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Αλέξανδρος Γ. Σφακιανάκης

Thursday, October 14, 2021

Diagnostic accuracy of [99mTc]Tc‐tilmanocept compared to [99mTc]Tc‐nanocolloid for sentinel lymph node identification in early‐stage oral cancer

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The prevalence of oropharyngeal squamous cell carcinoma in patients admitted with symptoms of peritonsillar abscess or cellulitis: A retrospective multicentre study

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In healthy subjects nasal nitric oxide does not correlate with olfactory sensitivity, trigeminal sensitivity, and nasal airflow

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Evaluation of laryngeal vascular changes with image1 s enhancement system in reference to the European laryngological society guideline

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Otoendoscopic characterisation of middle ear masses by the aid of narrow‐band imaging: A preliminary report

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Intraoperative Ultrasonographic Assessment of Vocal Cord motion under sedation, following paediatric thyroidectomy in the Era of COVID‐19: A double‐blinded preliminary study

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Comparing ultrasound assessment of thyroid nodules using BTA U classification and ACR TIRADS measured against histopathological diagnosis

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Increased incidence of unilateral sudden sensorineural hearing loss in patients with hematological malignancies requiring hematopoietic stem cell transplantation

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The role of sepsis screening, SIRS and qSOFA in head and neck infections: An audit of 104 patients

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The Systemic Inflammatory Response Syndrome (SIRS)
SIRS was defined as fulfilling at least two of the following four criteria:
fever >38.0°C or hypothermia <36.0°C,
tachycardia >90 beats/minute,
tachypnea >20 breaths/minute,
leucocytosis >12*109/l or leucopoenia <4*109/l.

The qSOFA Score was introduced by the Sepsis-3 group as a simplified version of the SOFA Score, a validated ICU mortality prediction score, to help identify patients with suspected infection that are at high risk for poor outcome (defined as in-hospital mortality, or ICU length of stay ≥3 days) outside of the ICU.

Patients with SIRS or sepsis require immediate stabilization and treatment. It is recommended that treatment be centered on fluid resuscitation, antimicrobial therapy, infectious source control, and overall supportive care (e.g., pain control, nutrition).



TRIAGE OF SEPSIS PATIENTS: SIRS OR QSOFA – WHICH IS BEST?
N Gunn, C Haigh, JR Thomson
Abstract
Objectives & Background Recent consensus guidelines have suggested using the qSOFA score as a tool for the identification of patients with sepsis outwith the ICU setting. In the UK, we currently use the SIRS criteria as a means of identifying these patients in the ED. We wanted to look at whether the qSOFA would reliably identify septic patients in our ED population.

Methods We retrospectively reviewed 200 cases of adult patients presenting to our ED over a six month period who had a sepsis 6 form completed. SIRS and qSOFA scores were calculated for all patients and the results compared. Patients identified as requiring critical care input and those who died were noted.

Results 200 patients were identified over a 6 month period–109 male, 91 female; age range 18–95 yrs; average 66.7 yrs; IQR 1–58 yr; IQR 3–79 yrs.

Of these 200 patients, 4 were admitted to ITU and 17 were admitted to HDU from the Emergency Department. There were 22 deaths in total of whom 1 died on ITU with full escalation of care, and 8 died in HDU with a decision they were not for further escalation. Of those that died outwith critical care, 8 had a decision of ward as ceiling of care made in the ED.

195 cases were positive for SIRS of which 4 were admitted to ICU; 16 to HDU and 22 died. SIRS identified all patients who died and all but 1 patient who received critical care input.

SIRS test was 97% sensitive and 2.4% specific. The positive predictive value is 15.9%, the negative predictive value is 80%.

29 cases were positive for qSOFA of whom 1 was admitted to ICU and 9 to HDU. There were 9 deaths in this group of which 5 were patients on HDU. 4 patients identified as qSOFA positive were determined as not for escalation of care and subsequently died.

qSOFA was 90% specific for identifying patients who died or required critical care input but only 48% sensitive. The positive predictive value is 42%, the negative predictive value is 92%.

Conclusion qSOFA is a more specific test to identify patients requiring critical care input or at risk of death. Although SIRS is more sensitive, its lack of specificity makes it a much less effective screening tool for severe sepsis.

Practically, SIRS is useful as a triage tool to identify potentially septic patients but once identified qSOFA should be used to assess severity and need for critical care involvement.


http://dx.doi.org/10.1136/emermed-2016-206402.23

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The acid test: Proton pump inhibitors in persistent throat symptoms: A systematic review of systematic reviews

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No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up.



Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4903 (Published 07 January 2021)
Cite this as: BMJ 2021;372:m4903
Article
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Peer review
James O'Hara, consultant otolaryngologist-head and neck surgeon, honorary senior clinical lecturer1 2, Deborah D Stocken, professor3, Gillian C Watson, trial manager4, Tony Fouweather, statistician5, Julian McGlashan, consultant otolaryngologist-head and neck surgeon, honorary consultant assistant professor6, Kenneth MacKenzie, consultant otolaryngologist-head and neck surgeon, visiting professor7, Paul Carding, professor8, Yakubu Karagama, consultant otolaryngologist-head and neck surgeon9, Ruth Wood, data manager4, Janet A Wilson, professor of otolaryngology-head and neck surgery10
Author affiliations
Correspondence to: J O'Hara James.O%E2%80%99Hara@newcastle.ac.uk
Accepted 28 November 2020
Abstract
Objective To assess the use of proton pump inhibitors (PPIs) to treat persistent throat symptoms.

