Αναζήτηση αυτού του ιστολογίου

Τετάρτη 2 Νοεμβρίου 2022

Comparison of clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Objectives

This study is aimed to investigate the differences in the clinical features and surgical outcomes between hypopnea- and apnea-predominant obstructive sleep apnea (OSA).

Design

Cohort study

Setting

Single tertiary care center

Participants

This study included 190 patients with OSA who underwent multilevel upper airway surgery between September 2012 and September 2021. The patients were divided into two groups according to the proportion of each respiratory event: hypopnea-predominant (n = 102) and apnea-predominant (n = 88).

Main outcome measures

The primary outcome measure was the percentage improvement in the apnea-hypopnea index (AHI) from baseline AHI after surgery.

Results

The apnea-predominant group included more male patients and had higher AHI, respiratory disturbance index (RDI), and oxygen desaturation index (ODI) than the hypopnea-predominant group. Both groups showed significant improvements in AHI, apnea index, RDI, supine AHI, REM AHI, non-REM AHI, ODI, lowest O2 saturation, and Epworth Sleepiness Scale scores following the surgery. Notably, hypopnea index increased after surgery in the apnea-predominant OSA group. Although the improvement in the absolute value of AHI by surgery was significantly greater in the apnea-predominant group than in the hypopnea-predominant group, the two groups showed no significant difference in the percentage improvement in AHI from baseline AHI.

Conclusion

Patients with apnea-predominant OSA had more severe disease than those with hypopnea-predominant OSA; however, surgical outcomes, as evaluated by percentage AHI improvement, were comparable between the two groups. In addition, multilevel upper airway surgery may induce the transition from apnea to hypopnea in patients with apnea-predominant OSA.
View on Web
στις Δεν υπάρχουν σχόλια:

¿Qué es la Hashitoxicosis?

alexandrossfakianakis shared this article with you from Inoreader

La tiroiditis de Hashimoto es la patología tiroidea más frecuente. Se presenta mucho más frecuentemente en mujeres y puede aparecer a cualquier edad. Es una inflamación crónica autoinmune, generalmente indolora, caracterizada por una infiltración linfocitaria de la glándula tiroidea, parcial o total. La función tiroidea puede no verse alterada o puede producirse una disminución de la misma (hipofunción tiroidea), y se caracteriza por la presencia de anticuerpos antiperoxidasa (anti-TPO) y/o anti-tiroglobulina (anti-Tg). En este tipo de tiroiditis se puede desarrollar un hipotiroidismo de forma lenta y generalmente progresiva.

Excepcionalmente algunos pacientes desarrollan una presentación clínica y bioquímica de hiperfunción tiroidea, desarrollando hipertiroidismo, cuadro conocido como "Hashitoxicosis". Se puede definir como una enfermedad mixta, caracterizada por tirotoxicosis, gran aumento sérico de anticuerpos antitiroideos y presencia de hiperplasia-hipertrofia (aumento de volumen) folicular e infiltración linfocítica.

¿Por qué algunas personas con tiroiditis de Hashimoto tienen Hashitoxicosis?

En pacientes con diagnóstico de tiroiditis de Hashimoto, la incidencia es escasa (5-10%), si bien es cierto que la alteración bioquímica no viene acompañada claramente de una clínica de hiperfunción tiroidea y la clínica puede pasar desapercibida.

La Hashitoxicosis es un cuadro de hipertiroidismo que se presenta generalmente en pacientes con o sin diagnóstico previo de tiroiditis de Hashimoto, que confunde muchas veces el diagnóstico por su similitud con un brote de Enfermedad de Graves – Basedow. De hecho, las características clínicas de hiperfunción tiroidea no varían. El tamaño del bocio suele ser evidente y con más dureza a la palpación, y a nivel bioquímico no difiere en cuanto al nivel de anticuerpos antitiroideos, pero se diferencia de la enfermedad de Graves en que las personas no tendrán niveles elevados de anticuerpos antirreceptor de TSH (TSI).

¿Cuál es la causa del hipertiroidismo derivado de la Hashitoxicosis en la tiroiditis de Hashimoto?

En este caso el hipertiroidismo no es causado por el estímulo de TSH sobre la liberación de hormonas tiroideas como ocurre con la enfermedad de Graves, sino que es producido por la liberación de las hormonas tiroideas contenidas en los folículos que se han destruido. De ahí que el cuadro generalmente sea de corta duración y muchas veces autolimitado.

Muchas veces el diagnóstico de la Hashitoxicosis es tardío y sobre todo debido a una hiperrespuesta al tratamiento con medicamentos antitiroideos en un paciente inicialmente diagnosticado de enfermedad de Graves, por eso es importante hacer una buena valoración clínica inicial que incluya determinación de anticuerpos antirreceptor de TSH (TSI).

