Low prevalence of influenza viruses and predominance of A(H3N2) virus with respect to SARS‐CoV‐2 during the 2021–2022 season in Bulgaria

alexandrossfakianakis shared this article with you from Inoreader Low prevalence of influenza viruses and predominance of A(H3N2) virus with respect to SARS‐CoV‐2 during the 2021–2022 season in Bulgaria via Journal of Medical Virology Abstract Social distancing, mask-wearing, and travel restrictions during the COVID-19 pandemic have significantly impacted the spread of influenza viruses. The objectives of this study were to analyze the pattern of influenza virus circulation with respect to that of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Bulgaria during the 2021–2022 season and to perform a phylogenetic/molecular analysis of the hemagglutinin (HA) and neuraminidase (NA) sequences of representative influenza strains. Influenza infection was confirmed using real-time reverse transcription polymerase chain reaction in 93 (4.2%) of the 2193 patients with acute respiratory illness tested wherein all detected viruses were subtyped as A(H3N2). SARS-CoV-2 was identified in 377 (24.3%) of the 1552 patients tested. Significant differences in the incidence of influenza viruses and SARS-CoV-2 were found between individual age groups, outpatients/inpatients, and in the seasonal distribution of cases. Two cases of coinfections were identified. In hospitalized patients, the C t values of influenza viruses at admission were lower in adults aged ≥65 years (indicating higher viral load) than in children aged 0–14 years (p < 0.05). In SARS-CoV-2-positive inpatients, this association was not statistically significant. HA genes of all A(H3N2) viruses analyzed belonged to subclade 3C.2a1b.2a. The sequenced viruses carried 11 substitutions in HA and 5 in NA, in comparison to the vaccine virus A/Cambodia/e0826360/2020, including several substitutions in the HA antigenic sites B and C. This study revealed extensive changes in the typical epidemiology of influenza infection, including a dramatic reduction in the number of cases, diminished genetic diversity of circulating viruses, changes in age, and seasonal distribution of cases. View on Web

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What ultimately matters in root canal treatment success and tooth preservation: a 25‐year cohort study

alexandrossfakianakis shared this article with you from Inoreader What ultimately matters in root canal treatment success and tooth preservation: a 25‐year cohort study via International Endodontic Journal Abstract Aim There are currently no prospective studies evaluating the long-term outcomes of non-surgical root canal treatments beyond 5 years, both in terms of treatment success and tooth preservation, and identifying factors predictive of treatment outcome. The aim of the present work was therefore to fill this gap by assessing these outcomes over time and identifying predictive variables based on a systematic data collection over a 25-year period. Methodology Data concerning the treatments (N=2500) were systematically collected since 1990. Information was recorded among clinical, technical, radiographic, patient-related characteristics, i.e. approximately 150 variables for each treatment. The data were analysed regarding both treatment success and tooth preservation by multivariable Cox proportional hazards model and survival curves were generated. Statistical significance level was set at 0.0125. Results 56.4% of the treatments could be followed over time (0−25y, mean=6.5y, median=5y). Survival probability decreased almost linearly for treatment success, with about 85% after 5 years and 60% after 20 years, and for tooth preservation, with about 90% at 5 years and 50% at 20 years. The variables significantly associated with treatment failure were: pre-operative pain (Hazard Ratio – HR=1.56 (95%CI 1.23−1.97), persistent pain (HR=2.63 (95%CI 1.44−4.80), good operator rating of treatment prognosis (HR=0.46 (95%CI 0.36−0.58), size of periapical bone radiolucency (HR=1.88 (95%CI 1.67−2.11), and tooth type (p=0.0006). For tooth extraction, they were: combined endodontic-periodontal lesion (HR=3.37 (95%CI 1.88−6.05), pre-existing complication before treatment (HR=1.67 (95%CI 1.26−2.21), good operator rating of treatment prognosis (HR=0.45 (95%CI 0.33−0.60), clinical failure of root canal treatment (HR=2.78 (95%CI 1.98−3.89) and tooth type (p=0.0012). Conclusion Root canal treatment success and tooth preservation on the arch are not static outcomes, but evolve with time. Among a substantial set of potential predictors, only a small proportion was significantly predictive of treatment success and tooth preservation, most of them being disease and patient characteristics, and not technical aspects, except pre-existing complications. These observations challenge the importance frequently given to byzantine considerations related to the numerous technical details of endodontic procedures, as opposed to general concepts of good clinical practice. View on Web

