The clinical application of head-shaking test combined with head-shaking tilt suppression test in distinguishing between peripheral and central vertigo at bedside vs. examination room

alexandrossfakianakis shared this article with you from Inoreader The clinical application of head-shaking test combined with head-shaking tilt suppression test in distinguishing between peripheral and central vertigo at bedside vs. examination room via ScienceDirect Publication: Brazilian Journal of Otorhinolaryngology Publication date: Available online 20 May 2022 Source: Brazilian Journal of Otorhinolaryngology Author(s): Huiying Sun, Yinping Wang, Hong Jiang, Zhiqiang Gao, Haiyan Wu View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Characteristics of Children ≤36 Months of Age with Diffuse Intrinsic Pontine Glioma (DIPG): A Report from the International DIPG Registry

alexandrossfakianakis shared this article with you from Inoreader Characteristics of Children ≤36 Months of Age with Diffuse Intrinsic Pontine Glioma (DIPG): A Report from the International DIPG Registry via Neuro-Oncology Advance Access ABSTRACT: Background Children ≤36 months with Diffuse Intrinsic Pontine Glioma (DIPG) have increased long-term survival (LTS, overall survival (OS) ≥24 months). Understanding distinguishing characteristics in this population is critical to improving outcomes. Methods Patients ≤36 months at diagnosis enrolled on the International DIPG Registry (IDIPGR) with central imaging confirmation were included. Presentation, clinical course, imaging, pathology and molecular findings were analyzed. Results Among 1183 patients in IDIPGR, 40 were eligible (median age: 29 months). Median OS was 15 months. Twelve patients (30%) were LTS, 3 (7.5%) very long-term survivors ≥ 5 years. Among 8 untreated patients, median OS was 2 months. Patients enrolled in the registry but excluded from our study by central radiology review or tissue diagnosis had median OS of 7 months. All but 1 LTS received radiation. Among 32 treated patients, 1-, 2-, 3 -, and 5-year OS rates were 68.8%, 31.2%, 15.6% and 12.5%, respectively. LTS had longer duration of presenting symptoms (p=0.018). No imaging features were predictive of outcome. Tissue and genomic data were available in 18 (45%) and 10 patients, respectively. Among 9 with known H3K27M status, 6 had a mutation. Conclusions Children ≤36 months demonstrated significantly more LTS, with an improved median OS of 15 months; 92% of LTS received radiation. Median OS in untreated children was 2 months, compared to 17 months for treated children. LTS had longer duration of symptoms. Excluded patients demonstrated a lower OS, contradicting the hypothesis that children ≤36 months with DIPG show improved outcomes due to misdiagnosis. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of carotid sparing intensity‐modulated radiotherapy for early stage glottic cancer in 201 patients: Multicenter study of Turkish Radiation Oncology Society/TROD‐01‐007

alexandrossfakianakis shared this article with you from Inoreader Outcomes of carotid sparing intensity‐modulated radiotherapy for early stage glottic cancer in 201 patients: Multicenter study of Turkish Radiation Oncology Society/TROD‐01‐007 via Head & Neck Abstract Background To assess and report clinical outcomes after carotid sparing intensity-modulated radiotherapy for early stage laryngeal cancer. Methods We retrospectively analyzed 201 patients with early stage glottic laryngeal cancer treated with carotid sparing intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) techniques in six TROD centers. Results After a median follow-up of 31 months the actuarial 1- and 3-year local and locoregional control rates were 99.4% and 94.7%, 98.4% and 93%, respectively. T classification, anterior commissure involvement, IMRT technique, and type of fractionation were not found to be prognostic for local control. Overall, eight patients had lost their organ function due to recurrence or toxicity. Grade 3 and 4 acute laryngeal edema was seen in eight (4%) and one (0.5%) of patients, respectively. Grade 3 and 4 late laryngeal edema developed in two (1%) and one patient (0.5%), respectively. Conclusion Oncologic outcomes of patients treated with carotid sparing IMRT were excellent; comparable with historical series, with acceptable side effects. Longer follow-up is needed to estimate long term effect on stroke. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Infectious complications in acute graft‐versus‐host disease after Liver transplantation

alexandrossfakianakis shared this article with you from Inoreader Infectious complications in acute graft‐versus‐host disease after Liver transplantation via Transplant Infectious Disease Abstract Background : Graft-versus-host disease (GVHD) following liver transplantation (LT) is rare but can lead to significant mortality. The leading cause of death following GVHD diagnosis is infectious complications. However, there is a lack of clear descriptions concerning infection and antimicrobial management patterns. Our study aims to provide the focused details of all infectious complications of acute GVHD following LT. Methods : We retrospectively reviewed all adult LT recipients with acute GVHD at Mayo Clinic's Transplant Centers from January 1, 2010, to December 31, 2021. Detailed characteristics of infection in each case were described. Results : Among 4,585 LTs performed during this period, 12 (0.3%) patients developed acute GVHD. The median time from transplantation to GVHD diagnosis was 49.0 days [IQR 31.5-99.0]. Ten (83.3%) patients developed severe infections leading to mortality. The most common cause of infection was nosocomial bacteremia from enteric bacteria such as vancomycin-resistant enterococci and gram-negative bacilli. Other infections included breakthrough invasive fungal infections, cytomegalovirus (CMV) reactivation, and Clostridioides difficile colitis. Antimicrobial prophylaxis strategies in most cases were based on the degree of neutropenia – these include levofloxacin for bacterial prophylaxis, nebulized pentamidine for Pneumocystis jiroveci pneumonia prophylaxis, posaconazole for invasive fungal prophylaxis, and valganciclovir based on CMV status. All GVHD patients with severe infections succumbed to these complications. Conclusions : Our study reiterates that despite prophylaxis, infectious complications in GVHD following LT are common and lead to exceptionally high mortality. Individualized antimicrobial treatment, prophylaxis and monitoring strategies remain a critical component of GVHD management. Further study to optimize these practices is required. This article is protected by copyright. All rights reserved View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer

