Higher levels of cerebrospinal fluid and plasma neurofilament light in human immunodeficiency virus-associated distal sensory polyneuropathy

alexandrossfakianakis shared this article with you from Inoreader Higher levels of cerebrospinal fluid and plasma neurofilament light in human immunodeficiency virus-associated distal sensory polyneuropathy via Clinical Infectious Diseases Advance Access Abstract Background Neurofilament light chain (NFL) concentrations, reflecting axonal damage, are seen in several polyneuropathies, but have not been studied in HIV distal sensory polyneuropathy (DSP). We evaluated NFL in CSF and plasma in relation to DSP in people with HIV (PWH) from two independent cohorts, and in people without HIV (PWoH). Methods Cohort 1 consisted of PWH from the CHARTER Study. Cohort 2 consisted of PWH and PWoH from the HIV Neurobehavioral Research Center (HNRC). We evaluated DSP signs and symptoms in both cohorts. Immunoassays measured NFL in CSF for all and for plasma as well in Cohort 2. Results Cohort 1 consisted of 111 PWH, mean ± SD age 56.8 ± 8.32 years, 15.3% female, 38.7% black, 49.6% white, current CD4+ T-cells (median, IQR) 532/µL (295, 785), 83.5% with plasma HIV RNA ≤ 50 copies/mL. Cohort 2 consisted of 233 PWH of similar demographics to PWH in Cohort 1, but also 51 PWoH, t ogether age 58.4 ± 6.68 years, 41.2% female, 18.0% black, Hispanic, non-Hispanic white 52.0%, 6.00% white. In both cohorts of PWH, CSF and plasma NFL were significantly higher in both PWH with DSP signs. Findings were similar, albeit not significant, for PWoH. The observed relationships were not explained by confounds. Conclusions Both plasma and CSF NFL were elevated in PWH and PWoH with DSP. The convergence of our findings with others demonstrates that NFL is a reliable biomarker reflecting peripheral nerve injury. Biomarkers such as NFL might provide, validate, and optimize clinical trials of neuroregenerative strategies in HIV DSP. View on Web

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Recurrence of symptoms following cryptococcal meningitis - characterizing a diagnostic conundrum with multiple etiologies

alexandrossfakianakis shared this article with you from Inoreader Recurrence of symptoms following cryptococcal meningitis - characterizing a diagnostic conundrum with multiple etiologies via Clinical Infectious Diseases Advance Access Abstract Background Cryptococcal meningitis is a common cause of AIDS-related mortality. Although symptom recurrence after initial treatment is common, the etiology is often difficult to decipher. We sought to summarize characteristics, etiologies and outcomes among persons with second-episode symptomatic recurrence. Methods We prospectively enrolled Ugandans with cryptococcal meningitis and obtained patient characteristics, ART and cryptococcosis histories, clinical outcomes, and CSF analysis results. We independently adjudicated cases of second-episode meningitis to categorize patients as 1: microbiological relapse, 2: paradoxical Immune Reconstitution Inflammatory Syndrome (IRIS), 3: persistent elevated intracranial pressure (ICP) only, or 4: persistent symptoms only; along with controls of primary cryptococcal meningitis. We compared groups with chi-square or Kruskal Wallis tests as appropriate. Results 724 participants wer e included (n = 607 primary episode, n = 81 relapse, n = 28 paradoxical IRIS, n = 2 persistently elevated ICP, n = 6 persistent symptoms). Participants with culture-positive relapse had lower CD4 (25 cells/mcL, IQR 9-76) and lower CSF WBC (4 cells/mcL, IQR 4-85) counts than paradoxical IRIS (CD4 78 cells/mcL, IQR 47-142 and WBC 45 cells/mcL, IQR 8-128). Among those with CSF WBC <5 cells/mcL, 86% (43/50) had relapse. Among those with CD4 counts < 50 cells/mcL, 91% (39/43) had relapse. 18-week mortality (from current symptom onset) was 47% among first episodes of cryptococcal meningitis, 31% in culture-positive relapses, and 14% in paradoxical IRIS. Conclusions Poor immune reconstitution was noted more often in relapse compared to IRIS as evidenced by lower CSF WBC counts and blood CD4 counts. These easily obtained lab values should prompt initiation of antifungal treatment while awaiting culture results. View on Web