Design Pragmatic, double blind, placebo controlled, randomised trial.

Setting Eight ear, nose, and throat outpatient clinics, United Kingdom.

Participants 346 patients aged 18 years or older with persistent throat symptoms who were randomised according to recruiting centre and baseline severity of symptoms (mild or severe): 172 to lansoprazole and 174 to placebo.

Intervention Random blinded allocation (1:1) to either 30 mg lansoprazole twice daily or matched placebo twice daily for 16 weeks.

Main outcome measures Primary outcome was symptomatic response at 16 weeks measured using the total reflux symptom index (RSI) score. Secondary outcomes included symptom response at 12 months, quality of life, and throat appearances.

Results Of 1427 patients initially screened for eligibility, 346 were recruited. The mean age of the study sample was 52.2 (SD 13.7) years, 196 (57%) were women, and 162 (47%) had severe symptoms at presentation; these characteristics were balanced across treatment arms. The primary analysis was performed on 220 patients who completed the primary outcome measure within a window of 14-20 weeks. Mean RSI scores were similar between treatment arms at baseline: lansoprazole 22.0 (95% confidence interval 20.4 to 23.6) and placebo 21.7 (20.5 to 23.0). Improvements (reduction in RSI score) were observed in both groups—score at 16 weeks: lansoprazole 17.4 (15.5 to19.4) and placebo 15.6 (13.8 to 17.3). No statistically significant difference was found between the treatment arms: estimated difference 1.9 points (95% confidence interval −0.3 to 4.2 points; P=0.096) adjusted for site and baseline symptom severity. Lansoprazole showed no benefits over placebo for any secondary outcome measure , including RSI scores at 12 months: lansoprazole 16.0 (13.6 to 18.4) and placebo 13.6 (11.7 to 15.5): estimated difference 2.4 points (−0.6 to 5.4 points).

Conclusions No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up.

Trial registration ISRCTN Registry ISRCTN38578686 and EudraCT 2013-004249-17.

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Characterization of otologic involvement in patients with X‐Linked Hypophosphatemia

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DOI:10.1007/s00431-004-1504-zCorpus ID: 9983916
Hearing impairment in familial X-linked hypophosphatemic rickets
G. Fishman, Denise R. Miller-Hansen, +2 authors U. Alon
Published 2004
Medicine
European Journal of Pediatrics
Hearing impairment in patients with X-linked dominant hypophosphatemic rickets (XLH) is likely part of the natural history of the disease, developing during adulthood. Therefore, whereas close follow up and hearing monitoring is recommended in adults, serial audiograms in children with XLH are not justified. Furthermore, in a child with XLH and hearing impairment, other etiologies should be explored. Hearing impairment in XLH patients has been reported a few times in the 1970s and 1980s [1, 2, 4, 5]; however, it was our impression that our pediatric XLH patients did not manifest clinical hearing impairment. Therefore, in order to better clarify the association between XLH and hearing status, and consequently provide information regarding patients' management, we prospectively evaluated the hearing status in our XLH patients and their afflicted parents. Hearing evaluations including audiometry, tympanometry and stapedial reflex thresholds recording were performed in 16 children with XLH (age 1–18 years, median 9.0 years, six males) and all of their ten afflicted parents (age 22–55 years, three male). None had a history of treatment with ototoxic drugs, noise exposure, previous ear surgery or chronic ear disease. Of 16 children, 15 demonstrated normal hearing. One with bilateral profound hearing loss was found to have a Mondini congenital inner ear malformation, documented by a temporal bone CT scan. Two adult males and one female, all with severe XLH-related orthopedic manifestations, demonstrated sensorineural hearing loss. More than two decades passed since hearing impairment was first described in XLH [5]. Table 1 summarizes the main findings of previous studies that have reported on this association, showing evidence of hearing impairment in a significant percentage of adult XLH patients versus minimal incidence of hearing loss in children [1, 2, 4, 5]. We compared the hearing status in a relatively large group of XLH children in a wide range of ages w ith that of their afflicted parents. None of our children had a hearing impairment attributable to XLH. The only child with hearing impairment was the one with a Mondini inner ear malformation which is believed to result from a developmental arrest of the membranous labyrinth during the first trimester of pregnancy [3], and is not known to be associated with rickets which is a post-natal disease. In contrast to the normal hearingwe found in ourXLH children, three of their ten parents had sensorineural hearing loss. These patientswere under 52 years old; hence presbyacusis was ruled out. Since in all three etiologies other than the disease process were excluded and in the light of the fact that all had severe orthopedic manifestations of rickets, we suspect that their hearing impairment is part of the disease process. They were referred to adult otolaryngologists for further management. Even though two of the earlier studies [2, 5] found hearing impairment in a very few children, lat er studies which investigated much larger cohorts of children [1, 4] as well as ours, did not find evidence of XLH-related hearing impairment in childhood. Therefore, it cannot G. Fishman Department of Pediatric Otolaryngology, ''Dana'' Children's Hospital, Tel-Aviv Medical Center, ''Sackler'' School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

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Serum hypoxia‐inducible factor‐2: A candidate prognostic biomarker for laryngeal cancer

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