Prognostic factors in patients with advanced differentiated thyroid cancer treated with multikinase inhibitors - a single Brazilian center experience

xlomafota13 shared this article with you from Inoreader Prognostic factors in patients with advanced differentiated thyroid cancer treated with multikinase inhibitors - a single Brazilian center experience Via radioactive iodine Arch Endocrinol Metab. 2021 Apr 29:2359-3997000000364. doi: 10.20945/2359-3997000000364. Online ahead of print. ABSTRACT OBJECTIVE: The aim of this study was to describe the real-world experience multikinase inhibitors (MKI) in the treatment advanced differentiated thyroid carcinoma (DTC) refractory to radioactive iodine (RAIR) therapy. METHODS: We reviewed the records of all patients with MKI-treated DTC from 2010 to 2018. Progression free survival (PFS), response rates (RR) and adverse events (AE) profiles were assessed. Clinical parameters were compared between groups with different outcomes (disease progression and death) to identify possible prognostic factors and benefit from treatment. RESULTS: Forty-four patients received MKI for progressive RAIR DTC. Median PFS was 24 months (10.2-37.7) and median overall survival (OS) was 31 months. Best overall response was complete response in one patient (4.5%), partial response in nine (20.4%), stable disease in twenty-two (50%), and progressive disease (PD) in twelve (27.3%). Seventy-two point 7 percent patients had clinical benefit and AE were mild in most cases (82.7%). Progressive patients were more likely to have FDG positive target lesion than those who did not progress (p = 0.033) and higher maximum SUV on target lesions (p = 0.042). Presence of lung-only metastasis and lower thyroglobulin (Tg) during treatment was associated with stable disease (p = 0.015 and 0,049, respectively). Patients wi th shorter survival had larger primary tumor size (p = 0.015) and higher maximum SUV on target lesions (p = 0.023). CONCLUSION: Our findings demonstrate safety and effectiveness of MKI in patients with advanced RAIR DTC. We were able to identify as possible prognostic markers of better outcomes: absence of FDG uptake on target lesions, lower maximum SUV on PET-CT, presence of lung-only metastasis and lower Tg during treatment. PMID:33939907 | DOI:10.20945/2359-3997000000364 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

ὁ δὲ ἡγεμὼν ἔφη· τί γὰρ κακὸν ἐποίησεν; οἱ δὲ περισσῶς ἔκραζον λέγοντες· σταυρωθήτω

Bruxismo y su relación con otorrinolaringología: una revisión de la literatura

xlomafota13 shared this article with you from Inoreader Bruxismo y su relación con otorrinolaringología: una revisión de la literatura Via Otorrinolaringología y cirugía de cabeza y cuello Resumen El bruxismo es una condición que se observa frecuentemente en los pacientes y estos a menudo consultan por sus consecuencias físicas, como pueden ser el desgaste o destrucción dentaria, el dolor orofacial, así como también por el deterioro de la calidad de vida tanto de ellos mismos como de las personas cercanas. En la última década han aumentado en forma importante las investigaciones en torno a esta condición, así como los consensos en cuanto a su definición, clasificación y manejo clínico. Los dentistas son quienes actualmente reconocen esta actividad parafuncional y manejan estos problemas, pero es importante que los profesionales de otras áreas de la salud, como médicos y en especial otorrinolaringólogos, puedan identificar los signos, síntomas y consecuencias del bruxismo, ayudando en la detección de esta condición. Así, el objetivo de esta revisión es establecer un estado del arte sobre bruxismo e incentivar la formación de equipos multidisci plinares que ayuden en el diagnóstico y la terapéutica de esta condición. Abstract Bruxism is a condition that is frequently observed in patients, and they often consult for physical consequences, such as teeth wear or destruction, orofacial pain, as well as for the decrease of the quality of life, of both patients and their loved ones. In the last decade, research on this phenomenon has increased significantly, as well as the consensus in terms of definition, classification and clinical management. Dentists are those who at present recognize this parafunctional activity and manage these problems, but it is important that professionals from other health areas, such as medical doctors, and specially otolaryngologists, can identify signs, symptoms and consequences of bruxism, helping in the detection of this condition. Thus, the objective of this review is to establish a state of the art about bruxism and encourage the formation of multidisciplinary teams that help to in the dia gnosis and better management of this condition. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión

