cyclosporine based-regimen (p = 0.007). Conclusion Despite heterologous prime-booster vaccination 44% of this vulnerable population ultimately continue to have no detectable antibodies. This article is protected by copyright. All rights reserved View on Web

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Impact of antimetabolite discontinuation following cytomegalovirus or BK polyoma virus infection in kidney transplant recipients

alexandrossfakianakis shared this article with you from Inoreader Impact of antimetabolite discontinuation following cytomegalovirus or BK polyoma virus infection in kidney transplant recipients via Transplant Infectious Disease Abstract Background Development of cytomegalovirus (CMV) and BK polyoma virus (BKV) infection following kidney transplantation have been associated with allograft dysfunction and allograft loss. Reduction in immunosuppression is a mainstay of management yet has been associated with increased risk of rejection. According to international consensus guidelines, one approach to management of these viral infections is to discontinue the antimetabolite. Little is known surrounding long-term outcomes in these patients, and it remains unclear if consideration should be given to resuming the antimetabolite as variable re-escalation strategies have been reported. The objective was to describe episodes of rejection and identify risk factors for rejection following antimetabolite withdrawal after CMV or BKV DNAemia in kidney transplant recipients. Methods This single-center, retrospective review evaluated adult kidney transplant recipients with a serum CMV or BKV DNA PCR ≥ 500 copies/mL who underwent antimetabolite discontinuation. The primary outcome assessed was the incidence of biopsy-proven acute rejection (BPAR). Results 159 patients were included. Overall, 14 patients (8.8%) experienced BPAR at a median of 1.6 years after antimetabolite discontinuation. Compared to CMV, discontinuation after BKV DNAemia was associated with a higher incidence of BPAR. Characteristics observed more frequently in patients with BPAR included younger age, female sex, higher initial viral load, and development of de novo donor-specific antibody (DSA). Conclusion These findings suggest that antimetabolite discontinuation after CMV or BKV DNAemia in kidney transplant recipients is a reasonable and safe approach. Further prospective studies investigating optimal immunosuppression management following CMV or BKV DNAemia in kidney transplant recipients are warranted. This article is protected by copyright. All rights reserved View on Web

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Evolution and transmission of cefiderocol-resistant Acinetobacter baumannii during an outbreak in the burn intensive care unit

alexandrossfakianakis shared this article with you from Inoreader Evolution and transmission of cefiderocol-resistant Acinetobacter baumannii during an outbreak in the burn intensive care unit via Clinical Infectious Diseases Advance Access Abstract We report 11 critically-ill burn patients treated with cefiderocol for carbapenem-resistant Acinetobacter baumannii infections. Clinical success was achieved in 36% and complicated by treatment-emergent resistance and inter-patient transmission of cefiderocol-resistant A. baumannii between patients. Resistant isolates harbored disrupted pirA and piuA gen es that were not disrupted among susceptible isolates. View on Web

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Novel mutations in antiviral multiresistant HSV‐2 genital lesion: a case report

alexandrossfakianakis shared this article with you from Inoreader Novel mutations in antiviral multiresistant HSV‐2 genital lesion: a case report via Journal of Medical Virology ABSTRACT Introduction HSV-2 antiviral resistance mainly occurs in immunocompromised patients and especially in HIV-positive individuals receiving long-term antiviral treatment. Those situations can be challenging as few alternatives are available for HSV infection management. Objective To describe clinical and virological significance of two novel potential HSV-2 resistance mutations after treating an obese patient with a pseudotumoral genital HSV-related lesion. Results Consecutive different antiviral treatments were used: valacyclovir (VACV) then foscarnet (FOS) then topical cidofovir (CDV) and finally imiquimod. Under VACV, genotypic resistance testing revealed a novel mutation within viral thymidine kinase (TK, gene UL23) not previously reported but probably accounting for antiviral resistance: W89G, similar to W88R mutation reported in HSV-1 TK, known to be associated with ACV resistance for HSV-1. Under FOS, while initial mutations were still prese nt, a second genotypic resistance testing performed on persisting lesions showed a novel mutation within viral DNA polymerase (DNA pol, gene UL30): C625R. All three antivirals used in this case are small molecules and pharmacokinetics of VACV, FOS, and CDV have not been evaluated in animals and there are very few studies in human. As small molecules are poorly bound to proteins and distribution volume is increased in obese patients, there is risk of underdosage. This mechanism is suspected to be involved in emergence of resistance mutation and further data is needed to adapt, closely to patient profile, antiviral dosage. Conclusions This report describes a chronic HSV-2 genital lesion, with resistance to current antivirals and novel mutations within viral TK and DNA pol which may confer antiviral resistance. This article is protected by copyright. All rights reserved. View on Web

