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Τετάρτη 14 Δεκεμβρίου 2022

Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

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Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

We describe the results of exome sequencing for genetic diagnosis of hearing loss among a clinically heterogeneous cohort of 218 pediatric patients. We found a higher diagnostic rate for unilateral hearing loss than previously reported as well as a significant number of syndromic forms of hearing loss. Based on these results, we advocate for expanded access to genetic testing for phenotypically diverse hearing loss patients.


Objectives

Genetic testing is the standard-of-care for diagnostic evaluation of bilateral, symmetric, sensorineural hearing loss (HL). We sought to determine the efficacy of a comprehensive genetic testing method, exome sequencing (ES), in a heterogeneous pediatric patient population with bilateral symmetric, bilateral asymmetric, and unilateral HL.

Methods

Trio-based ES was performed for pediatric patients with confirmed HL including those with symmetric, asymmetric, and unilateral HL.

Results

ES was completed for 218 probands. A genetic cause was identified for 31.2% of probands (n = 68). The diagnostic rate was 40.7% for bilateral HL, 23.1% for asymmetric HL, and 18.3% for unilateral HL, with syndromic diagnoses made in 20.8%, 33.3%, and 54.5% of cases in each group, respectively. Secondary or incidental findings were identified in 10 families (5.52%).

Conclusion

ES is an effective method for genetic diagnosis for HL including phenotypically diverse patients and allows the identification of secondary findings, discovery of deafness-causing genes, and the potential for efficient data re-analysis.

Level of Evidence

Level IV Laryngoscope, 2022

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Induced Paresis for Awake Laryngoscopy Procedures

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Induced Paresis for Awake Laryngoscopy Procedures

This article describes an anesthetic technique that induces temporary adductor vocal fold paresis and dense sensory loss of the posterior glottis. This method allows for improved precision of treatment and patient tolerance during awake office-based laryngeal surgery.


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Τρίτη 13 Δεκεμβρίου 2022

Wide mismatches in the sequences of primers and probes for Monkeypox virus diagnostic assays

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Rapid and accurate diagnosis of infections is fundamental to containment of disease. Several monkeypox virus (MPV) real-time diagnostic assays have been recommended by the CDC; however, the specificity of the primers and probes in these assays for the ongoing MPV outbreak has not been investigated. We analyzed the primer and probe sequences present in the CDC recommended monkeypox virus (MPV) generic real-time PCR assay by aligning those sequences against 1,730 MPV complete genomes reported in 2022 worldwide. Sequence mismatches were found in 99.08% and 97.46% of genomes for the MPV generic forward and reverse primers, respectively. Mismatch-corrected primers were synthetized and compared to the generic assay for MPV detection. Results showed that the two primer-template mismatches resulted in a ~11-fold underestimation of initial template DNA in the reaction and 4-fold increase in the 95% LOD. We further evaluated the specificity of seven other real-time PCR assays used for MPV a nd orthopoxvirus (OPV) detection and identified two assays with the highest matching score (>99.6%) to the global MPV genome database in 2022. Genetic variations in the primer-probe regions across MPV genomes could indicate the temporal and spatial emergence pattern of monkeypox disease. Our results show that the current MPV real-time generic assay may not be optimal to accurately detect MPV, and the mismatch-corrected assay with full complementarity between primers and current MPV genomes could provide a more sensitive and accurate detection of MPV.

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Burden of Neutropenia and Leukopenia Among Adult Kidney Transplant Recipients

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Abstract

Background

: Leukopenia and neutropenia (L/N) may affect treatment decisions, potentially resulting in poor clinical and economic outcomes among kidney transplant recipients (KTRs). The burden of L/N is poorly quantified systematically. This systematic literature review aimed to summarize the incidence of, risk factors for, and clinical and economic outcomes associated with L/N post-KT.

Methods

: We systematically searched MEDLINE, Embase, and the Cochrane Library (from database inception-June 14, 2021) and conferences (past 3 years) to identify observational studies examining epidemiology, risk factors, or outcomes associated with L/N among adult KTRs.

Results

: Of 2,081 records, 82 studies met inclusion criteria. Seventy-three studies reported the epidemiology of L/N post-KT. Pooled incidence of neutropenia, defined as absolute neutrophil counts (ANC) <1000/μL, ranged from 13%-48% within 1 year post-transplant; ANC <500/μL ranged from 15%-20%. Leukopenia, defined as white blood cell counts <3500/μL, was 19%-83%. Eleven studies reported independent risk factors associated with L/N post-KT. D+/R- cytomegalovirus (CMV) status, mycophenolic acid (MPA), and tacrolimus use were the most consistent risk factors across studies. Fourteen studies reported L/N-associated clinical outcomes. We noted a trend toward a positive association between neutropenia and acute rejection/opportunistic infections. Mixed findings were noted on the association between L/N and graft failure or mortality. Dosage modifications of valganciclovir, MPA, cotrimoxazole, and anti-thymoglobulin and the need for G-CSF use were common with L/N.