xlomafota13 shared this article with you from Inoreader Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión Via Otorrinolaringología y cirugía de cabeza y cuello Resumen El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) en niños forma parte del espectro de trastornos respiratorios del sueño en la infancia. Tiene una prevalencia entre un 0,69% y 4,7% en la población infantil con una mayor incidencia entre los 2 y 6 años debido principalmente a la hiperplasia adenoamigdaliana y constituye una importante causa de morbilidad neurocognitiva y conductual en quienes lo padecen. El principal tratamiento quirúrgico del SAHOS infantil lo constituye la adenoamigdalectomía, cirugía que logra la resolución de los síntomas entre un 20% y 75% de los pacientes. Los pacientes con comorbilidades asociadas tales como obesidad, enfermedades neuromusculares y alteraciones craneofaciales, entre otras, tienen mayor riesgo de SAHOS persistente. En la presente revisión de la literatura abordaremos el diagnóstico, enfrentamiento, estudio y tratamiento del SAHOS persistente posadenoamigdalectomía en niños. Abstract Obstructive sleep apnea syndrome (OSA) in children is part of the spectrum of respiratory sleep disorders in childhood. It has a prevalence between 0.69 and 4.7% in pediatric population, with a higher incidence between 2 and 6 years old, mainly due to adenotonsillar hyperpla-sia. OSA constitutes an important cause of neurocognitive and behavioral morbidity. The main surgical treatment for childhood OSA is adenotonsi-llectomy, which resolves symptoms in 20%-75% of patients. Patients with associated comorbidities such as obesity, neuromus-cular diseases, and craniofacial malformations are at higher risk of having persistent OSA. In this literature review, we will discuss the diagnosis, evaluation and treatment of persistent OSA after adenotonsillectomy in children. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluación electrofisiológica del procesamiento auditivo

xlomafota13 shared this article with you from Inoreader Evaluación electrofisiológica del procesamiento auditivo Via Otorrinolaringología y cirugía de cabeza y cuello Resumen En la actualidad existen distintas herramientas para la evaluación del procesamiento auditivo y sus alteraciones. Además de las pruebas conductuales y de las mediciones electroacústicas, se ha establecido que la batería mínima de evaluación del procesamiento auditivo debe incluir exámenes electrofisiológicos que permitan dar cuenta del estado funcional de las estructuras anatómicas a nivel de tronco cerebral, la corteza auditiva y del sistema nervioso auditivo central en general. Las pruebas electrofisiológicas más descritas en la literatura corresponden a las respuestas auditivas complejas de tronco cerebral, potenciales evocados auditivos de latencia media, potenciales evocados auditivos de latencia tardía, y los potenciales auditivos asociados a eventos como el potencial de disparidad y el P300. A pesar de que diversos organismos internacionales como la American Speech-Language-Hearing Association y la American Academy of Audiology han recomendado su util ización en el proceso diagnóstico del trastorno del procesamiento auditivo y han mencionado su utilidad en la diferenciación de cuadros asociados, no existe evidencia concluyente en relación con sus aplicaciones clínicas. Esto último ha llevado a organizaciones como la British Society of Audiology a poner en duda su verdadera utilidad en estos casos. Abstract Currently, there are different tools for the assessment of auditory processing and its disorders. In addition to behavioral tests and electroacoustic measurements, it has been established that the minimum battery for auditory processing assessment must include electrophysiological examinations that allow to verify the functional state of anatomical structures at the brainstem, the auditory cortex and, broadly, the central auditory nervous system. In literature, the most described electrophysiological tests correspond to complex auditory brainstem responses, auditory middle latency evoked responses, auditory late latenc y evoked responses and event related evoked potentials, such as mismatch negativity and P300. Although several international organizations such as the American Speech-Language-Hearing Association and the American Academy of Audiology have recommended its use in the diagnostic process of auditory processing disorder and have mentioned its usefulness in the differentiation of associated conditions, there is no conclusive evidence in relation to its clinical applications. The latter has led organizations such as the British Society of Audiology to question its true usefulness in these cases. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management

