scholarly journals Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1467
Author(s):  
Miquel Quer ◽  
Juan C. Hernandez-Prera ◽  
Carl E. Silver ◽  
Maria Casasayas ◽  
Ricard Simo ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Clinical Symptoms ◽  
Scientific Evidence ◽  
Current Trend ◽  
Recurrent Infection ◽  
Slow Growth Rate ◽  
Ethanol Sclerotherapy ◽  
Number Of Patients ◽  
Management Protocol ◽  
Active Observation

Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.

scholarly journals Tips and Pearls for Tracheostomy during the Covid-19 Pandemic

2021 ◽  
Vol 25 (03) ◽  
pp. e459-e462
Author(s):  
Darwin Kaushal ◽  
Shilpa Goyal ◽  
Nithin Prakasan Nair ◽  
Kapil Soni ◽  
Bikram Choudhury ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Present Article ◽  
Critically Ill ◽  
Current Literature ◽  
Literature Search ◽  
Scientific Evidence ◽  
Early Tracheostomy ◽  
Life Saving ◽  
Number Of Patients ◽  
Elective Tracheostomy

AbstractThe number of critically-ill coronavirus disease 2019 (Covid-19) patients requiring mechanical ventilation is on the rise. Most guidelines suggest keeping the patient intubated and delay elective tracheostomy. Although the current literature does not support early tracheostomy, the number of patients undergoing it is increasing. During the pandemic, it is important that surgeons and anesthesiologists know the different aspects of tracheostomy in terms of indication, procedure, tube care and complications. A literature search was performed to identify different guidelines and available evidence on tracheostomy in Covid-19 patients. The purpose of the present article is to generate an essential scientific evidence for life-saving tracheostomy procedures.

Neuronal intranuclear hyaline inclusion disease is a neurodegenerative condition which can be a target for gene therapy

2021 ◽  
Author(s):  
Moataz Dowaidar
Keyword(s):  
Gene Therapy ◽  
Clinical Symptoms ◽  
Repeat Expansion ◽  
Gene Identification ◽  
Therapeutic Assessment ◽  
Causative Gene ◽  
Central Nervous System Disorders ◽  
Number Of Patients ◽  
Mechanism Research ◽  
Or Gene

NIHID (neuronal intranuclear hyaline inclusion disease) is a neurodegenerative condition that is easy to detect but also easy to misdiagnose. Thanks to breakthroughs in MRI detection, the availability of skin biopsied pathology, and, most critically, the finding of the causative gene which can be targeted by gene therapy, the rate of NIID diagnosis before death has grown significantly in recent years. Symptoms linked with central nervous system disorders, autonomic and peripheral neuropathy, and myopathy may be experienced by patients with NIID. Regardless of how far clinical symptoms or gene identification have progressed in NOTCH2NLC gene-related repeat expansion disorders (NRED), it not only adds to our understanding of NIID, but it also adds to the number of challenges we must address. East Asia has seen a substantial number of patients with GGC repeat expansion in NOTCH2NLC. Clinicians should work together to develop a database of NIID clinical and biological samples, as well as perform additional clinical diagnostic, therapeutic assessment, and pathogenic mechanism research.

Außerklinische Beatmung – Konzepte und Therapieempfehlungen

2017 ◽  
Vol 142 (16) ◽  
pp. 1197-1204 ◽  
Author(s):  
Sarah Schwarz ◽  
Friederike Magnet ◽  
Bernd Schönhofer ◽  
Wolfram Windisch
Keyword(s):  
Mechanical Ventilation ◽  
Scientific Evidence ◽  
Underlying Disease ◽  
Home Mechanical Ventilation ◽  
Term Survival ◽  
Number Of Patients ◽  
Related Quality ◽  
Außerklinische Beatmung ◽  
Health Related

AbstractThe prognosis of patients receiving home mechanical ventilation is very heterogeneous and depends on the underlying disease, the degree of respiratory dependency and the comorbidities. Due to the severe chronic diseases, the initiation of a long-term NIV must be done during an inpatient treatment. Two recently published randomized controlled trials using more aggressive forms of NPPV targeted at normalizing hypercapnic PaCO2 values, showed improved long term survival also in patients with an underlying diagnosis of COPD. Consequently, the number of patients receiving home mechanical ventilation has dramatically increased in recent years and more and more outpatient settings has been established without scientific evidence. Nevertheless, beside reliable care structures, ethical aspects and health related quality of life are of great importance in the context of home mechanical ventilation.

scholarly journals Treatment-emergent hypomania possibly associated with over-the-counter supplements

