Πέμπτη 29 Δεκεμβρίου 2022

Testing for Mycoplasma Genitalium and Using Doxycycline as First-Line Therapy at Initial Presentations for Non-Gonococcal Urethritis (NGU) Correlate with Reductions in Persistent NGU

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Abstract
We found that the odds of return clinic visits for persistent non-gonococcal urethritis (pNGU) were significantly lower (OR 0.4, 95% CI 0.3-0.6, p < 0.0001) after implementing: (1) testing for Mycoplasma genitalium during initial evaluations for non-gonococcal urethritis (NGU) and (2) switching from azithromycin to doxycycline as first-line NGU treatment.
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Topical Adenosine Inhibits Inflammation and Mucus Production in Viral Acute Rhinosinusitis

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Topical Adenosine Inhibits Inflammation and Mucus Production in Viral Acute Rhinosinusitis

Topical adenosine treatment inhibits inflammation and mucus production in a mouse model of viral acute rhinosinusitis. It may be an effective treatment for viral ARS. Original work created with Biorender.com.


Objective

Viral acute rhinosinusitis (ARS) is the leading cause of work and school absence and antibiotic over-prescription. There are limited treatment options available to ameliorate the symptoms caused by viral ARS. We have previously demonstrated that topical adenosine treatment enhances mucociliary clearance in the sino-nasal tract. Here, we assessed the therapeutic potential of topical adenosine in a mouse model of viral ARS.

Methods

The effect of topical adenosine on inflammatory response and mucin gene expression was examined in a mouse model of viral ARS induced by respiratory syncytial virus (RSV) nasal-only infection. We also investigated the inflammatory effect of both endogenous and exogenous adenosine in the sino-nasal tract.

Results

Topical adenosine significantly inhibited the expression of pro-inflammatory cytokines, goblet hyperplasia, mucin expression, and cell damage in the nose of mice with viral ARS. This treatment did not prolong virus clearance. This inhibitory effect was primarily mediated by the A2A adenosine receptor (AR). Although previous studies have shown that adenosine induces a robust inflammatory response in the lungs, neither endogenous nor exogenous adenosine produced inflammation in the sino-nasal tract. Instead, exogenous adenosine inhibited the baseline expression of TNF and IL-1β in the nose. Additionally, baseline expression of ARs was lower in the nose than that in the trachea and lungs.

Conclusion

We demonstrated that intranasal adenosine administration effectively decreased inflammation and mucus production in a mouse model of viral ARS.

Level of Evidence

N/A Laryngoscope, 2022
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Reassessing Endotracheal Tube Size in Critically Ill Patients

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Otolaryngology.png

To the Editor We read with great interest the article by Esianor and colleagues on endotracheal tube (ETT) size in critically ill patients. Laryngotracheal injuries after invasive mechanical ventilation range from reversible pressure injuries to permanent damage, scarring, fistulas, and transmural lesions. Endotracheal tubes larger than 7.0 mm pose greater risk of laryngeal injury, and ETTs larger than 7.5 mm are often selected for critically ill patients in efforts to improve airflow resistance, avoid blockage, and facilitate procedural int erventions. Little is known as to whether larger ETTs improve recovery. Esianor and colleagues found no difference in 30-day all-cause in-hospital survival between patients with small, appropriate, or large-for-height endotracheal tubes. If larger tubes do not improve survival, is survivorship a better focus? Even with optimally sized tubes, translaryngeal intubation carries risks for impaired speech, swallowing, and airway protection. The investigation presented new questions around selection of ETT size, and has several implications for current practice and future investigation.
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Künstliche Intelligenz auf dem Vormarsch – Hohe Vorhersage-Genauigkeit bei der Früherkennung pigmentierter Melanome

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Laryngorhinootologie
DOI: 10.1055/a-1949-3639

