Πέμπτη 29 Δεκεμβρίου 2022

Diagnosis and Management of Vocal Complications after Chondrolaryngoplasty

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Diagnosis and Management of Vocal Complications after Chondrolaryngoplasty

Anterior commissure dislocation should be suspected with signs of vocal impairment after chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique.


Objective

Transfeminine patients (transwomen/feminine nonbinary folks assigned male at birth) can undergo chondrolaryngoplasty ("tracheal shave") to feminize their neck appearance. While isolated cases of vocal complications have been reported following the procedure, aggregated outcomes have not been quantitatively studied. We present acoustic and stroboscopic data to describe a patient cohort with vocal complications after chondrolaryngoplasty and discuss reparative surgical technique.

Methods

Subjective and objective data, including videostroboscopy, were collected from patients with voice complaints after chondrolaryngoplasty. Dislocated anterior commissures were reconstructed with feminization laryngoplasty. Postoperative voice data were recorded and statistically compared to preoperative data using paired t-tests.

Results

On consecutive chart review, of the 94 transfeminine women with prior outside history of chondrolaryngoplasty, 27 (29%) reported chronic postoperative hoarseness, deepened pitch, or loss of upper register. On endoscopy, short, lax vocal folds with persistent anterior glottic gap and phase asymmetry were commonly noted; anterior commissure dislocation was confirmed in-office by using needle localization through absent thyroid cartilage. After open resuspension of the anterior commissure with feminization laryngoplasty, post-repair modal-speaking, minimum, and maximum fundamental frequencies (F0) increased on average by 7, 8, and 5 semitones, respectively (p < 0.01), when compared to pre-repair values. On average, perioperative maximum phonation time did not change significantly (p = 0.15). Average self-assessment of vocal femininity increased by 48% (p < 0.01).

Conclusion

Anterior commissure dislocation should be suspected with signs of vocal impairment after chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique.

Level of Evidence

This work represents a 2011 OCEBM Level 4 evidence as a case series Laryngoscope, 2022
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Dysphagie bei tracheotomierten Patienten nach Langzeitbeatmung

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Laryngorhinootologie 2023; 102: 27-31
DOI: 10.1055/a-1076-9686

Unabhängig von der Art der kritischen Erkrankung haben tracheotomierte Patienten ein hohes Risiko für die Entwicklung einer Schluckstörung. Diese ist potenziell lebensbedrohlich, da sie zu Aspiration und Pneumonie führen kann. Vor einer oralen Nahrungsgabe sollte daher unbedingt eine Schluckdiagnostik mittels Bolusfärbetest und/oder FEES durchgeführt werden. Da ein physiologischer Luftstrom durch den Larynx und ein adäquater subglottischer Druck Schlüsselkomponenten eines effektiven Schluckaktes sind, sollte eine Oralisierung bei geblockter Trachealkanüle möglichst vermieden werden.
[...]

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

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

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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Multisystem inflammatory syndrome in adults: Characteristics, treatment, and outcomes

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ABSTRACT

Following the rapidly increasing number of multisystem inflammatory syndromes in children (MIS-C), a similar clinical scenario has been observed in adult patients. Although its prevalence is low and probably related to underdiagnosis, its development can be associated with high mortality. Multisystem inflammatory syndrome in adults (MIS-A) can develop following both asymptomatic and symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and in previously healthy people. Like MIS-C, MIS-A is a multisystem disease that can involve the cardiovascular, respiratory, gastrointestinal, dermatologic, hematologic, and neurologic systems. In addition to the clinical manifestations, the diagnosis of MIS-A requires laboratory evidence of inflammation and SARS-CoV-2 infection. The appropriate treatment for MIS-A remains unclear; anti-inflammatory agents, including intravenous immunoglobulin and corticosteroids, are commonly used. However, there are still many unknow ns regarding MIS-A. Further studies are needed to determine the true prevalence, pathogenesis, and effective treatment for MIS-A.

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Viruses Responsible for Acute Respiratory Infections Before (2016‐2019) and During (2021) Circulation of the SARS‐CoV‐2 virus in Pediatric Patients in a Reference Center at Barranquilla Colombia: A Pattern Analysis

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Summary

Objective

To evaluate the behavior of the viruses responsible for acute respiratory infections before (2016-2019) and after (2020-2021) the start of the circulation of the SARS-CoV-2 virus in pediatric patients treated at a reference center from Barranquilla, Colombia.

Materials and methods

A descriptive observational study was carried out, and data were obtained by reviewing the influenza-like illness and severe acute respiratory infection database in the pediatric population of the sentinel surveillance reference center in the district of Barranquilla during the years 2016 - 2021, applying inclusion and exclusion criteria.

