Title: Hearing Aid Upkeep Often Out of Reach for the PoorCategory: Health NewsCreated: 1/8/2019 12:00:00 AMLast Editorial Review: 1/9/2019 12:00:00 AM (Source: MedicineNet Hearing General)
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Πέμπτη 10 Ιανουαρίου 2019
Hearing Aid Upkeep Often Out of Reach for the Poor
Using phenol for treating pilonidal sinus: a systematic review and meta-analysis
Abstract
Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.
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Using phenol for treating pilonidal sinus: a systematic review and meta-analysis
Abstract
Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QAzgo4
Using phenol for treating pilonidal sinus: a systematic review and meta-analysis
Abstract
Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QAzgo4
Using phenol for treating pilonidal sinus: a systematic review and meta-analysis
Abstract
Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QAzgo4
11 C-choline PET/CT predicts survival in prostate cancer patients with PSA < 1 NG/ml
Abstract
Purpose
The main drawback of 11C-choline PET/CT for restaging prostate cancer (PCa) patients with biochemical failure is the relatively low positive detection rate for prostate specific antigen (PSA) < 1 ng/ml. This study assessed whether 11C-choline PET/CT predicts survival in PCa patients with PSA < 1 ng/ml.
Methods
This retrospective study included 210 PCa patients treated with radical prostatectomy who underwent 11C-choline PET/CT from December 1, 2004 to July 31, 2007 due to biochemical failure. PCa-specific survival was estimated using Kaplan–Meier curves. Cox regression analysis was used to evaluate the association between clinicopathologic variables and PCa-specific survival. PCa-specific survival was computed as the interval from radical prostatectomy to PCa-specific death.
Results
Median follow-up after radical prostatectomy was 6.9 years (95% confidence interval, CI, 2.0–14.5 years). 11C-choline PET/CT was positive in 20.5% of patients. Median PCa-specific survival was 13.4 years (95% CI, 9.9–16.8 years) in patients with positive 11C-choline PET/CT, and it was not achieved in patients with negative 11C-choline PET/CT (log-rank, chi-square = 15.0, P < 0.001). Ten-year survival probabilities for patients with negative 11C-choline PET/CT and for patients with positive 11C-choline PET/CT were 86.0% (95% CI: 80.7%–91.3%) and 63.6% (95% CI: 54.5–72.7%). At multivariate analysis, only 11C-choline PET/CT significantly predicted PCa-specific survival (hazard ratio = 2.54, 95% CI, 1.05–6.13, P = 0.038). Patients with pathological 11C-choline uptake in the prostatic bed or in pelvic lymph nodes had longer PCa-specific survival in comparison to patients with pathological tracer uptake in the skeleton (log-rank: chi-square = 27.4, P < 0.001).
Conclusion
Despite the relatively low positive detection rate for PSA < 1 ng/ml, positive 11C-choline PET/CT predicts PCa-specific survival in this low PSA range. As long as more sensitive radiotracers, such as 68Ga-PSMA-11, do not become more widely available, these results might support a broader use of radiolabeled choline in restaging PCa for PSA < 1 ng/ml.
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Automatic Vertebrae Localization and Identification by Combining Deep SSAE Contextual Features and Structured Regression Forest
Abstract
Automatic vertebrae localization and identification in medical computed tomography (CT) scans is of great value for computer-aided spine diseases diagnosis. In order to overcome the disadvantages of the approaches employing hand-crafted, low-level features and based on field-of-view priori assumption of spine structure, an automatic method is proposed to localize and identify vertebrae by combining deep stacked sparse autoencoder (SSAE) contextual features and structured regression forest (SRF). The method employs SSAE to learn image deep contextual features instead of hand-crafted ones by building larger-range input samples to improve their contextual discrimination ability. In the localization and identification stage, it incorporates the SRF model to achieve whole spine localization, then screens those vertebrae within the image, thus relieves the assumption that the part of spine in the field of image is visible. In the end, the output distribution of SRF and spine CT scans properties are assembled to develop a two-stage progressive refining strategy, where the mean-shift kernel density estimation and Otsu method instead of Markov random field (MRF) are adopted to reduce model complexity and refine vertebrae localization results. Extensive evaluation was performed on a challenging data set of 98 spine CT scans. Compared with the hidden Markov model and the method based on convolutional neural network (CNN), the proposed approach could effectively and automatically locate and identify spinal targets in CT scans, and achieve higher localization accuracy, low model complexity, and no need for any assumptions about visual field in CT scans.
