Actividad de la enzima diaminoxidasa en pacientes con rinitis alérgica (estudio DAO-RIN): resultados preliminares

[Resumen] Introducción: La rinitis es una inflamación del revestimiento mucoso de la nariz caracterizada por: rinorrea, estornudos, picor nasal, congestión nasal, secreción postnasal. La histamina es una de los principales mediadores de esta patología. La intolerancia a la histamina resulta de un desequilibrio de la histamina acumulada y la capacidad para su degradación, siendo su causa principal un déficit en la degradación de la histamina causado por un error en la función enzimática de la DAO. El objetivo de este estudio es identificar la prevalencia de déficit en la actividad de la DAO en pacientes con rinitis alérgica. Material y métodos: Estudio descriptivo y analítico observacional de corte transversal con pacientes diagnosticados de rinitis alérgica reclutados de manera consecutiva de las consultas externas de Otorrinolaringología del Complexo Hospitalario Universitario A Coruña. Resultados: Un total de 105 pacientes con rinitis alérgica fueron reclutados, 33.33 % hombres y 66.67 % mujeres. La prevalencia de déficit de actividad DAO en pacientes con rinitis alérgica fue del 46.3% (IC95% 0.44 – 0.63). El peakflow nasal inspiratorio en pacientes con déficit de la actividad DAO fue de 80.40 ± 31.87 L/ min frente a los 91.72 ± 39.83 L/ min de los pacientes con actividad enzimática normal (p = 0.081). Discusión: El análisis preliminar de los resultados mostró que alrededor de la mitad de los pacientes con rinitis alérgica padecen de manera concomitante déficit de actividad DAO, no existiendo estudios previos que puedan servir de comparación en este tipo de población. La diferencia existente entre el flujo inspiratorio en pacientes con actividad normal frente a pacientes con déficit de actividad no resultó estadísticamente significativa. A pesar de ello, estas diferencias sí pueden ser clínicamente significativas, por lo que estos resultados preliminares deben ser tomarlos con prudencia y realizar un nuevo análisis cuando se obtenga el tamaño muestral.[Abstract] Introduction: Rhinitis is an inflammation of the mucous lining of the nose characterized by: rhinorrhea, sneezing, nasal itching, nasal congestion, postnasal secretion. Histamine is one of the main mediators of this pathology. The histamine intolerance results from an imbalance of accumulated histamine and the capacity for its degradation, being its main cause a deficit in the degradation of histamine caused by an error in the enzymatic function of the DAO. The objective of this study is to identify the prevalence of deficit in the activity of DAO in patients with allergic rhinitis. Material and methods: Cross-sectional descriptive and analytical observational study with patients diagnosed with allergic rhinitis consecutively recruited from the Otorhinolaryngology department of the Complexo Hospitalario Universitario A Coruña. Results: A total of 105 patients with allergic rhinitis were recruited, 33.33% men and 66.67% women. The prevalence of DAO activity deficit in patients with allergic rhinitis was 46.3% (CI95% 0.44 - 0.63). The inspiratory nasal peakflow in patients with a deficit in DAO activity was 80.40 ± 31.87 L/ min compared to 91.72 ± 39.83 L/ min in patients with normal enzymatic activity (p = 0.081). Discussion: The preliminary analysis of the results showed that about half of the patients with allergic rhinitis concomitantly suffer a deficit of DAO activity, and there are no previous studies that can be used as a comparison in this type of population. The difference between inspiratory flow in patients with normal activity versus patients with activity deficit was not statistically significant. In spite of this, these differences can be clinically significant, so these preliminary results should be taken prudently and perform a new analysis when the sample size is obtained.[Resumo] Introdución: A rinite é unha inflamación do revestimento mucoso do nariz, caracterizado por: rinorreia, espirros, prurido nasal, conxestión nasal e goteo post-nasal. A histamina é un dos principais mediadores desta patoloxía. A intoleracnia a histamina resulta dun desequilibrio entre a histamina acumulada e a capacidade de degradación, sendo a súa principal causa un déficit na degradación de histamina causada por un erro na función enzimática da DAO. O obxectivo deste estudo é identificar a prevalencia de déficit na actividade da DAO en pacientes con rinite alérxica. Material e métodos: Estudo observacional de tipo transversal descritivo e analítico con pacientes diagnosticados de rinite alérxica recrutados consecutivamente das consultas de Servizo de Otorrinolaringoloxía do Complexo Hospitalario Universitario A Coruña. Resultados: Un total de 105 pacientes con rinite alérxica foron reclutados, 33,33% homes e 66,67% mulleres. A prevalencia do déficit de actividade DAO en pacientes con rinite alérxica foi do 46,3% (IC do 95%: 0,44 a 0,63). O peakflow nasal inspiratorio en pacientes con déficit de actividade DAO foi 80,40 ± 31,87 L/ min contra 91,72 ± 39,83 L/ min en doentes con actividade enzimática normal (p = 0,081). Discusión: A análise preliminar dos resultados mostrou que preto da metade dos pacientes con rinite alérxica sofren concomitantemente déficit da actividade DAO, non existindo estudos previos que poden servir de comparación para esta poboación. A diferenza entre o fluxo inspiratorio en pacientes con actividade normal fronte a pacientes con déficit de actividade non foi estadísticamente significativo. Con todo, estas diferenzas en si pode ser clínicamente significativas, polo que estes resultados preliminares debe ser tomados con precaución e realizar unha nova análise, cando o tamaño da mostra sexa obtida.Traballo fin de mestrado (UDC.FCS). Asistencia e investigación sanitaria. Especialidade en investigación clínica. Curso 2017/201