2017 ◽  
Vol 7 (4) ◽  
pp. 160-163
Author(s):  
William Olsufka ◽  
Mary-Ann Abraham
Keyword(s):  
Adverse Effects ◽  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Safety Profile ◽  
General Public ◽  
Scientific Evidence ◽  
Western World ◽  
Over The Counter ◽  
Treatment Of Depression ◽  
Number Of Patients

Abstract The use of complementary and alternative medicine (CAM) is gaining popularity in the Western world. Among the general public, CAM is often perceived to be associated with less stigma, fewer adverse effects, and may be more affordable. A number of patients utilize CAM for the treatment of depression; however, as there is limited scientific evidence, the safety profile of these supplements are largely unknown. In this case, a 42-year-old man developed hypomania approximately 1 week after S-adenosylmethionine (SAMe) and 5-hydroxytryptophan (5-HTP) therapy was initiated for depression. The combination of SAMe and 5-HTP can potentially induce hypomanic episodes.

scholarly journals Study of mammography reports made between 2015 and 2019

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Marina Hernandes Carvalho ◽  
Pedro César Garcia Gonçalves ◽  
Gabriel Carvalho Carnelossi ◽  
Maria Júlia Carvalho Carnelossi ◽  
Felipe Colombelli Pacca
Keyword(s):  
Breast Cancer ◽  
Information System ◽  
High Risk ◽  
Scientific Evidence ◽  
Radiological Finding ◽  
Develop Breast Cancer ◽  
Cáncer De Mama ◽  
Cancer Information ◽  
Age Group ◽  
Number Of Patients

Introduction: Screening and early diagnosis are crucial strategies for the detection of breast cancer. In Brazil, the Ministry of Health recommends annual clinical screening in women over 40 years of age, with the addition of biennial mammography for those aged between 50 and 69 years. However, high-risk patients should have mammography annually after the age of 35 years. Objectives: To study the reasons for mammography screening in the age group 50 to 69 years. Method: This is an ecological study of the number of patients per mammography report according to age group, from 2015 to 2019. Data from the Cancer Information System (Sistema de Informação do Câncer – SISCAN) were obtained from the Technology Department of the public health system (Departamento de Informática do Sistema Único de Saúde – DATASUS). Results: When comparing data from the Breast Cancer Information System (Sistema de Informação do Câncer de Mama – SISMAMA) from 2015 to 2019, we found 8,569,457 mammographies, of which 5,216,473 were performed in women aged 50 years to 69 years, which corresponds to 60.87% of the procedures. In addition, 4.90% of these women were high-risk individuals, and 1.24% had been treated for breast cancer. Mammography reports showed that 12.01% of the results were inconclusive, 38.28% were normal, 46.12% had a benign radiological finding, 2.58% had a probably benign finding, 0.78% had a suspicious finding, 0.14% had a highly suspicious finding, and 0.04% had malignant confirmation. The proportion of BI-RADS categories 4, 5, and 6 totaled 83,852 screenings, the equivalent to 0.97% of reports. In addition, 59.49% (49,891) of women who presented mammographic findings with malignant characteristics belonged to the age group 50–69 years. Conclusion: This study concluded that the strategy of biennial breast cancer screening shows scientific evidence of mortality reduction, given that 59.49% of the reports with malignant characteristics corresponded to the age group 50 to 69 years. However, the data presented did not allow calculating the number of women outside this age group who do not receive care and develop breast cancer.

scholarly journals The fast-track outpatient clinic significantly decreases hospitalisation rates among polymyalgia rheumatica patients

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Stavros Chrysidis ◽  
Philip Rask Lage-Hansen ◽  
Nikoletta Svendsen ◽  
Andreas P. Diamantopoulos
Keyword(s):  
Polymyalgia Rheumatica ◽  
Fast Track ◽  
Clinical Symptoms ◽  
Classification Criteria ◽  
Duration Of Symptoms ◽  
Prednisolone Dose ◽  
South West ◽  
Hospitalised Patients ◽  
Number Of Patients ◽  
The Impact