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Acute hepatitis associated with an echovirus 9 infection in a heart transplant recipient

alexandrossfakianakis shared this article with you from Inoreader Acute hepatitis associated with an echovirus 9 infection in a heart transplant recipient via Journal of Medical Virology Abstract We report a case of severe acute hepatitis due to echovirus 9 in a heart transplant patient treated with conventional immunosuppressive therapy. This case supports the importance of testing for enteroviruses in any type of infectious presentation in immunocompromised populations. This article is protected by copyright. All rights reserved. View on Web

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Outcome and associated predictors for non‐surgical management of large cyst‐like periapical lesions: A CBCT‐based prospective cohort study.

alexandrossfakianakis shared this article with you from Inoreader Outcome and associated predictors for non‐surgical management of large cyst‐like periapical lesions: A CBCT‐based prospective cohort study. via International Endodontic Journal Abstract Aim The aim of this cone-beam computed tomography (CBCT) based study was to evaluate the outcome of non-surgical root canal treatment (RCT) performed for the management of large cyst like periapical lesions (LCPL) and to identify the predictive factors affecting healing. Methodology 54 subjects (77 permanent maxillary anterior teeth) with LCPL (>10mm) of endodontic origin were included. A single operator performed standardised multi-visit RCT. Patients were clinically and radiographically examined at 6,12 months and a CBCT scan was taken at 24 months. Two independent blinded evaluators measured the pre and postoperative volume of periapical lesions on CBCT scans using ITK snap software (version 3.8.0-beta-20181028-win64). The outcome was assessed as a percentage change in lesion volume and dichotomized as success (resolved/reduced) or failure (unchanged/enlarged). Ten pre-operative (gender; age; intraoral draining sinus, soft tissue swelling, tooth discoloration, pulp canal obliteration, open apex, root resorption, cortical bone defect and lesion volume) and four intraoperative (apical extent and density of root filling; number of treatment visits and type of root filling) predictive factors were observed. Bivariate and stepwise multivariable linear regres sion analysis was performed to identify independent predictors affecting treatment outcomes. The significance level was set at 5%. Results A recall rate of 88% was achieved. The success rate of RCT was 82.2% (8.9% resolved, 73.3% reduced). Median lesion volume reduction was 75% (IQR 61%-93%). No pre or intra-operative factors were related to treatment failure. However, presence of preoperative cortical bone defect (palatal versus no cortical defect, β= -51.5; 95% CI: -86.9 to -16, p = 0.006) and apical extent of obturation (long versus flush, β= -27.2; 95% CI: -53.8 to -0.6, p = 0.04) were negatively associated with reduction in lesion volume (%). Conclusion LCPL may be successfully managed with RCT. Preoperative cortical bone defect and apical extent of obturation may negatively influence osseous healing. View on Web

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Post‐COVID‐19 vaccination arm pain diagnosed as complex regional pain syndrome: a case report

alexandrossfakianakis shared this article with you from Inoreader Post‐COVID‐19 vaccination arm pain diagnosed as complex regional pain syndrome: a case report via Pain Practice Abstract As the vaccination efforts against the coronavirus disease-2019 (COVID-19) continue, more patients are likely to present with complications related to COVID-19 vaccination. We describe the first reported case of complex regional pain syndrome (CRPS), involving the upper extremities, that occurred after COVID-19 vaccination. The patient presented with acute-onset severe arm pain and swelling following vaccine administration. Based on the clinical, electrodiagnostic, and radionuclide three-phase bone scan findings, the patient was diagnosed with postvaccination CRPS. The COVID-19 vaccine possibly elicited an immune-mediated inflammatory response to the injected antigen in the patient, who was predisposed to CRPS due to inflammatory immunity. The COVID-19 vaccine elicited an immune-mediated inflammatory response to the injected antigen, resulting in CRPS following COVID-19 vaccination. View on Web