¿Hay que tratar la Hashitoxicosis?

El tratamiento con fármacos antitiroideos es pocas veces necesario, porque el cuadro suele ser transitorio y se indica porque la clínica lo aconseja. Debe valorarse al paciente a corto plazo por el riesgo de hipotiroidismo yatrógeno (hipotiroidismo inducido por medicación). Lo más aconsejable es mantener al paciente con un betabloqueante. Durante la fase aguda de la tirotoxicosis, los betabloqueantes pueden ser útiles.

La Hashitoxicosis generalmente precede a un cuadro de hipofunción tiroidea que requerirá tratamiento sustitutivo permanente con hormonas tiroideas.

Si te ha gustado este artículo, quizá te interese leer:

La entrada ¿Qué es la Hashitoxicosis? se publicó primero en Cuida tu tiroides.
View on Web
στις Δεν υπάρχουν σχόλια:

Hiperparatiroidismo: Todo lo que debes saber

alexandrossfakianakis shared this article with you from Inoreader

¿Qué es el hiperparatiroidismo?

Las glándulas paratiroideas, generalmente en número de 4 o 5, son pequeñas glándulas situadas en la parte posterior de la glándula tiroides. Son independientes del mismo pero muchas veces están incrustadas dentro del tejido tiroideo. Segregan la hormona paratiroidea (PTH), que junto con la vitamina D, es esencial para mantener el equilibrio fosforo-calcio de forma constante, y así tener una buena salud ósea y un buen funcionamiento del sistema nervioso y muscular.

El hiperparatiroidismo (HPT) se define como un exceso de secreción de la hormona paratiroidea (PTH). Es una patología frecuente, que afecta más a mujeres y su incidencia se incrementa con la edad a partir de la menopausia. La presencia en un paciente joven o de antecedentes familiares obliga a descartar una patología genética asociada.

Tipos de Hiperparatiroidismo

Existen dos tipos de hiperparatiroidismo:

1.Hiperparatiroidismo primario. Es debido a la hipersecreción autónoma de PTH por una glándula paratiroidea (adenoma paratiroideo), o varias glándulas (hiperplasia paratiroidea). Las lesiones son generalmente benignas. La presencia de un carcinoma paratiroideo es excepcional. La mayoría de las veces el HPT es esporádico, pero existen casos familiares de HPT aislados o asociados a otras patologías genéticas endocrinológicas (denominadas MEN), que coexisten con otras glándulas afectadas (hipófisis, suprarrenales, islotes pancreáticos u hormonas digestivas).

2.Hiperparatiroidismo secundario. Se produce por la respuesta secretoria de las glándulas paratiroideas a una disminución de la calcemia, lo que secundariamente provoca la hipersecreción de PTH para mantener la homeostasis de calcio-fósforo.

Las causas más frecuentes de HPT secundario son:

  • Deficiencia de Vitamina D cuya acción principal es favorecer la absorción del calcio intestinal. Se precisa una deficiencia severa de vitamina D para que se produzca un estímulo secundario de la hipersecreción de PTH por las glándulas paratiroideas. El déficit poblacional de vitamina D es cada vez más frecuente por baja exposición solar o por baja ingesta oral.
  • Hipocalcemia secundaria a baja ingesta de calcio o alteración de la absorción del mismo como consecuencia de cirugías abdominales con resecciones intestinales.
  • Insuficiencia renal crónica (IRC): La IRC se asocia a una disminución de la hidroxilación renal de Vit D, así como hipocalcemia y secundariamente a una elevación de los niveles de PTH para mantener el equilibrio calcio-fósforo. La insuficiencia renal crónica es la causa más frecuente de HPT secundario y causa a su vez del HPT terciario que provoca una hipercalcemia causada por la secreción de PTH excesiva y autónoma en un paciente con HPT secundario.

¿Cuáles son los síntomas del Hiperparatiroidismo?

La mayoría de las veces, el diagnóstico del HPT, se realiza de forma casual observando una hipercalcemia en una analítica de rutina y suele ser asintomático en los estadios iniciales. Como es una enfermedad de desarrollo lento, los síntomas dependen del daño orgánico que provoca la hipercalcemia (cólicos renales secundarios a litiasis cálcica, dolores articulares por daño óseo y síntomas derivados de la osteoporosis, incluso mayor incidencia de fracturas e hipertensión arterial).

¿Cómo se trata el Hiperparatiroidismo?

  • El HPT primario se trata generalmente con intervención quirúrgica del adenoma si es localizado con técnicas de imagen. La indicación de cirugía además de la localización se realiza en base a criterios clínicos como nivel de calcemia, presencia de osteoporosis y presencia de otras complicaciones. Cuando existe hiperplasia o las condiciones del paciente impiden la cirugía podemos recurrir a opciones de tratamiento médico.
  • En el HPT secundario requiere controlar la causa como la suplementación de Vitamina D cuando hay déficit, aporte de calcio cuando hay déficit o tratamiento específico en el paciente con IRC, que incluso puede llegar a cirugía de glándulas paratiroides cuando se produce un HPT terciario.