Results

During 2016-2019, the average age of individuals was 1.3 (±1.7) years, during 2021, it was 2.3 (±3.5) years. The distribution by sex was similar, predominantly male. August and February were the months with the highest record of symptoms for 2016-2019 and 2021, respectively, the most frequent being cough, fever, shortness of breath, and diarrhea. By 2021 there was a higher use of antibiotics and antivirals reported than in 2016-2019. Most patients tested negative for viral detection. When comparing the percentage of viruses detected by age group and years of detection, positivity was lower in 2021 by every age group, and respiratory Syncytial Virus (RSV) was the most frequently detected.

Conclusions

There was less virus positivity in viral detection tests in the pediatric population in 2021. RSV persists as the main etiology affecting this population, especially infants. The use of antibiotic therapy in viral infections continues to be a problematic practice in their management. Sentinel surveillance can be strengthened throughout the country.

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The HBV web: An insight into molecular interactomes between the Hepatitis B virus and its host en route to hepatocellular carcinoma.

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ABSTRACT

Hepatitis B virus (HBV) is a major aetiology associated with the development and progression of hepatocellular carcinoma (HCC), the most common primary liver malignancy. Over the past few decades, direct and indirect mechanisms have been identified in the pathogenesis of HBV-associated HCC which include altered signaling pathways, genome integration, mutation-induced genomic instability, chromosomal deletions and rearrangements. Intertwining of the HBV counterparts with the host cellular factors, though well established, needs to be systemized to understand the dynamics of host-HBV crosstalk and its consequences on HCC progression. Existence of a vast array of protein-protein and protein-nucleic acid interaction databases has led to the uncoiling of the compendia of genes/gene products associated with these interactions. This review covers the existing knowledge about the HBV-host interplay and brings it down under one canopy emphasizing on the HBV-host interactomics; and thereby highlights new strategies for therapeutic advancements against HBV-induced HCC.

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Characterization of cross‐reactive monoclonal antibodies against SARS‐CoV‐1 and SARS‐CoV‐2: implication for rational design and development of pan‐sarbecovirus vaccines and neutralizing antibodies

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ABSTRACT

Emergence of various circulating SARS-CoV-2 variants of concern (VOCs) promotes the identification of pan-sarbecovirus vaccines and broadly neutralizing antibodies (bNAbs). Here, to characterize monoclonal antibodies cross-reactive against both SARS-CoV-1 and SARS-CoV-2 and to search the criterion for bNAbs against all emerging SARS-CoV-2, we isolated several SARS-CoV-1-cross-reactive monoclonal antibodies (mAbs) from a wildtype SARS-CoV-2 convalescent donor. These antibodies showed broad binding capacity and cross-neutralizing potency against various SARS-CoV-2 VOCs, including B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma) and B.1.617.2 (Delta), but failed to efficiently neutralize Omicron variant and its sublineages. Structural analysis revealed how Omicron sublineages, but not other VOCs, efficiently evade an antibody family cross-reactive against SARS-CoV-1 through their escape mutations. Further evaluation of a series of SARS-CoV-1/2-cross-reactive bNAbs showed a negative corre lation between the neutralizing activities against SARS-CoV-1 and SARS-CoV-2 Omicron variant. Together, these results suggest the necessity of using cross-neutralization against SARS-CoV-1 and SARS-CoV-2 Omicron as criteria for rational design and development of potent pan-sarbecovirus vaccines and bNAbs.

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Infectivity of pseudotyped SARS‐CoV‐2 variants of concern in different human cell types and inhibitory effects of recombinant spike protein and entry‐related cellular factors

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Abstract

Since the report of the first COVID-19 case in 2019, SARS-CoV-2 variants of concern (VOCs) have continued to emerge, manifesting diverse infectivity, evasion of host immunity and pathology. While ACE2 is the predominant receptor of SARS-CoV-2, TMPRSS2, Kim-1, NRP-1, CD147, furin, CD209L and CD26 have also been implicated as viral entry-related cofactors. To understand the variations in infectivity and pathogenesis of VOCs, we conducted infection analysis in human cells from different organ systems using pseudoviruses of VOCs including Alpha, Beta, Gamma and Delta. Recombinant spike S1, RBD, ACE2, Kim-1 and NRP-1 proteins were tested for their ability to block infection to dissect their roles in SARS-CoV-2 entry into cells. Compared with wild type SARS-CoV-2 (WT), numerous VOCs had significant increases of infectivity across a wide spectrum of cell types. Recombinant ACE2 protein more effectively inhibited the infection of VOCs including Delta and Omicron (BA .1 and BA.2) than that of WT. Interestingly, recombinant S1, RBD, Kim-1 and NRP-1 proteins inhibited the infection of all pseudoviruses in a manner dependent on the levels of ACE2 expression in different cell types. These results provide insights into the diverse infectivity of SARS-CoV-2 VOCs, which might be helpful for managing the emergence of new VOCs.

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