T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO2 Laser Microsurgery a Safe Option?

[Abstract] Objectives: Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. Methods: Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. Results: Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence (P < .000). The involvement of the anterior commissure does not influence the organ preservation (P = .548), the appearance of local recurrences (P = .391), or the survival (P = .33). Conclusions: Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients’ quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution

Improving heat and moisture exchanger therapy with a hydrogel base adhesive in laryngectomized patients: an open randomized crossover trial

[Abstract] Objective: To assess individual’s preference, symptoms and compliance between habitual use of Provox XtraFlow and the combination of Provox XtraFlow during the day and Provox Luna during the night for heat and moisture exchanger therapy in laryngectomized patients. Methods: Open randomized crossover trial for 25 days. After this first follow-up and a 5 days wash-out period, a treatment switching was performed for another 25 days. Results: A total of 28 subjects, were enrolled. Differences were found (p=0.009) in the incidence of dermatological problems with XtraFlow (46.4%) versus Provox Luna (14.3%), as well as in the need to abandon the use of adhesives (46.4%vs.10.7%; p=0.003). The 60.7% of the patients referred the Provox Luna system as their preference for heat and moisture exchanger therapy. Conclusions: The Provox Luna system is a viable additive to heat and moisture exchanger therapy, especially in the setting of compliance concerns and in subjects who desire dermatological relief overnight

COVID-19 Pandemic and its Impact on the Management of Head and Neck Cancer in the Spanish Healthcare System

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has represented a major challenge for healthcare systems worldwide, changing the habits of physicians. A reorganization of healthcare activity has been necessary, limiting surgical activity to essential cases (emergencies and oncology), and improving the distribution of health resources. Objective To analyze the impact of the COVID-19 pandemic on head and neck cancer surgery management in Spain. Methods A cross-sectional study, through an anonymous and voluntary online survey distributed to 76 Spanish otorhinolaryngology departments. Results A total of 44 centers completed the survey, 65.9% of which were high-volume. A total of 45.5% of them had to stop high-priority surgery and 54.5% of head and neck surgeons were relocated outside their scope of practice. Surgeons reported not feeling safe during their usual practice, with a decrease to a 25% of airway procedures. A total of 29.5% were "forced" to deviate from the "standard of care" due to the epidemiological situation. Conclusions Approximately half of the departments decreased their activity, not treating their patients on a regular basis, and surgeons were reassigned to other tasks. It seems necessary that the head and neck surgeons balance infection risk with patient care. The consequences of the reported delays and changes in daily practice should be evaluated in the future in order to understand the real impact of the pandemic on the survival of head and neck cancer patients