Conclusion

: Findings suggest post-transplant L/N were common and associated with frequent modifications of immunosuppressive agents, requiring G-CSF use, and rejection or opportunistic infections. Findings highlight the need for interventions to reduce risk of L/N post-KT.

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Trigeminal Sensitivity in Patients With Allergic Rhinitis and Chronic Rhinosinusitis

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Trigeminal Sensitivity in Patients With Allergic Rhinitis and Chronic Rhinosinusitis

Allergic patients react more sensitively to trigeminal stimuli in the nose than a comparable control group. This is important because it supports the suggestion that local factors in the nasal mucosa are significantly involved in influencing the trigeminal system of the nose.


Objective

Allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP) are of high importance in otorhinolaryngology. Some of their symptoms are related to changes in the nasal trigeminal sensitivity. The aim of this study was to compare nasal trigeminal sensitivity in patients with AR, CRSwNP, and healthy controls (HC).

Methods

A total of 75 individuals participated (age 19–78 years; 34 AR, 10 CRSwNP and 31 HC). Olfactory function was determined using the extended Sniffin' Sticks test battery. Trigeminal sensitivity was assessed with CO2 detection thresholds. Trigeminal negative mucosal potentials (NMP) and EEG-derived event-related potentials (ERP) were recorded in response to selective olfactory (phenylethyl alcohol) and trigeminal (CO2) stimuli using high-precision air-dilution olfactometry.

Results

In comparison to HC, AR patients had lower CO2 thresholds, also reflected in shorter peak latencies in NMP and trigeminal ERP measurements. CRSwNP patients had a decreased sensitivity for trigeminal stimuli, also reflected in prolonged trigeminal ERP latencies, and reduced olfactory function compared to HC.

Conclusion

AR patients seemed to be more sensitive to trigeminal stimuli than CRSwNP patients. Importantly, the differences could be shown on psychophysical and electrophysiological levels. The changes in trigeminal sensitivity appear to be present already at the level of the respiratory epithelium. The differences between the two groups may depend on the specific inflammatory changes accompanying each disorder, the degree of inflammatory activity, or duration of the inflammatory disorder. However, because the sample sizes are relatively small, these results need to be confirmed in the future studies with larger groups.

Level of Evidence

4 Laryngoscope, 2022

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Facial implant gingival level and thickness changes following maxillary anterior immediate tooth replacement with scarf‐connective tissue graft: A 4–13‐year retrospective study

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Objective

A scarf-shaped connective tissue graft can be placed at the facial and proximal aspect of the peri-implant soft tissue zone during immediate implant placement and provisionalization (IIPP) procedures in the esthetic zone to optimize implant esthetics without the need of flap reflection. This retrospective study evaluated soft tissue stability after scarf-connective tissue graft (S-CTG) in conjunction with IIPP procedures in the esthetic zone.

Materials and Methods

Patients who received IIPP with S-CTG with a minimum 1-year follow-up were evaluated. Mid-facial gingival level (MFGL) change and mid-facial gingival thickness (MFGT) change were measured and compared at the pre-op (T0), IIPP + S-CTG surgery (T1), follow up appointment with MFGT measurement (T2), and latest follow-up appointment (T3). Implant success rate and graft necrosis were also recorded.

Results

A total of 22 IIPP and S-CTG procedures in 20 patients were evaluated in the study. After a mean follow-up of 8.2 years (3.9–13.4) (T3), all implants remained osseointegrated (22/22 [100%]), with statistically insignificant mean midfacial gingival level change of −0.19 mm (−1.5 to 0.8). Statistically significant difference in midfacial gingival thickness (MFGT) was noted (2.5 mm [1.8–3.5 mm]) after a mean follow-up time (T2) of 2.3 years (1–8.6) when compared with MFGT at baseline (1.1 mm [0.6–1.3 mm]) (T1). Necrosis of S-CTG during initial healing phase was noted in 9% (2/22) of the sites.

Conclusions

Within the confines of this study, scarf-connective tissue graft at time of immediate implant placement and provisionalization can thicken the gingiva and maintain the gingival level at the critical soft tissue zone.

Clinical Significance

Managing the soft tissue zone is as important as that of the hard tissue zone for peri-implant esthetics. Connective tissue graft is one of the methods that can enhance the final esthetic outcomes. This retrospective study has demonstrated that Scarf-CTG technique is an effective treatment modality to maintain soft tissue stability.