Weltweit steigt die Inzidenz des malignen Melanoms an. Bei frühzeitiger Erkennung ist das Melanom gut behandelbar, eine Früherkennung ist also lebenswichtig.Die Hautkrebs-Früherkennung hat sich in den letzten Jahrzehnten bspw. durch die Einführung des Screenings im Jahr 2008 und die Dermatoskopie deutlich verbessert. Dennoch bleibt die visuelle Erkennung insbesondere von frühen Melanomen eine Herausforderung, weil diese viele morphologische Überlappungen mit Nävi zeigen. Daher ist der medizinische Bedarf weiterhin hoch, die Methoden zur Hautkrebsfrüherkennung gezielt weiterzuentwickeln, um Melanome bereits in einem sehr frühen Stadium sicher diagnostizieren zu können.Die Routinediagnostik zur Hautkrebs-Früherkennung umfasst die visuelle Ganzkörperinspektion, oft ergänzt durch die Dermatoskopie, durch die sich die diagnostische Treffsicherheit erfahrener Hautärzte deutlich erhöhen lässt. E in Verfahren, was in einigen Praxen und Kliniken zusätzlich angeboten wird, ist die kombinierte Ganzkörperfotografie mit der digitalen Dermatoskopie für die Früherkennung maligner Melanome, insbesondere für das Monitoring von Hochrisiko-Patienten.In den letzten Jahrzenten wurden zahlreiche nicht invasive zusatzdiagnostische Verfahren zur Beurteilung verdächtiger Pigmentmale entwickelt, die das Potenzial haben könnten, eine verbesserte und z. T. automatisierte Bewertung dieser Läsionen zu ermöglichen. In erster Linie ist hier die konfokale Lasermikroskopie zu nennen, ebenso die elektrische Impedanzspektroskopie, die Multiphotonen-Lasertomografie, die Multispektralanalyse, die Raman-Spektroskopie oder die optische Kohärenztomografie. Diese diagnostischen Verfahren fokussieren i. d. R. auf hohe Sensitivität, um zu vermeiden, ein malignes Melanom zu übersehen. Dies bedingt allerdings üblicherweise eine geringere Spezifität, was im Screening zu unnötigen Exzisionen vieler gutartiger Läsionen führen kann. Auch sind einige der Verfahren zeitaufwendig und kostenintensiv,was die Anwendbarkeit im Screening ebenfalls einschränkt.In naher Zukunft wird insbesondere die Nutzung von künstlicher Intelligenz die Diagnosefindung in vielfältiger Weise verändern. Vielversprechend ist v. a. die Analyse der makroskopischen und dermatoskopischen Routine-Bilder durch künstliche Intelligenz. Für die Klassifizierung von pigmentierten Hautläsionen anhand makroskopischer und dermatoskopischer Bilder erzielte die künstliche Intelligenz v. a. in Form neuronaler Netze unter experimentellen Bedingungen in zahlreichen Studien bereits eine vergleichbare diagnostische Genauigkeit wie Dermatologen. Insbesondere bei der binären Klassifikationsaufgabe Melanom/Nävus erreichte sie hohe Genauigkeiten, doch auch in der Multiklassen-Differenzierung von verschiedenen Hauterkrankungen zeigt sie sich vergleichbar gut wie Dermatologen. Der Nachweis der grundsätzlichen Anwendbark eit und des Nutzens solcher Systeme in der klinischen Praxis steht jedoch noch aus. Noch zu schaffende Grundvoraussetzungen für die Translation solcher Diagnosesysteme in die dermatologischen Routine sind Möglichkeiten für die Nutzer, die Entscheidungen des Systems nachzuvollziehen, sowie eine gleichbleibend gute Leistung der Algorithmen auf Bilddaten aus fremden Kliniken und Praxen.Derzeit zeichnet sich ab, dass computergestützte Diagnosesysteme als Assistenzsysteme den größten Nutzen bringen könnten, denn Studien deuten darauf hin, dass eine Kombination von Mensch und Maschine die besten Ergebnisse erzielt. Diagnosesysteme basierend auf künstlicher Intelligenz sind in der Lage, Merkmale schnell, quantitativ, objektiv und reproduzierbar zu erfassen, und könnten somit die Medizin auf eine mathematische Grundlage stellen – zusätzlich zur ärztlichen Erfahrung.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text
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Τετάρτη 28 Δεκεμβρίου 2022

three-dimensional airway changes after fibula flap reconstruction for benign and malignant tumours in the anterior mandible

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Surgical treatment of tumours in the anterior mandible and surrounding tissues may result in defects which can be restored by a fibula free flap. The upper airway may change during this process. The purpose of this retrospective study was to evaluate upper airway changes after fibula free flap reconstruction. A total of 37 patients who underwent anterior mandibulectomy and fibula free flap reconstruction between 2012 and 2020 were recruited. Patients with benign and malignant tumours involving the anterior mandible were included. (Source: International Journal of Oral and Maxillofacial Surgery)
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Individual “alveolar phenotype” limits dimensions of lateral bone augmentation

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Abstract

Aim

Alveolar ridge resorption following tooth extraction often renders a lateral bone augmentation inevitable. Some patients, however, suffer from severe early (during graft healing, Eres) and/or late (during follow-up, Lres) graft resorption. This study explored the hypothesis that the "individual phenotypic dimensions" may partially explains the degree of such resorptions.