Appropriateness for SARS-CoV-2 vaccination for otolaryngologist and head and neck surgeons in case of pregnancy, breastfeeding, or childbearing potential: Yo-IFOS and CEORL-HNS joint clinical consensus statement

Purpose SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available. Methods A multidisciplinary international panel of 33 specialists judged statements through a two-round modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience. Results Of the 13 statements, 7 reached consensus or strong consensus, 2 reached no consensus, and 2 reached near-consensus. According to the statements with strong consensus otorhinolaryngologists-head and neck surgeons who are pregnant, breastfeeding, or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination. Conclusion Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Resultados de la rehabilitación con prótesis de voz en pacientes intervenidos de laringectomía total

La voz traqueoesofágica se considera el tratamiento de elección para la rehabilitación vocal tras una laringectomía total debido a sus buenos resultados en calidad vocal y tasa de éxito en la obtención de voz inteligible. El objetivo principal de esta tesis doctoral fue evaluar los resultados actuales de la rehabilitación de voz mediante voz traqueoesofágica con el nuevo dispositivo Provox Vega y compararlos con los de su antecesora, la Provox 2. Los resultados confirmaron la hipótesis nula (H0), demostraron las diferencias no significativas (p = 0,261) en la duración de la Provox 2 (106,64 días) y la Provox Vega (124,19 días), así como el papel relevante del tratamiento con radioterapia sobre la duración de las PV. En relación a la duración de la Provox Vega (44,77 ± 2,82 días) y la Provox ActiValve (317,34 ± 116,8 días), se demostraron diferencias significativas (p <0,000). Estos resultados apoyan el uso de Provox ActiValve en pacientes con una disminución de la duración de las prótesis de voz por fuga endoprotésica, con el fin de reducir el número de recambios y los costes asociados. En relación a la duración de la Provox Vega (104,474 ± 7,29 días) y de la Provox XtraSeal (176,76 ± 26,46 días), se demostraron diferencias significativas (p = 0,012). Estos resultados apoyan el uso de la Provox XtraSeal en pacientes con un aumento de las sustituciones de prótesis debido a fugas periprotésicas, con el fin de reducir el número de cambios.2024-05-0

Recurrent Penicillin-Resistant Tonsillitis Due to Lactococcus garvieae, a New Zoonosis from Aquaculture

Zoonotic diseases are a group of infectious diseases that are transmitted naturally from animals to humans. L. garvieae is a Gram-positive bacterium which is present in the aquaculture of freshwater and marine fish. Some isolated cases of infection have been described, considering it an opportunistic agent in immunosuppressed patients. The most recent appearance of severe infections in immunocompetent patients or colonizing cardiac prostheses has set off the alarms. This manuscript presents the first two patients with recurrent tonsillitis due to L. garvieae. A 15-year-old male and an 8-year-old male had recurrent tonsillitis with more than three episodes per year. A culture of tonsillar exudate in both cases showed growth of L. garvieae with an antibiogram showing multi-resistance to antibiotics. Given the parents&rsquo; wish not to carry out surgery, an autovaccine regimen with lysed bacteria was proposed with good evolution and remission of tonsillitis episodes in both cases. The oral autovaccine produces an immunomodulatory effect and could be a therapeutic weapon in the prevention of this zoonosis. Further studies are needed to determine the importance of foodborne transmission in human L. garvieae infections and to find suitable treatments for this wide range of infections

In Reference to Association of Dry Eye with Laryngopharyngeal Reflux in Clinical Practice

SCOPUS: le.jDecretOANoAutActifinfo:eu-repo/semantics/publishe