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Associations between snoring and dental sleep conditions: a systematic review

alexandrossfakianakis shared this article with you from Inoreader Associations between snoring and dental sleep conditions: a systematic review via Journal of Oral Rehabilitation Abstract Background It is important for dentists to know if the presence of snoring is associated with the presence of other dental sleep conditions (e.g., obstructive sleep apnea [OSA], sleep bruxism [SB], gastroesophageal reflux disease [GERD], xerostomia, and orofacial pain). If so, dentists could play a significant role in the early recognition and management of these conditions. Objectives This systematic review aimed to: i) investigate the associations between the presence of snoring and the presence of other dental sleep conditions; and ii) determine if it is clinically relevant that dentists assess snoring in their population. Methods The literature search was performed in PubMed and Embase.com in collaboration with a medical librarian. Studies were eligible if they employed regression models to assess whether snoring was associated with other dental sleep conditions, and/or investigated the incidence of snoring in patients with other dental sleep conditions and vice versa. Results Of the 5,299 retrieved references, 36 eligible studies were included. The available evidence indicates that the presence of snoring is associated with higher probabilities of OSA, GERD, and headache. Due to limited evidence and conflicting findings, the currently available articles are not indicative of associations between the presence of snoring and the presence of SB and oral dryness. Conclusion Within the limitations of this study, it can be concluded that the presence of snoring is associated with higher probabilities of OSA, GERD, and headache. Therefore, it is clinically relevant that dentists assess snoring in their patient population. View on Web

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Strategies to build and maintain competence in pain management: insights from a SIAARTI survey on educational needs among Italian anesthesiologists

alexandrossfakianakis shared this article with you from Inoreader Strategies to build and maintain competence in pain management: insights from a SIAARTI survey on educational needs among Italian anesthesiologists via Pain Practice Abstract Purpose Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. Methods SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed with a 5-point Likert-type scale. Results Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31-40 years). Regarding cancer and chronic non-cancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, non-cancer, musculoskeletal and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children and use of drugs with abuse potential. Conclusion This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy. View on Web

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Preoperative Prediction of Sinonasal Inverted Papilloma‐associated Squamous Cell Carcinoma (IP‐SCC)

alexandrossfakianakis shared this article with you from Inoreader Preoperative Prediction of Sinonasal Inverted Papilloma‐associated Squamous Cell Carcinoma (IP‐SCC) via The Laryngoscope The relatively low diagnostic sensitivity of in-office punch biopsy to detect inverted papilloma associated squamous cell carcinoma (IP-SCC) indicates the need to identify other clinical and radiological features associated with IP-SCC. IP patients with chronic systemic diseases, a history of tobacco smoking, facial pain, or epistaxis, and those with bony destruction, remodeling, or invasion of adjacent structures on preoperative radiologic imaging may be at higher risk of IP-SCC, suggesting the need for more aggressive surgical strategies. Introduction Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. Material and Methods Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. Results The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. Conclusion IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. Level of Evidence 3 Laryngoscope, 2023 View on Web

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Extended External Rhinoplasty Approach For Nasal Dermoids With Intracranial Extension

alexandrossfakianakis shared this article with you from Inoreader Extended External Rhinoplasty Approach For Nasal Dermoids With Intracranial Extension via The Laryngoscope We present an extended external rhinoplasty approach with bilateral marginal and alar base incisions for removal of a nasal dermoid cyst with intracranial extension in a 3-year-old patient. This approach provides adequate exposure, enables nasal bone osteotomies, and allows access to the skull base while achieving a cosmetically acceptable scar. Laryngoscope, 2023 View on Web

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Characteristics of Nasal Foreign Bodies and Equipment on Complications During Removal Procedures

alexandrossfakianakis shared this article with you from Inoreader Characteristics of Nasal Foreign Bodies and Equipment on Complications During Removal Procedures via The Laryngoscope This study aimed to clarify the equipment for the safe removal of nasal foreign bodies. Suction, paper clips, and cotton swabs were considered beneficial equipment for the safe removal of nasal foreign bodies because of minimizing complications and their high versatility. Objective The treatment of nasal foreign bodies involves safe and reliable removal. Few reports have investigated the relationship between equipment and the incidence of complications. Methods This retrospective study included 300 patients with nasal foreign bodies (average: 3.28 years, interquartile range: 2–4 years). Patients' background, characteristics of nasal foreign body, equipment to remove the nasal foreign body, and complications were obtained from medical records. Statistical analysis was performed using Pearson's chi-square test for associated factors and the incidence of epistaxis among the complications. Results Nasal foreign bodies were found and removed in 256 patients. Forceps, hooks, suction, modified paper clips, and cotton swabs were mainly used to remove the nasal foreign bodies. Epistaxis due to the removal procedure was observed in 26 patients. The occurrence of epistaxis differed depending on the equipment (p = 0.077) and was less frequent in suction and paper clips than in forceps (p < 0.05 and p = 0.077). Epistaxis was not observed when a cotton swab was used. Aspiration and septal perforation were not observed. A statistical relationship was not detected between the hardness of foreign bodies and the occurrence of epistaxis (p = 0.251). The incidence of epistaxis was higher in cases nasal foreign bodies remained for 1 day and over than in cases foreign bodies were removed within 1 day (p < 0.05). Conclusions This study revealed that suction, modified paper clips, and cotton swabs could be beneficial options for minimizing complications in the removal of nasal foreign bodies. Level of Evidence Level 4 Laryngoscope, 2023 View on Web

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