Material & methods

Patients who underwent a guided bone regeneration (GBR) were screened for inclusion according to the following criteria: (1) a relatively symmetrical maxillary arch, (2) an intact contra-lateral alveolar bone dimension, (3) the presence of a pre-operative cone-beam CT (CBCT), (4) a CBCT taken immediately after GBR, and (5) at least one CBCT scan ≥6 months after surgery. CBCT scans from different timepoints were registered and imported into Mimics software (Materialise, Leuven, Belgium). Bone dimensions of the contra-lateral site of the augmentation, representing the "individual phenotypical dimension of the alveolar crest" (IPD) were super-imposed on the augmented site and registered accordingly. As such, Eres and Lres could be measured over time, in relation to the IPD (in 2D; per millimetre apically from the alveolar crest, in the centre of the GBR), as well as in 3D (the entire GBR, 2 mm away from the mesial, distal, and apical border for standardisation).

Results

A total of 17 patients (23 augmented sites) were included. After Eres, the outline of the augmentation was in general located ±1 mm outside the IPD, but ≥1,5 years after GBR, it further moved towards the IPD (85% within 0.5 mm distance).

Conclusions

Within the limitations of this study the results indicate that the dimensions of a lateral bone augmentation are defined by the "individual phenotypic bone boundaries" of the patient.

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Clinical reproducibility of different centric relation recording techniques in edentulous individuals: an observational cross sectional study

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Abstract

Purpose

To assess the reproducibility of four different centric relation (CR) recording techniques, and time spent performing each technique in edentulous individuals.

Materials and Methods

Four techniques were assessed: extraoral gothic arch tracing (EOGA), intraoral gothic arch tracing (IOGA), deglutition (D), and frontal manipulation with tongue elevation (FMTE). Twelve subjects participated in the study; four technique records were performed on each volunteer by the same operator. Each record was repeated three times, in the same period of the day, with a 30 min interval between each technique. The reproducibility of each technique was assessed by the tri-dimensional displacement of the position of the condylar housing (mandible condyle) to the wall of the condylar guide (glenoid cavity) in the semi-adjustable articulator (anteroposterior, mediolateral, and superior-inferior). The time spent on each technique was timed in seconds (from the beginning of each technique until the wax occlusion fixation). The analysis of variance and the Tukey test were performed for anteroposterior displacement (two-way) and for time spent on CT recording techniques (one-way) (α &l t; 0.05). Regarding mediolateral and superior-inferior displacements, the non-parametric Kruskal-Wallis was performed for the comparison between recording methods, while the Mann-Whitney test was performed for the comparison between sides (α < 0.05).

Results

The factor recording technique interfered with the anteroposterior displacement (ANOVA: α < 0.001; F = 11.396). The technique D (right side: 3.78 ± 0.69 mm; left side: 3.45 ± 0.74 mm) showed a statistically significant difference compared to the other techniques (EOGA: right side: 3.00 ± 0.00 mm; left side: 3.00 ± 0.00 mm; FMTE: right side: 2.81 ± 0.52 mm; left side: 2.82 ± 0.79 mm; IOGA: right side: 2.90 ± 0.65 mm; left side: 3.12 ± 0.44 mm). The time spent on the recording technique influenced the results (ANOVA: α < 0.001; F = 21.118). The IOGA (340.40 ± 163.41 seconds) and EOGA (285.93 ± 133.84 seconds) required more time compared to the D (86.00 ± 34.33 seconds) and FMTE (101.33 ± 36.72 seconds) techniques.

Conclusion

Graphic recordings showed better reproducibility and accuracy of the position of the centric relation.

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Esthetic and clinical outcomes after immediate placement and restoration: Comparison of two implant systems in the anterior maxilla—A cross‐sectional study

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Abstract

Aim

To assess the esthetic and clinical performance of a novel self-tapping implant system for single-tooth restorations in the esthetic zone after immediate placement and provisionalization.