xlomafota13 shared this article with you from Inoreader Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management Via leak of cerebrospinal fluid Int J Spine Surg. 2021 Apr;15(2):280-294. doi: 10.14444/8038. Epub 2021 Apr 1. ABSTRACT BACKGROUND: Incidental dural tears during lumbar endoscopy can be challenging to manage. There is limited literature on their appropriate management, risk factors, and the clinical consequences of this typically uncommon complication. MATERIALS AND METHODS: To improve the statistical power of studying durotomy with lumbar endoscopy, we performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks, including WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeons' recorded responses to multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, the decompression instruments they use, and incidental durotomy incidence with routine lu mbar endoscopy. RESULTS: There were 689 dural tears in 64 470 lumbar endoscopies, resulting in an incidental durotomy incidence of 1.07%. Seventy percent of the durotomies were reported by 20.4% of the surgeons. Eliminating these 19 outlier surgeons yielded an adjusted durotomy rate of 0.32. Endoscopic stenosis decompression (54.8%; P < .0001), rather than endoscopic discectomy (44.1%; 41/93), was significantly more associated with durotomy. Medium-sized dural tears (1-10 mm) were the most common (52.2%; 48/93). Small pinhole durotomies (less than 1 mm) were the second most common type (46.7%; 43/93). Rootlet herniations were seen by 46.2% (43/93) of responding surgeons. The posterior dural sac injury during the interlaminar approach (57%; 53/93) occurred more frequently than traversing nerve-root injuries (31.2%) or anterior dural sac (23.7%; 22/93). Exiting nerve-root injuries (10.8%;10/93) were less common. Over half of surgeons did not attempt any repair or closu re (52.2%; 47/90). Forty percent (36/90) used sealants. Only 7.8% (7/90) of surgeons attempted an endoscopic repair or sutures (11.1%; 10/90). DuralSeal was the most commonly used brand of commercially available sealant used (42.7%; 35/82). However, other sealants such as Tisseal (15.9%; 13/82), Evicel (2.4%2/82), and additional no-brand sealants (38; 32/82) were also used. Nearly half of the patients (48.3%; 43/89) were treated with 24-48 hours of bed rest. The majority of participating surgeons (64%; 57/89) reported that the long-term outcome was unaffected. Only 18% of surgeons reported having seen the development of a postoperative cerebrospinal fluid (CSF)-fistula (18%;16/89). However, the absolute incidence of CSF fistula was only 0.025% (16/64 470). Severe radiculopathy with dysesthesia; sensory loss; and motor weakness in association with an incidental durotomy were reported by 12.4% (11/89), 3.4% (3/89), and 2.2% (2/89) of surgeons, respectively. CONCLUSIONS: The inci dence of dural tears with lumbar endoscopy is about 1%. The incidence of durotomy is higher with the use of power drills and the interlaminar approach. Stenosis decompression that typically requires the more aggressive use of these power instruments has a slightly higher incidence of dural tears than does endoscopic decompression for a herniated disc. Most dural tears are small and can be successfully managed with mechanical compression with Gelfoam and sealants. Two-thirds of patients with incidental dural tears had an entirely uneventful postoperative course. The remaining one-third of patients may develop a persistent CSF leak, radiculopathy with dysesthesia, sensory loss, or motor function loss. Patients should be educated preoperatively and reassured. LEVEL OF EVIDENCE: 3. PMID:33900986 | DOI:10.14444/8038 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Study on Otorhinolaryngological Presentations in Covid 19 Patients in a Tertiary Health Care Center

xlomafota13 shared this article with you from Inoreader A Study on Otorhinolaryngological Presentations in Covid 19 Patients in a Tertiary Health Care Center Via Otolaryngology Indian Abstract Corona virus also known as 2019 novel corona virus, a single stranded positive sense RNA virus is the causative agent of COVID 19 disease. It mainly spreads via the respiratory route by means of aerosols. The objectives of our study were. To know the prevalence of ENT presentations in COVID 19 patients and to know the relationship between the symptoms and category of the disease as well as to know the relation between the blood group and recovery from the disease. The first 500 patients who were tested positive for COVID 19 and getting treated in our hospital were included in the study after taking written informed consent from the patients who were willing to participate in the study. A detailed history was taken from all the patients and more stress was given on the ENT symptoms with respect to its onset, duration and time taken for the relief of symptoms. The ENT symptoms were compared with the category of the disease as well as the blood group of the patients . Statistical analysis was done using Chi square test and Statistical Package for Social Sciences [SPSS] for Windows Version 22.0 Released 2013. Armonk, NY: IBM Corp., was used to perform statistical analyses. In our study 310 (62.0%) were males and 190 (38.0%) patients were females (38%), of age group ranging from 2 years to 87 years. In our study 367 (73.3%) patients were symptomatic and the rest 133 (26.6%) were asymptomatic. There were 335 (67.0%) patients in category A, 140 (28.0%) in category B and 25 (5.0%) in category C. The most common ENT presentation was headache and its prevelance was more in category C and it was of statistical significance. On comparing the blood group and the ENT symptoms occurrence of sore throat was of statistical significance and its prevelance was more among the O blood group patients. In terms of recovery from the disease the patients with blood group O had good recovery rate. Covid 19 pandemic is still an on going problem and newer strains of th e virus are arising as well hence. In our study we found out that isolated ENT symptoms such as aguesia and anosmia were the only presentation of the disease. Thus they can be considered as early marker of the disease and it will be helpful in early detection and isolation of the patient as well as prevention of further spread of the disease. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.