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Benign stratified intraepithelial mucinous proliferation of the uterine cervix: Significance of a previously unreported potential mimic of SMILE

alexandrossfakianakis shared this article with you from Inoreader Benign stratified intraepithelial mucinous proliferation of the uterine cervix: Significance of a previously unreported potential mimic of SMILE via Annals of Diagnostic Pathology Publication date: Available online 17 August 2022 Source: Annals of Diagnostic Pathology Author(s): Elizabeth Arslanian, Kamaljeet Singh, Katrine Hansen, M. Ruhul Quddus View on Web

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Onkolytische Virotherapie bei Kopf-Hals-Karzinomen

alexandrossfakianakis shared this article with you from Inoreader Onkolytische Virotherapie bei Kopf-Hals-Karzinomen via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1901-9214 Ziel Onkolytische Viren (OV) infizieren und töten Krebszellen und lösen eine antitumorale Immunantwort aus. Durch ihr Potenzial, die Immunresistenz von Tumoren zu durchbrechen, könnten OV eine zukünftige zusätzliche Behandlungsoption bei Patient*innen mit fortgeschrittenen Kopf-Hals-Karzinomen (HNC) sein. Wirkungsweise und Modifikationen der OV zur Behandlung von HNC werden erläutert, ebenso die Risiken bei der Anwendung. Ergebnisse präklinischer und klinischer Studien werden vorgestellt. Methoden Präklinische und klinische Studien zu OV und HNC wurden in der PubMed-Literaturdatenbank und internationalen Studienregistern analysiert. Untersuchungen zum onkolytischen Herpes-Simplex-Virus (HSV), Adenovirus, Vacciniavirus und Reovirus wurden ausgewählt. Ergebnisse In jüngsten präklinischen Studien wurde eine verstärkte Infektion und Abtötung von Tumorzellen durch OV mit Kapsid- und Genommodifikationen beschrieben. Die meisten klinischen Studien waren Phase-I/II-Studien. In Phase-III-Studien wurden nach Behandlung mit onkolytischem HSV, Adenoviren und Reoviren eine partielle Tumorregression und ein verlängertes Überleben beobachtet. In den meisten Studien wurden OV mit Radiochemotherapie oder Immuntherapie kombiniert. Schlussfolgerung In den vorliegenden Studien war die OV-Therapie zur Behandlung von Patient*innen mit HNC sicher, oft gut verträglich und zeigte vielversprechende Ergebnisse in Hinsicht auf Ansprechen und Überleben, insbesondere in Kombination mit einer Radiochemotherapie oder Checkpoint-Inhibitoren. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

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Tension pneumocephalus: case report and review

alexandrossfakianakis shared this article with you from Inoreader Tension pneumocephalus: case report and review via International Journal of Oral and Maxillofacial Surgery via MedWorm.com This report presents a case of traumatic tension pneumocephalus associated with an anterior and posterior table frontal sinus fracture in a patient with pneumosinus dilatans and osteogenesis imperfecta. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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Effect of cut‐out rescan procedures on the accuracy of an intraoral scanner used for digitizing an ear model: An in vitro study

alexandrossfakianakis shared this article with you from Inoreader Effect of cut‐out rescan procedures on the accuracy of an intraoral scanner used for digitizing an ear model: An in vitro study via Journal of Prosthodontics Abstract Purpose The purpose of this study was to evaluate the impact of the rescanning of mesh holes of different diameters on the accuracy of an intraoral scanner (IOS) used to digitize an ear model. Materials and methods An ear model was digitized using an intraoral scanner (Medit i500) to obtain a reference mesh. A baseline experimental scan was created by editing a duplicate of the reference mesh using the cut-out tool of the IOS software. Three equal groups were created based on the diameter of the cut-out areas: 2-mm (G1), 5mm (G2), and 8-mm (G3) (n = 15). The cut-out areas were rescanned and a total of 45 digital files were exported. The discrepancy between the reference and the experimental digital scans was measured using the root mean square calculation (RMS). The data were analyzed by a Kruskal–Wallis test followed by a post hoc Dunn's test with Bonferroni correction. Results The trueness values ranged from 19.53 to 27.13 μm. There were significant differences in the RMS error values among the groups tested (p<.001) and post hoc multiple comparisons showed significant differences between the G1 and G2 groups (p = .04), G1 and G3 groups (p<.001), and G2 and G3 groups (p = .004). Overall, the precision values ranged from 4.93 to 7.73 μm and significant differences in the RMS values were only found between the G1 and G2 groups (p = .014). Conclusions Mesh hole rescanning affected the scanning accuracy (trueness and precision) of the IOS tested. The larger the diameter of the mesh holes, the less the trueness of the IOS tested. The precision values seemed to be less affected compared with the trueness by the cut-out and rescanning procedures. This article is protected by copyright. All rights reserved View on Web

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