Materials and Methods

This cross-sectional study included 52 patients contributing a total of 52 immediately placed and restored implants with ≥12 months after functional loading, comparing two different implant systems: Straumann® BLX (Institut Straumann AG, Basel, Switzerland; 25 patients) and Ankylos® (Dentsply Sirona, Hanau, Germany; 27 patients). As the primary outcome measure, peri-implant tissue esthetics were assessed by means of pink esthetics score (PES) rated by three independent clinicians. Moreover, as secondary outcome measures, the peri-implant tissue health was assessed by means of bleeding on probing, probing depth, and suppuration. Apart from that, the modified plaque index, keratinized mucosa width, and the presence of mucosal recessions were also assessed. When clinical signs suggested the possibility of peri-implantitis, radiographs were indicated to assess progressive bone loss.

Results

The mean PES ratings were 12.10 ± 1.10 for Ankylos versus 11.2 ± 1.86 for BLX, both achieving good esthetic results without significant differences (p = 0.143). There were no differences among most clinical parameters (plaque, bleeding on probing, probing depth, peri-implant mucosal recession), although peri-implant mucositis was present in one-third of the cases. The inter-rater agreement on esthetics was not significant (p < 0.250).

Conclusion

Within the limitations of the present study, it was concluded that the use of either BLX or Ankylos implant systems was associated to comparable peri-implant health and good pink esthetic outcomes during immediate implantation and restoration protocols, for at least 12 months.
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Τρίτη 27 Δεκεμβρίου 2022

Transmitted drug resistance to integrase based first-line HIV antiretroviral regimens in the Mediterranean Europe

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Abstract
Objective
To study the prevalence of transmitted drug resistance (TDR) to INSTIs and NRTIs, and of clinically relevant resistance (CRR), in newly-diagnosed people with HIV (PWH) naïve to antiretroviral therapy (ART) in Europe.
Methods
MeditRes HIV is a consortium that includes ART naïve PWH newly diagnosed in France, Greece, Italy, Portugal, and Spain during the years 2018-2021. Reverse transcriptase (RT) and Integrase (INSTI) sequences were provided by participating centers. To evaluate the prevalence of surveillance drug resistance mutations (SDRM) we used the CPR tools from Stanford HIV-website. To evaluate clinically relevant resistance (CRR), defined as any resistance level >= 3, we used the Stanford v.9.1HIVDB Algorithm.
Results
We included 2705 PWH, 72% men, median age of 37 (IQR, 30-48); 43.7% infected by non-B subtypes. The prevalence of INSTI-SDRMs was 0.30% (T66I, T66A, E92Q, E138T, E138K, Y143R, S147G and R263K, all n = 1), and of NRTI-SDRMs was 5.77% (M184V n = 23, 0.85%; M184I n = 5, 0.18%; K65R/N n = 3, 0.11%; K70E n = 2, 0.07%; L74V/I n = 5, 0.18%; any TAMs n = 118, 4.36%). INSTI-CRR was 2.33% (0.15% dolutegravir/bictegravir; 2.29% raltegravir/elvitegravir), and 1.74% to first-line NRTIs (0.89% tenofovir/tenofovir alafenamide fumarate; 1.74% abacavir; 1.07% lamivudine/emtricitabine).
Conclusions
We present the most recent data on TDR to integrase based first-line regimens in Europe. Given the low prevalence of CRR to second generation integrase inhibitors and to first-line NRTIs, in the years 2018-2021 it is unlikely that newly diagnosed PWH in MeditRes countries would present with baseline resistance to a first-line regimen based on second generation integrase inhibitors.
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Coronavirus disease 2019 rebounds following nirmatrelvir/ritonavir treatment

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Abstract

Nirmatrelvir/ritonavir (NMV-r) is an effective anti-SARS-CoV-2 agent and has been recommended in the treatment of non-hospitalized patients with COVID-19. In rare occasions, some patients experience virologic and symptomatic rebound after initial resolution, which we call COVID-19 rebound after NMV-r. Although COVID rebound can also occur after molnupiravir treatment or even no antiviral treatment, we have more serious concern about the rebound after NMV-r, which remains the most effective antiviral. Due to a lack of information about its frequency, mechanism, outcomes, and management, we conducted this review to provide comprehensive and updated information to address these questions. Based on the limited evidence, the incidence of COVID-19 rebound after NMV-r was less than 2%, and most cases developed 5–15 days after initiating NMV-r treatment. Almost all reported cases had mild symptoms, and the clinical condition gradually subsided without additional treatment. Overall, the clinical outcome was favourable, and only a small number of patients required emergency department visits or hospitalization. Regarding virologic rebound, culturable SARS-CoV-2 with possible transmission was observed, so re-isolation may be needed.

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