alexandrossfakianakis shared this article with you from Inoreader Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer via Radiation Oncology - Latest Articles We investigated the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced rectal cancer (LARC) and whether modifiable factors in radiotherapy (RT) influenced the NLR. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ralstonia pickettii and Pseudomonas aeruginosa Bloodstream Infections Associated with Contaminated Extracorporeal Membrane Oxygenation Water Heater Devices

alexandrossfakianakis shared this article with you from Inoreader Ralstonia pickettii and Pseudomonas aeruginosa Bloodstream Infections Associated with Contaminated Extracorporeal Membrane Oxygenation Water Heater Devices via Clinical Infectious Diseases Advance Access Abstract We report on probable factory-based contamination of portable water heaters with waterborne pathogens and two bloodstream infections potentially attributable to off-label use of these water heaters to warm extracorporeal membrane oxygenation circuits. Great caution is warranted when using water-based devices to care for critically ill patients. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of antiviral treatment on hepatitis B virus integration and hepatocyte clonal expansion

alexandrossfakianakis shared this article with you from Inoreader Effect of antiviral treatment on hepatitis B virus integration and hepatocyte clonal expansion via Clinical Infectious Diseases Advance Access Abstract Background This study investigated the effect of nucleos(t)ide analogues (NUC) treatment on HBV DNA integration and hepatocyte clonal expansion, both of which are implicated in hepatocellular carcinoma (HCC) in chronic hepatitis B. Methods Twenty-eight patients receiving NUCs (11 lamivudine, 7 telbivudine, 10 entecavir) were included. All had liver biopsies at baseline and year 1, and seven had a third biopsy at year 10. HBV DNA integration and hepatocyte clone size were assessed by inverse PCR. Results All patients had detectable HBV integration at baseline, with a median integration frequency of 1.01×109 per liver and hepatocyte clone size of 2.41×105. Neither integration frequency nor hepatocyte clone size correlated with age and HBV virologic parameters. After one year of treatment, HBV integration was still detectable in all patients, with a median of 5.74×108 integration per li ver (0.22 log reduction; P = .008) and hepatocyte clone size of 1.22×105 (0.40 log reduction; P = .002). HBV integration remained detectable at year 10 of treatment, with a median integration frequency of 4.84×107 integration per liver (0.93 log reduction from baseline) and hepatocyte clone size of 2.55×104 (1.02 log reduction from baseline). From baseline through year 1 to year 10, there was a decreasing trend in both integration frequency and hepatocyte clone size (P = .066 and.018, respectively). Conclusions NUCs reduced both HBV DNA integration and hepatocyte clonal expansion, suggesting another alternative pathway besides direct viral suppression to reduce HCC risk. Our findings supported the notion for a long-term NUC treatment to prevent HCC. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Supporting the Art: Medication Adherence Patterns in Persons Prescribed Ingestible Sensor-enabled Oral Pre-Exposure Prophylaxis to Prevent HIV Infection

alexandrossfakianakis shared this article with you from Inoreader Supporting the Art: Medication Adherence Patterns in Persons Prescribed Ingestible Sensor-enabled Oral Pre-Exposure Prophylaxis to Prevent HIV Infection via Clinical Infectious Diseases Advance Access Abstract Background Timely, accurate adherence data may support oral PrEP success and inform prophylaxis choice. We evaluated an FDA-approved digital health feedback system (DHFS) with ingestible-sensor-enabled (IS) tenofovir-disoproxil-fumarate plus emtricitabine (Truvada®) in persons starting oral PrEP. Methods HIV-negative adults were prescribed IS-Truvada® with DHFS for 12 weeks to observe medication taking behavior. Baseline demographics, urine toxicology and self-report questionnaires were obtained. Positive detection accuracy and adverse events were computed as percentages, with Kaplan Meier Estimate for persistence-of-use. In participants persisting ≥ 28 days, adherence patterns (taking and timing) were analyzed and mixed-effects logistic regression modelled characteristics associated with treatment adherence. Results Seventy-one participants enrolled, mean age 37.6 years (range 18-69), 90.1% male, 77.5% white, 33.8% Hispanic, 95.8% housed and 74.6% employed. Sixty-three participants (88.7%) persisted ≥28 days, generating 4987 observation days, average 79.2 (29-105). Total confirmed doses were 86.2% (CI95 82.5, 89.4), decreasing over time, OR 0.899 (CI95 0.876, 0.923) per week, p < 0.001; 79.4% (CI95 66.7%, 87.3%) of participants had ≥80% adherence. Pattern analysis showed days without confirmed doses clustered (p = 0.003); regular dose timing was higher among participants with ≥80% confirmed doses (0.828, CI95 0.796 to 0.859) than among those with <80% (0.542, CI95 0.405 to 0.679) p < 0.001. In multi-predictor models, better adherence was associated with older age, OR 1.060 (CI95 1.033, 1.091) per year, p < 0.001; negative vs positive methamphetamine screen, OR 5.051 (CI95 2.252, 11.494), p < 0.001. Conclusions DHFS with IS-Truvada® distinguished adherent persons from those potentially at risk of prophylactic failure. Ongoing methamphetamine substance use may impact oral PrEP success. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.