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Δευτέρα 12 Δεκεμβρίου 2022

Influenza Vaccine Effectiveness Against Influenza A(H3N2)-Related Illness in the United States During the 2021–2022 Influenza Season

alexandrossfakianakis shared this article with you from Inoreader
Abstract
Background
In the United States, influenza activity during the 2021-2022 season was modest and sufficient enough to estimate influenza vaccine effectiveness for the first time since the beginning of the COVID-19 pandemic. We estimated influenza vaccine effectiveness against lab-confirmed outpatient acute illness caused by predominant A(H3N2) viruses.
Methods
Between October 2021 and April 2022, research staff across 7 sites enrolled patients aged ≥6 months seeking outpatient care for acute respiratory illness with cough. Using a test-negative design, we assessed VE against influenza A(H3N2). Due to strong correlation between influenza and SARS-CoV-2 vaccination, participants who tested positive for SARS-CoV-2 were excluded from vaccine effectiveness estimations. Estimates were adjusted for site, age, month of illness, race/ethnicity and general health status.
Results
Among 6,260 participants, 468 (7%) tested positive for influenza only, including 440 (94%) for A(H3N2). All 206 sequenced A(H3N2) viruses were characterized as belonging to genetic group 3C.2a1b subclade 2a.2, which has antigenic differences from the 2021–2022 season A(H3N2) vaccine component that belongs to clade 3C.2a1b subclade 2a.1. After excluding 1,948 SARS-CoV-2 positive patients, 4,312 patients were included in analyses of influenza VE; 2,463 (57%) were vaccinated against influenza. Effectiveness against A(H3N2) for all ages was 36% (95%CI, 20-49%) overall.
Conclusion
Influenza vaccination in 2021–2022 provided protection against influenza A(H3N2)-related outpatient visits among young persons.
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State-of-the-art: septal perforation repair

alexandrossfakianakis shared this article with you from Inoreader
imagePurpose of review To provide a comprehensive overview of the evolution of the different techniques described for the surgical repair of nasal septal perforation, and a surgical decision-making algorithm for its surgical treatment. Recent findings Septal perforation surgery has evolved and improved in recent years. It has gone from being an avoided or discouraged surgical procedure to a procedure with success rates of >90%. Nowadays, there is no standard approach or single technique. The different techniques described include unilateral random pattern flaps, interposition grafts, unilateral pedicle septal local flaps, free mucosal grafts and bilateral random patter flaps. The incidence of success is higher in pediculated septal flaps such as the anterior ethmoidal artery flap or the greater palatine artery pedicled flap combined with additional techniques. Summary Nowadays, surgical closure of septal perforation is possible and should be an option to consider in symptomatic patients without response to medical treatment. The surgical approach that we recommend when planning the surgical closure of nasal septum (or nasoseptal) perforation is based on the osseocartilaginous support and the location of the defect.
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The link between allergic rhinitis and chronic rhinosinusitis

alexandrossfakianakis shared this article with you from Inoreader
imagePurpose of review Allergic rhinitis and chronic rhinosinusitis (CRS) are common disorders affecting millions of people worldwide. Although allergic rhinitis and CRS are distinct clinical entities, certain CRS endotypes share similar pathological mechanisms as those seen in patients with allergic rhinitis. This review assesses the literature behind the similarities and differences seen in patients with CRS and allergic rhinitis, and the role atopy might play in the pathophysiology of CRS. Recent findings In examining the associations between allergic rhinitis and CRS, most studies have focused primarily on CRS with nasal polyps and type 2 inflammation in CRS. Recent studies have demonstrated the similarities and differences in pathologic mechanisms behind allergic rhinitis and CRS, with an emphasis on patient endotypes, genetics, and the nasoepithelial immunologic barrier. Related immunopathology shared by allergic rhinitis and type 2 inflammation in CRS has allowed for therapeutic overlap with biologic treatments. Summary Allergic rhinitis and CRS often present as comorbid conditions, and understanding the relationship between allergic rhinitis and CRS is important when considering treatment options. Advances in understanding the genetics and immunology, as well as biologic and immunotherapeutic treatments have improved outcomes in patients with CRS, especially in the setting of atopy.
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Κυριακή 11 Δεκεμβρίου 2022

Transcriptomic reveals the ferroptosis features of host response in a mouse model of Zika virus infection

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

Zika virus (ZIKV) is a neurotropic flavivirus. The outbreak of ZIKV in 2016 created a global health emergency. However, the underlying pathogenic mechanisms remain elusive.

Methods

We investigated the host response features of in vivo replication in a mouse model of ZIKV infection, by performing a series of transcriptomic and bioinformatic analyses of ZIKV and mock-infected brain tissue.

Results

Tissue damage, inflammatory cells infiltration and high viral replication were observed in the brain tissue of ZIKV infected mice. RNA-Seq of the brain indicated the activation of ferroptosis pathways. Enrichment analysis of ferroptosis regulators revealed their involvement in pathways such as mineral absorption, fatty acid biosynthesis, fatty acid degradation, PPAR signaling pathway, peroxidase and adipokinesine signalling pathway. We then identified 12 interacted hub ferroptosis regulators (CYBB, HMOX1, CP, SAT1, TF, SLC39A14, FTL, LPCAT3, FTH1, SLC3A2, TP53 and SLC40A1) that were related to the differential expression of CD8+ T cells, microglia and monocytes. CYBB, HMOX1, SALT and SLAC40A1 were selected as potential biomarkers of ZIKV infection. Finally, we validated our results using RT-qPCR and outside available datasets.

Conclusions

For the first time, we proposed a possible mechanism of ferroptosis in brain tissue infected by ZIKV in mice and identified the four key ferroptosis regulators.

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