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Automatic Vertebrae Localization and Identification by Combining Deep SSAE Contextual Features and Structured Regression Forest
Abstract
Automatic vertebrae localization and identification in medical computed tomography (CT) scans is of great value for computer-aided spine diseases diagnosis. In order to overcome the disadvantages of the approaches employing hand-crafted, low-level features and based on field-of-view priori assumption of spine structure, an automatic method is proposed to localize and identify vertebrae by combining deep stacked sparse autoencoder (SSAE) contextual features and structured regression forest (SRF). The method employs SSAE to learn image deep contextual features instead of hand-crafted ones by building larger-range input samples to improve their contextual discrimination ability. In the localization and identification stage, it incorporates the SRF model to achieve whole spine localization, then screens those vertebrae within the image, thus relieves the assumption that the part of spine in the field of image is visible. In the end, the output distribution of SRF and spine CT scans properties are assembled to develop a two-stage progressive refining strategy, where the mean-shift kernel density estimation and Otsu method instead of Markov random field (MRF) are adopted to reduce model complexity and refine vertebrae localization results. Extensive evaluation was performed on a challenging data set of 98 spine CT scans. Compared with the hidden Markov model and the method based on convolutional neural network (CNN), the proposed approach could effectively and automatically locate and identify spinal targets in CT scans, and achieve higher localization accuracy, low model complexity, and no need for any assumptions about visual field in CT scans.
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Prescription Opioids May Raise Pneumonia Risk
(Source: Pulmonary Medicine News - Doctors Lounge)
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The science is clear: with HIV, undetectable equals untransmittable
(NIH/National Institute of Allergy and Infectious Diseases) An overwhelming body of clinical evidence has firmly established the HIV Undetectable = Untransmittable (U=U) concept as scientifically sound. U=U means that people living with HIV who achieve and maintain an undetectable viral load -- the amount of HIV in the blood -- by taking and adhering to antiretroviral therapy (ART) as prescribed cannot sexually transmit the virus to others. NIAID officials review the scientific evidence underlying U=U and discuss implications of widespread acceptance of the message. (Source: EurekAlert! - Infectious and Emerging Diseases)
MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.
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E - Cigarette Aerosol Exposure Tied to Asthma Symptoms
Findings seen among youth reporting asthma diagnosis, secondhand exposure to e - cigarette aerosols (Source: Pulmonary Medicine News - Doctors Lounge)
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E - Cigarette Aerosol Exposure Tied to Asthma Symptoms
Findings seen among youth reporting asthma diagnosis, secondhand exposure to e - cigarette aerosols (Source: Pulmonary Medicine News - Doctors Lounge)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CcNYg0
Risk scores for predicting dysphagia in critically ill patients after cardiac surgery
Abstract
Background
This study aimed at developing and validating a scoring model to stratify critically ill patients after cardiac surgery based on risk for dysphagia, a common but often neglected complication.
Methods
Data were prospectively collected and analyzed from January 2016 to June 2017 from 395 consecutive post cardiac surgery patients at the cardiac care unit (CCU) at a single center; 103 (26.1%) developed dysphagia. Univariate and multivariate logistic analyses were used to identify independent predictors for dysphagia. The survival nomogram was developed on the basis of a multivariable Cox model, which allowed us to obtain survival probability estimations. The predictive performance of the nomogram was verified for discrimination and calibration. Areas under receiver operating characteristic curve analysis were used to illustrate and evaluate the diagnostic performance of the novel model.
Results
The final novel scoring model, named SSG-OD, consists of three independent factors: gastric intubation (OR = 1.024, 95% CI 1.015–1.033), sedative drug use duration (OR = 1.031, 95% CI 1.001–1.063) and stroke or not (OR = 6.182, 95% CI 3.028–12.617). SSG-OD identified patients at risk for dysphagia with sensitivity of 68.5% and specificity of 89.0% (OR = 0.833, 95% CI: 0.782–0.884). The positive and negative likelihood ratios were 6.22 and 0.35.
Conclusions
The novel SSG-OD scoring system to risk stratify CCU patients for dysphagia is an easy-to-use bedside prognostication aid with good predictive performance and the potential to reduce aspiration incidence and accelerate recovery.
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The evaluation of a better intubation strategy when only the epiglottis is visible: a randomized, cross-over mannequin study
Abstract
Background
The Cormack-Lehane (C-L) grade III airway is considered to be a challenging airway to intubate and is associated with a poor intubation success rate. The purpose of this study was to investigate whether the holding position, shapes, bend angles of the endotracheal tube (ET) and the stylet-assisted lifting of the epiglottis could improve the success rate of intubation.
Methods
Thirty-two participants, 26 physicians, 2 residents, and 4 nurse practitioners, with 12.09 ± 5.38 years of work experience in the emergency department and more than 150 annual intubation events, were enrolled in this randomized, cross-over mannequin study. We investigated the effects of straight-to-cuff ET shapes with 35° and 50° bend angles, banana-shaped ET with longitudinal distances of 28 cm and 26 cm, two methods of holding the ET (either on the top or in the middle), and lifting or not the epiglottis, on the intubation duration, its success rate, and its subjective difficulty. The aim of the study is to provide optimized intubation strategies for difficult airway with C-L IIb or III grades, when the inlet of the trachea cannot be visualized.