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Total calcium, dairy foods and risk of colorectal cancer: a prospective cohort study of younger US women

alexandrossfakianakis shared this article with you from Inoreader Total calcium, dairy foods and risk of colorectal cancer: a prospective cohort study of younger US women via International Journal of Epidemiology - Advance Access Abstract Background Although colorectal cancer (CRC) incidence is declining among adults aged ≥65 years, CRC incidence in younger adults has been rising. The protective role of calcium in colorectal carcinogenesis has been well established, but evidence is lacking on whether the association varies by age at diagnosis. We investigated the association between total calcium intake and risk of overall CRC and CRC before age 55 years. Methods In the Nurses' Health Study II (1991–2015), 94 205 women aged 25–42 years at baseline were included in the analysis. Diet was assessed every 4 years through validated food frequency questionnaires. Multivariable-adjusted hazard ratios (HRs) and 95% CIs for CRC were estimated using the Cox proportional hazards model. Results We documented 349 incident CRC cases during 2 202 604 person-years of follow-up. Higher total calcium intake was associated with a reduced risk of CRC. Compared with those with <750 mg/day of total calcium intake, the HR of CRC was 0.61 (95% CI, 0.38–0.97) for those who consumed ≥1500 mg/day (P for trend = 0.01). The HR per 300 mg/day increase was 0.85 (95% CI, 0.76–0.95). There was a suggestive inverse association between total calcium intake and CRC before age 55 years (HR per 300 mg/day increase, 0.87; 95% CI, 0.75–1.00), suggesting the importance of calcium intake in the younger population. Conclusions In a cohort of younger women, which reflects the birth cohorts, time periods and age ranges paralleling the recent rise in CRC, higher calcium intake was associated with a decreased risk of CRC. View on Web

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The Necessity of Nostril Retention Application After Secondary Unilateral Cleft Rhinoplasty

alexandrossfakianakis shared this article with you from Inoreader The Necessity of Nostril Retention Application After Secondary Unilateral Cleft Rhinoplasty via The Laryngoscope The nostril retention after secondary unilateral cleft rhinoplasty could help preserve nasal morphology but worsen the patient's quality of life of the patients. The necessity of nostril retention should consider the forms of nasal deformity and the patient's quality of life. Background This study aims to investigate the necessity of nostril retention after secondary unilateral cleft rhinoplasty. Methods Seventy four patients who underwent secondary unilateral cleft rhinoplasty were categorized into control group, nasal retainer group, and nasal clip group. A nasal retainer or nasal clip was applied 7 days after secondary correction and retained in the nostrils of the patients for 6 to 12 months. Measurements from pre- and post-operative photos and patient-reported outcomes were used in this study. Results After 6 to 12 months, although relapse still occurred in three groups, the nasal retainer group showed a better effect in the ratio of nostril height, whereas the nasal clip group showed a significant improvement in the ratio of nasal base. And both the two groups also showed significant improvement in the ratio of nasal columella. Patients from the control group generally had lower Derriford Appearance Scale (DAS) scores than the nasal retainer group and nasal clip group. Wearing a nasal retainer may negatively influence self-concept, facial self-consciousness of appearance and physical state, and significant differences in mean scores were also found in 9 items. Conclusions The nostril retention after secondary unilateral cleft rhinoplasty could help preserve nasal morphology and reduce postoperative relapse but worsen the patients' quality of life. The necessity of applying the nostril retention should consider the forms of nasal deformity and the potential influence on the quality of life. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Postoperative analysis of osseous midface reconstructions: The value of imaging and a novel scoring system for complexity and operative success

alexandrossfakianakis shared this article with you from Inoreader Postoperative analysis of osseous midface reconstructions: The value of imaging and a novel scoring system for complexity and operative success via Head & Neck Abstract Background Few standardized methods exist for evaluating the postoperative outcomes of osteocutaneous free flaps. We propose an anatomic-based scoring system for midface free flap reconstruction. Methods One hundred and twelve patients across four institutions underwent osteocutaneous reconstruction of the midface. Postoperative scans were scored based on the number of independent osseous subunits reconstructed (Subunit Score), the number of different bony appositions with bony contact (Contact Score), and the number of osseous segments in anatomic position (Position Score). These were added together to create a Total Score. Results Osteocutaneous radial forearm flaps had the lowest Subunit Score (p = 0.001). Fibula flaps had the highest Contact Score (p = 0.0008) and Position Score (p = 0.001). Virtual surgical planning was associated with an increased Subunit Score (p = 0.02) and Total Score (p = 0.04). Conclusions We propose a novel scoring system for osseous midface reconstruction based on postoperative imaging scans. This can help guide management decisions and create a common language to compare outcomes. View on Web