Si te ha gustado este artículo, quizá te interese leer:

La entrada Hiperparatiroidismo: Todo lo que debes saber se publicó primero en Cuida tu tiroides.
View on Web
στις Δεν υπάρχουν σχόλια:

Τρίτη 1 Νοεμβρίου 2022

An Endoscopic Cap Electrode for Posterior Cricoarythenoid Muscle Stimulation in a Porcine Model

alexandrossfakianakis shared this article with you from Inoreader
An Endoscopic Cap Electrode for Posterior Cricoarythenoid Muscle Stimulation in a Porcine Model

The article describes the development of a diagnostic procedure with a novel endoscopic cap to identify patients with vocal fold immobility who are eligible for implantation of future laryngeal pacing systems. The concept aims at transferring the examination to a gastroscopy setting.


Objective

Laryngeal pacing (LP) is a highly anticipated therapeutic option for patients suffering from bilateral vocal fold paralysis with synkinesis. Identification of candidate patients requires confirmation of a stimulable posterior cricoidarythenoid muscle (PCA) by neuromuscular electrical stimulation (NMES). A silicone endoscopic cap electrode (ECE50) was designed to be operated as an endoscopic extension tip for selective PCA stimulation and confirmation of a glottic opening movement in a setting comparable to a gastroscopy procedure.

Methods

A porcine animal model (n = 6) was applied to develop and test endoscopic cap prototypes in general anesthesia and sedation at a biomedical research center. Two ENT endoscopy experts evaluated and refined the cap design and performance in regard to procedure safety, endoscope handling, accessibility of the PCA by the transoral approach and selective muscle stimulation.

Results

Vocal fold opening movements could be evoked by the investigators in 9 of 12 PCA muscles to stimulate with similar electric parameters. The endoscopic approach using the ECE50 proved to be atraumatic and sufficiently controlled under sedation to locate the required hotspot for NMES of the PCA.

Conclusion

The functionality of the novel endoscopic cap concept has been proven in a porcine model. It can be expected to be transferable to human application and to be of diagnostic importance in the screening and identification of LP candidate patients in future.

Level of Evidence

NA Laryngoscope, 2022
View on Web
στις Δεν υπάρχουν σχόλια:

Tracking down the recent surge of polio virus in endemic and outbreak countries.

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Continuous and progressive efforts are being made globally to eradicate the incidence of polio virus. The detrimental nature of polio calls for action of global vaccination. Owing to large scale vaccination efforts, many countries have been declared polio-free and the people are fully vaccinated against polio virus. However, concern still remains as new cases are being identified in countries declared polio free. This scenario is particularly noticed due to the comprised healthcare system in the past three years of the Corona pandemic. Conditions for lower middle income countries are more problematic, where there are meager healthcare resources and the burden on the healthcare system is higher. Studies indicate some cases of non-paralytic species of polio including cVDPV1, cVDPV2, and cVDPV3 in the group of outbreak countries. However, the major problem is associated with wild type polio virus i.e. WPV1 that leads to paralytic disease and is still present in endemic countries, such as Afghanistan and Pakistan. The incidence rate of wild polio cases has significantly decreased in comparison to the past years but the problem needs to be dealt with at the grass-roots level. In this article, the most recent data has been collected pertaining to the incidence of multi-variant species of polio virus, with a special focus on endemic and outbreak countries. A short overview of challenges to vaccination and a recommendatory overview has also been included for dealing with polio surges.

This article is protected by copyright. All rights reserved.
View on Web
στις Δεν υπάρχουν σχόλια:

A congenital CSF3R mutation in chronic neutropenia reveals a vital role for a cytokine receptor extracellular hinge motif in the response to granulocyte colony‐stimulating factor

alexandrossfakianakis shared this article with you from Inoreader

Abstract

We describe a patient with congenital neutropenia (CN) with a homozygous germline mutation in the colony-stimulating factor 3 receptor gene (CSF3R). The patient's bone marrow shows lagging neutrophil development with subtle left shift and unresponsiveness to CSF3 in in vitro colony assays. This patient illustrates that the di-proline hinge motif in the extracellular cytokine receptor homology domain of CSF3R is critical for adequate neutrophil production, but dispensable for in vivo terminal neutrophil maturation. This report underscores that CN patients with inherited CSF3R mutations should be marked as a separate clinical entity, characterized by a failure to respond to CSF3.
View on Web
στις Δεν υπάρχουν σχόλια:

In vitro inflammatory modulation of bioceramic endodontic sealer in macrophages stimulated by bacterial lipopolysaccharide

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Aim

To evaluate the effects of AH Plus (Dentsply, Germany), Sealer 26 (Dentsply), and Sealer Plus BC (Produtos Médicos e Odontológicos, Brazil) on cytotoxicity and inflammation in macrophage cultures exposed to bacterial lipopolysaccharide (LPS).