Results
The two groups that lifted the epiglottis using the stylets, in bend angles of 35° and 50°, had the shortest duration of intubation (23.75 ± 14.24 s and 20.72 ± 6.90 s, hazard ratios 1.54 and 1.85 with 95% confidence intervals [95% CI] of 1.01–2.34 and 1.23–2.78, respectively) and a 100% success rate in intubations. In the survival analysis, lifting of the epiglottis was the only significant factor (p < 0.0001, 95% CI 1.34–2.11) associated with the success rate of intubation.
Conclusions
The use of the epiglottic lift as an adjunctive technique can facilitate the intubation and improve its success rate without increasing procedure difficulty, in C-L III airway, when only the epiglottis is seen.
Trial registration
ClinicalTrials Registry (https://clincaltrials.gov, identifier NCT03366311).
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Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans
Abstract
Background
Several methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.
Methods
Three-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient's Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack–Lehane grade.
Results
The area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697–0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.
Conclusions
One factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.
Trial registration
ClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.
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Repetition Reduction Revisited: The Prosody of Repeated Words in Papuan Malay.
Conclusions partially confirm previous work and challenge theories on how the prosody and information value of a word are related. PMID: 30618355 [PubMed - as supplied by publisher] (Source: Language and Speech)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D1HguT
Risk scores for predicting dysphagia in critically ill patients after cardiac surgery
Abstract
Background
This study aimed at developing and validating a scoring model to stratify critically ill patients after cardiac surgery based on risk for dysphagia, a common but often neglected complication.
Methods
Data were prospectively collected and analyzed from January 2016 to June 2017 from 395 consecutive post cardiac surgery patients at the cardiac care unit (CCU) at a single center; 103 (26.1%) developed dysphagia. Univariate and multivariate logistic analyses were used to identify independent predictors for dysphagia. The survival nomogram was developed on the basis of a multivariable Cox model, which allowed us to obtain survival probability estimations. The predictive performance of the nomogram was verified for discrimination and calibration. Areas under receiver operating characteristic curve analysis were used to illustrate and evaluate the diagnostic performance of the novel model.
Results
The final novel scoring model, named SSG-OD, consists of three independent factors: gastric intubation (OR = 1.024, 95% CI 1.015–1.033), sedative drug use duration (OR = 1.031, 95% CI 1.001–1.063) and stroke or not (OR = 6.182, 95% CI 3.028–12.617). SSG-OD identified patients at risk for dysphagia with sensitivity of 68.5% and specificity of 89.0% (OR = 0.833, 95% CI: 0.782–0.884). The positive and negative likelihood ratios were 6.22 and 0.35.
Conclusions
The novel SSG-OD scoring system to risk stratify CCU patients for dysphagia is an easy-to-use bedside prognostication aid with good predictive performance and the potential to reduce aspiration incidence and accelerate recovery.
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Closing the gap – detection of clinically relevant von Willebrand disease in emergency settings through an improved algorithm based on rotational Thromboelastometry
Abstract
Background
Hemorrhage and blood loss are still among the main causes of preventable death. Global hemostatic assays are useful point-of-care test (POCT) devices to rapidly detect cumulative effects of plasma factors and platelets on coagulation. Thromboelastography (TEG) and Thromboelastometry (ROTEM) are established methods in many anesthesiological departments for guided hemostatic treatment. However, von Willebrand disease remains undetected by standard ROTEM, especially during emergency care, despite being the most prevalent congenital hemostatic disorder.
Methods
In our monocentric cohort pilot study we focused on hemostatic challenges associated with von Willebrand disease. Twenty-seven patients with suspected von Willebrand disease were included. We modified the routine ROTEM assay by adding a preincubation with ristocetin and commercially available plasma-derived von Willebrand factor to identify clinically relevant von Willebrand disease (VWD).
Results
Addition of von Willebrand factor to the ristocetin assay of a VWD type 3 patient restored the reaction of the whole blood probe to match the response of a healthy person. Our modified ROTEM assay with ristocetin (Ricotem) showed that all high responders (n = 7) had VWD. In the low responder group (n = 16) – 10 of 16 had VWD and in the normal responder group (n = 5), 2 of 5 had mild type 1 VWD.
Conclusions
This new modification of the standard ROTEM assay enables the detection of otherwise unnoticed critical von Willebrand disease based on alterations in clot formation and might serve as a novel approach to reliably assess severe VWD patients by platelet-mediated blood clotting in an emergency setting. We recommend incorporating this new VWD-focused screening tool into the current ROTEM-based management algorithm of acute microvascular bleeding.
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Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans
Abstract
Background
Several methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.
Methods
Three-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient's Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack–Lehane grade.
Results
The area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697–0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.
Conclusions
One factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.
Trial registration
ClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TBJ1nK
Repetition Reduction Revisited: The Prosody of Repeated Words in Papuan Malay.
Conclusions partially confirm previous work and challenge theories on how the prosody and information value of a word are related. PMID: 30618355 [PubMed - as supplied by publisher] (Source: Language and Speech)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D1HguT
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