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Efficacy of optical coherence tomography in the diagnosing of oral cancerous lesion: systematic review and meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader Efficacy of optical coherence tomography in the diagnosing of oral cancerous lesion: systematic review and meta‐analysis via Head & Neck Abstract Non-invasive diagnostic tools that facilitate visualization of potentially malignant oral lesions and cancers have been introduced. Oral lesions detected by optical coherence tomography (OCT) were compared to reference results based on histological findings. The diagnostic odds ratio (DOR), along with summary receiver operating characteristic curve (SROC), area under SROC, sensitivity, specificity, and negative predictive values, were the outcomes. The DOR of OCT was 86.9190 (95% confidence interval [CI]: 38.7435, 194.9985), and the area under SROC was 0.951. OCT showed good sensitivity (0.9138; 95% CI: 0.8758, 0.9409) and specificity (0.9110; 95% CI: 0.8568, 0.9460), and a high negative predictive value (0.9225; 95% CI: 0.8863, 0.9478). Diagnostic sensitivity was higher when using artificial intelligence and automated algorithms compared to diagnoses made by clinicians. OCT is non-invasive, provides rapid results without radiation exposure, and can aid in the diagnosis and follow -up of oral cancer and oral precancerous lesions. View on Web

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The Use of Dissemination and Implementation to Improve Multimodal Analgesia in Head and Neck Surgery

alexandrossfakianakis shared this article with you from Inoreader The Use of Dissemination and Implementation to Improve Multimodal Analgesia in Head and Neck Surgery via The Laryngoscope The use of a multimodal analgesia approach in a Randomized Clinical Trial including acetaminophen, ketorolac, gabapentin, and a neurogenic extremity block in patients undergoing major head and neck ablative and reconstructive surgery significantly reduced the need for opioids in the immediate postoperative period of a seven-day hospital stay. Coordination of care and reducing variability in pain medication administration were highly dependent on dissemination and implementation processes put in place for perioperative phases of care. Objectives To optimize the delivery of multimodal analgesia to patients undergoing major head and neck oncologic surgeries. Methods Pilot study included patients enrolled to receive either scheduled acetaminophen and as-needed opioids (control group) or scheduled acetaminophen, gabapentin, ketorolac, and as-needed opioids (experimental group). RCT, a hybrid type 1 effectiveness-implementation pragmatic trial, was designed to test the effectiveness of the intervention. Arm A received scheduled acetaminophen and as-needed opioids. Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the free tissue donor site, scheduled acetaminophen and as-needed opioids. Results Pilot: Thirty-one patients undergoing major head and neck surgery were enrolled. Mean MMEs administered in control group (n = 15) was 251.60 mg (SD = 224.57 mg); mean MMEs in Experimental group (n = 16) was 195.78 mg (SD = 131.08 mg), p = 0.401. LOS was 8.0 days in control versus 7.0 days in experimental group (p = 0.054). RCT: Interim analysis for safety and futility was planned during trial's design after 30 patients (n = 14 Arm A, and n = 16 Arm B). Mean MMEs administered were 135.1 mg in Arm A, (SD = 86.0 mg) versus mean MME of 51.3 mg in Arm B (SD = 43.3 mg, (p < 0.05)). Given clear superiority results, the trial was prematurely terminated. Functional pain scores, LOS, and complications were similar between the arms (p > 0.05). Variability of mean MME was compared before and after implementation of the management protocols: SD in RCT#1 was 181.46 mg versus 124.6 mg in RCT#2. Conclusion Multimodal analgesia significantly reduced the need for opioids in patients undergoing major head and neck surgery. Level of Evidence 1, Randomized Clinical Trial Laryngoscope, 2022 View on Web

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