Methodology

After initial setting, the sealers were conditioned with serum-free culture medium for 24 h (1mL/cm 2 ). Macrophages from the RAW 264.7 strain were exposed to sealer extracts in a 1:16 ratio in a culture medium with or without LPS. Cell morphology, viability, mitochondrial activity, oxidative stress, and gene expression of interleukin 1β (IL-1β) and tumour necrosis factor-alpha (TNF-α) were evaluated. Data on mitochondrial activity, oxidative stress, and TNF-α were analysed using a two-way analysis of variance (ANOVA) test, followed by the Student -Newman -Keuls post-test. IL-1β data were analysed using one-way ANOVA, followed by SNK, and the t-test was used for intragroup comparison. The significance level was set at 5%.

Results

In the absence of LPS, only AH Plus and Sealer 26 showed a reduction in cell density, while in the presence of LPS, Sealer 26 had the lowest density compared to the other groups. In terms of mitochondrial activity, at 24 and 48 h, Sealer Plus BC had significantly higher mean values than Sealer 26 and AH Plus (p< 0.05). Sealer 26 exhibited the lowest levels of oxidative stress and IL-1β and TNF-α expression, regardless of the presence of LPS (p < 0.05).

Conclusions

Although all sealers interfere with the response of macrophages to LPS, contact with epoxy resin-based sealers can impair cell activity in vitro, while bioceramic sealer seems to favour the inflammatory functions of these cells.
View on Web
στις Δεν υπάρχουν σχόλια:

Association of preoperative low skeletal muscle mass with postoperative complications after selective neck dissection

alexandrossfakianakis shared this article with you from Inoreader
Skeletal muscle mass (SMM) is an emerging predictive and prognostic factor in head and neck cancer patients. The aim of this study was to investigate the predictive value of low SMM for postoperative complications in clinically T1 –2 oral cavity cancer patients undergoing selective neck dissection. A retrospective study in clinically T1–2 oral cavity cancer patients who underwent selective neck dissection between 2011 and 2017 was performed. The predictive value of low SMM for the occurrence of postoperative complications and prolonged hospital stay was evaluated. (Source: International Journal of Oral and Maxillofacial Surgery)
View on Web
στις Δεν υπάρχουν σχόλια:

Deep-learning-based automatic facial bone segmentation using a two-dimensional U-Net

alexandrossfakianakis shared this article with you from Inoreader
In this study, a U-Net was used to investigate the automatic segmentation of facial bones into eight areas, with the aim of facilitating virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) in maxillofacial surgery. (Source: International Journal of Oral and Maxillofacial Surgery)
View on Web
στις Δεν υπάρχουν σχόλια:

COVID-19 Vaccination and the Timing of Surgery Following COVID-19 Infection

alexandrossfakianakis shared this article with you from Inoreader
imageObjective: To evaluate whether COVID-19 vaccination status or mode of anesthesia modified the temporal harms associated with surgery following coronavirus disease-2019 (COVID-19) infection. Background: Surgery shortly after COVID-19 infection is associated with higher rates of complications, leading to recommendations to delay surgery following COVID-19 infection when possible. However, prior studies were based on populations with low or no prevalence of vaccination. Methods: A retrospective cohort study of patients who underwent scheduled surgery in a health system from January 1, 2018 to February 28, 2022 (N=228,913) was performed. Patients were grouped by time of surgery relative to COVID-19 test positivity: 0 to 4 weeks after COVID-19 ("early post-COVID-19"), 4 to 8 weeks after COVID-19 ("mid post-COVID-19"), >8 weeks after COVID-19 ("late post-COVID-19"), surgery at least 30 days before subsequent COVID-19 ("pre-COVID-19"), and surgery with no prior or subsequent test positivity for COVID-19. Results: Among patients who were not fully vaccinated at the time of COVID-19 infection, the adjusted rate of perioperative complications for the early post-COVID-19 group was significantly higher than for the pre-COVID-19 group (relative risk: 1.55; P=0.05). No significantly higher risk was identified between these groups for patients who were fully vaccinated (0.66; P=1.00), or for patients who were not fully vaccinated and underwent surgery without general anesthesia (0.52; P=0.83). Conclusions: Surgery shortly following COVID-19 infection was not associated with higher risks among fully vaccinated patients or among patients who underwent surgery without general anesthesia. Further research will be valuable to understand additional factors that modify perioperative risks associated with prior COVID-19 infection.
View on Web
στις Δεν υπάρχουν σχόλια:
Εγγραφή σε: Αναρτήσεις (Atom)