Abstract Objectives This study aimed to investigate the hospitalisation rates and the reasons for hospitalisation in patients with polymyalgia rheumatica (PMR). Furthermore, it aimed to clarify the impact of a newly established Fast Track Clinic (FTC) approach on hospitalisation rates in connection with PMR diagnosis. Methods Patients diagnosed with PMR at South-West Jutland Hospital, Denmark, between 2013 and 2018 were included retrospectively. Only patients fulfilling the 2012 EULAR/ACR classification criteria were included in our cohort. An FTC for patients suspected of having PMR was established in the rheumatologic department of South-West Jutland Hospital in January 2018. Results Over 6 years (2013 to 2017), 254 patients were diagnosed with PMR, 56 of them while hospitalised. Hospitalised patients were more likely to have a higher initial CRP mean ± standard deviation (SD) 99.53 ± 59.36 vs 45.82 ± 36.96 mg/lt (p <  0.0001) and a shorter duration of symptoms (p = 0.0018). After implementing the FTC, a significant decrease in hospitalisation rates (from 20.4% to 3,5%) and inpatient days of care (mean ± SD 4.15 ± 3.1 vs 1 ± 0) were observed. No differences between the two groups were observed regarding clinical symptoms, laboratory values and initial prednisolone dose. Conclusion A substantial number of patients are hospitalised in connection with the PMR diagnosis. The FTC approach can decrease the hospitalisation rates significantly among these patients. Trial registration Retrospectively registered.

scholarly journals The Results of Giardiasis Treatment Using Giardicidal Drugs and their Combination with Probiotics in Children: A Retrospective Cohort Study

2018 ◽  
Vol 17 (4) ◽  
pp. 301-306
Author(s):  
Olga G. Kimirilova ◽  
Gennady A. Kharchenko
Keyword(s):  
Abdominal Pain ◽  
Combination Therapy ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Saccharomyces Boulardii ◽  
Lactase Deficiency ◽  
Intestinal Dysbiosis ◽  
Number Of Patients ◽  
Freeze Dried ◽  
Inpatient Settings

Background. Giardiasis in children remains an urgent problem, the significance of which is determined by the endemicity for many countries and regions, outbreaks of sporadic epidemics, polymorphism of clinical symptoms, and insufficient treatment efficacy. Objective. Our aim was to study the results of giardiasis treatment using giardicidal drugs or their combination with probiotics in children. Methods. We analyzed the frequency of Giardia lamblia elimination (the main outcome) as a result of giardiasis treatment (laboratory confirmed) in children aged from 3 months to 18 years who received giardicidal drugs (nifuratel, albendazole) or their combination with probiotics based on Saccharomyces boulardii (probiotic 1) and live freeze-dried lactic acid bacteria Lactobacillus acidophilus (L. gasseri), Bifidobacterium infantis, and Enterococcus faecium (probiotic 2) in outpatient or inpatient settings. Additionally, we registered the duration of the main symptoms of giardiasis (abdominal pain, diarrhea), the prevalence of intestinal dysbiosis and lactase deficiency. The considering period is from January 2015 to September 2017. Results. The results of giardiasis treatment were studied in 4 groups: monotherapy with nifuratel (n = 65) or albendazole (n = 64), a combination of nifuratel + probiotic 1 (n = 67) or albendazole + probiotic 2 (n = 64). The groups were comparable by sex, age, and clinical manifestations of the disease. The elimination of lamblia on the 14–16th day of monotherapy with giardicidal drugs was achieved in 56–60%, when combined with probiotics — in 84% of patients for each combination (df = 3, p < 0.001). Against the background of combination therapy, the disease symptoms (abdominal pain, diarrhea, vomiting) were reversed 1.5 times faster; the number of patients with lactase deficiency and intestinal dysbiosis decreased two and more times, under monotherapy with giardicidal drugs — 1.2 times (df = 3, p < 0.001). Conclusion. Giardiasis treatment in children using combination therapy, including giardicidal drugs and probiotics, is more effective than monotherapy with giardicidal drugs.

scholarly journals 10-Year Incidence of Diabetic Ketoacidosis at Type 1 Diabetes Diagnosis in Children Aged Less Than 16 Years From a Large Regional Center (Hangzhou, China)

2021 ◽  
Vol 12 ◽  
Author(s):  
Wei Peng ◽  
Jinna Yuan ◽  
Valentina Chiavaroli ◽  
Guanping Dong ◽  
Ke Huang ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Abdominal Pain ◽  
Diabetic Ketoacidosis ◽  
Primary Care Physicians ◽  
Clinical Symptoms ◽  
Diabetes Diagnosis ◽  
Regional Center ◽  
Retrospective Audit ◽  
Number Of Patients

BackgroundDiabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes (T1D), and a leading cause of death in children aged &lt;15 years with new-onset T1D.Aimsi) to assess the incidence of DKA in children and adolescents newly diagnosed with T1D over a 10-year period at a large regional center in China; and ii) to examine the clinical symptoms and demographic factors associated with DKA and its severity at diagnosis.MethodsWe carried out a retrospective audit of a regional center, encompassing all youth aged &lt;16 years diagnosed with T1D in 2009–2018 at the Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China). DKA and its severity were classified according to ISPAD 2018 guidelines.Results681 children were diagnosed with T1D, 50.1% having DKA at presentation (36.0% mild, 30.0% moderate, and 33.9% severe DKA). The number of patients diagnosed with T1D progressively rose from approximately 39 cases/year in 2009–2010 to 95 cases/year in 2017–2018 (≈2.5-fold increase), rising primarily among children aged 5–9 years. DKA incidence was unchanged but variable (44.8% to 56.8%). At T1D diagnosis, 89% of patients reported polyuria and 91% polydipsia. Children presenting with DKA were more likely to report vomiting, abdominal pain, and particularly fatigue. DKA was most common among the youngest children, affecting 4 in 5 children aged &lt;2 years (81.4%), in comparison to 53.3%, 42.7%, and 49.3% of patients aged 2–4, 5–9, and ≥10 years, respectively. Children with severe DKA were more likely to report vomiting, fatigue, and abdominal pain, but less likely to report polyuria, polydipsia, and polyphagia than those with mild/moderate DKA. Rates of severe DKA were highest in children aged &lt;2 years (51.1%).ConclusionsThe number of children diagnosed with T1D at our regional center increased over the study period, but DKA rates were unchanged. With 9 of 10 children reporting polyuria and polydipsia prior to T1D diagnosis, increasing awareness of this condition in the community and among primary care physicians could lead to earlier diagnosis, and thus potentially reduce rates of DKA at presentation.

Research Utilization in Critical Care: An Exemplar

1994 ◽  
Vol 5 (2) ◽  
pp. 124-132
Author(s):  
Marita G. Titler ◽  
Linda Moss ◽  
Jane Greiner ◽  
Michele Alpen ◽  
Gerry Jones ◽  
...  
Keyword(s):  
Critical Care ◽  
Pain Management ◽  
Research Utilization ◽  
Care Center ◽  
Tertiary Care ◽  
Practice Change ◽  
Research Committee ◽  
Staff Members ◽  
Number Of Patients ◽  
Management Protocol

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain

scholarly journals Sensitivity and specificity of different imaging modalities in diagnosing necrotising enterocolitis in a Polish population of preterm infants: a diagnostic test accuracy study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e033519
Author(s):  
Joanna Seliga-Siwecka ◽  
Jakub Rutkowski ◽  
Wojciech Margas ◽  
Joanna Puskarz- Gąsowska ◽  
Renata Bokiniec
Keyword(s):  
Very Low Birth Weight ◽  
Clinical Symptoms ◽  
Newborn Infants ◽  
Pneumatosis Intestinalis ◽  
Abdominal Ultrasound ◽  
Necrotising Enterocolitis ◽  
Test Accuracy ◽  
Detection Rates ◽  
Vlbw Infants ◽  
Number Of Patients

IntroductionNecrotising enterocolitis (NEC) is one of the most serious conditions in newborn infants, affecting up to 10% of very low birth weight (VLBW) infants. Mortality rates can rise as high as 60%.The suspected diagnosis is confirmed with typical findings on abdominal radiography (AR) such as pneumatosis intestinalis (PI), portal vein gas (PVG) and in extreme cases pneumoperitoneum. Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases ahead of AR), but it also provides other crucial information such as bowel wall viability (thickness or thinning) and free abdominal fluid. These additional findings are helpful in diagnosing and managing NEC.Methods and analysisThe hypothesis being tested is that preforming an AR in patients with clinical symptoms of NEC, but inconclusive/normal AR will enhance detection rates, and expedite treatment in infants born at <32 weeks. Additionally, the time needed to initiate treatment, according to decision made based on AR or AR and AUS will also be compared. The use of AUS together with AR as an add-on test may increase the accuracy of diagnosing NEC and expedite life-saving treatment. We plan to recruit 200 VLBW infants, who are most prone to NEC. It will also be the first multicentre study evaluating the use of AUS as an add-on test, enabling us to recruit a significantly higher number of patients compared with published studies.Ethics and disseminationThe Bioethical Committee of the Medical University of Warsaw has approved the study (KB 130/2017). We plan to submit our findings to international peer-reviewed journals. Abstract will be submitted to local and international conferences.Trial registration numberNCT03188380; Protocol version: V.2.08.2019; Pre-results.

Sign in / Sign up

Export Citation Format

Share Document