Porterfieldbarrera2928
Myringoplasty contributed to decreased postoperative eosinophilic otitis media severity scores and should be considered to protect the patients from recurrent bacterial infections and pathogenic antigen parasitism in the middle ear.
We examined the incidence, risk factors, and recovery time for postoperative facial nerve paralysis in patients with benign parotid tumors and also investigated the usefulness of intraoperative facial nerve monitoring (FNM).
Subjects were 902 patients with benign parotid tumors. Univariate and multivariate analyses were conducted for risk factors of postoperative facial nerve paralysis. We investigated the relationship between intraoperative FNM and postoperative facial nerve paralysis, and the recovery time for postoperative facial nerve paralysis according to tumor site.
Postoperative facial nerve paralysis occurred in 179 (19.8%) of 902 patients. Among them, 15.1%, 15.8%, and 37.5% had tumors in the superficial lobe, lower pole, and deep lobe, respectively. Paralysis risk factors were deep tumors, large tumors, long operation times, extensive bleeding, and non-use of FNM. Multivariate analysis determined female patients, deep tumors, and long operation times as significant risk factors, and female patients and deep tumors had an odds ratio of nearly 2. Use of intraoperative FNM resulted in a significantly lower incidence of facial nerve paralysis and was particularly useful in patients with superficial lobe tumors. Time to recovery from facial nerve paralysis was 6 months in 88% of the patients.
The incidence of paralysis should be kept as low as possible to enhance the postoperative quality of life of patients. The use of intraoperative FNM significantly lowered the incidence of paralysis in female patients with superficial tumors.
The incidence of paralysis should be kept as low as possible to enhance the postoperative quality of life of patients. The use of intraoperative FNM significantly lowered the incidence of paralysis in female patients with superficial tumors.The use of opioids across all specialties has increased greatly over the last 2 decades and along with it, opioid misuse, overdose and death. The contribution of opioids prescribed for gynecologic cancers to this problem is unknown. Data from other surgical specialties show prescriber factors including gender, geographic location, board certification, experience, and fellowship training influence opioid prescribing. To characterize national-level opioid prescription patterns among gynecologic oncologists treating Medicare beneficiaries. The Centers for Medicare and Medicaid Services database was used to access Medicare Part D opioid claims prescribed by gynecologic oncologists in 2016. Prescription and prescriber characteristics were recorded including medication type, prescription length, number of claims, and total day supply. Region of practice was determined according to the US Census Bureau Regions. Board certification data were obtained from American Board of Obstetrics and Gynecology website. Bivariate statistical analysis and linear regression modeling were performed using Stata version 14.2. In 2016, 494 board-certified US gynecologic oncologists wrote 24,716 opioid prescriptions for a total 267,824 days of treatment (median 8 [interquartile range IQR 6, 11] prescribed days per claim). Gynecologic oncologists had a median of 33 opioid claims (IQR 18, 64). Male physicians had significantly more opioid prescription claims than females (P 15 years had a greater number of median opioid claims (28 IQR 16, 50) than those with less then 5 years since board certification (22 IQR 15, 38) (P= 0.04). Physicians who were board certified in palliative care (n = 19) had significantly more opioids claims (median 40; IQR 18, 91) than those without (median 32; IQR 18, 64) (P less then 0.01). In 2016, there were gender-based, regional, and experience-related variations in opioid prescribing by providers caring for Medicare-insured patients.
Major depression is common among people with epilepsy (PWE), but it is underdiagnosed. The aim of the present study was to assess the reliability and validity of the Persian version of the Neurological Disorders Depression Inventory for Epilepsy (P-NDDI-E) as a screening tool for major depression in patients with epilepsy.
A total of 210 patients suffering from epilepsy have been assessed using the NDDI-E and the Beck Depression Inventory-II (BDI-II) with no difficulty in understanding or answering the Persian version of the questionnaire. Patients identified as depressed under BDI-II underwent a psychiatric evaluation to confirm depression according to 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) criteria.
According to the BDI-II and the ICD-10 criteria, major depression was diagnosed in 75 patients (32% men, 68% women). Cronbach's α coefficient was 0.826, suggesting a very good internal consistency. The receiver operating characteristic analysis showed an area under the curve of 0.90 (95% confidence interval [CI] = 0.86-0.94, standard error [SE] 0.02, p < 0.001). A cutoff of ≥14 resulted in an 83% sensitivity, an 80% specificity, a 70.1% positive predictive value, and an 88.6% negative predictive value. A significant and positive correlation between the P-NDDI-E and the BDI-II was shown (Spearman's ρ = 0.604, p < 0.001).
The P-NDDI-E could be used as a reliable and valid instrument in detecting major depression in PWE.
The P-NDDI-E could be used as a reliable and valid instrument in detecting major depression in PWE.Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening disorder. SCAD is gaining importance as an emerging cause of acute coronary syndrome (ACS), especially in otherwise healthy young women. While SCAD and ACS show similarity in presentation, the management of SCAD differs to that of ACS. If not managed properly SCAD can lead to sudden death. This review examines the pathophysiology, clinical presentation, diagnostic algorithms, and the current and future management of SCAD.
Computed tomography (CT)-defined sarcopenia is a demonstrated poor prognostic factor for survival in patients with cancer, however, its impact in patients with head and neck cancer (HNC) has only recently been explored. This study aimed to determine the prognostic impact of CT-defined sarcopenia at the level of the third lumbar vertebra (L3) on overall survival in patients with HNC undergoing radiotherapy±other treatment modality of curative intent.
A systematic review of the literature published between January 2004 and May 2020 was conducted in Medline, Embase, CINAHL, AMED and PubMed. Empirical studies in adults (≥18 years) who had completed radiotherapy of curative intent±other treatment modalities that evaluated sarcopenia using the gold standard method at L3 and applied sex-specific cut-offs were included. Outcome of interest was overall survival. Study quality was assessed using the Quality In Prognosis Studies (QUIPS) tool. Hazard ratios with 95% confidence intervals derived from multivariate analevidence for overall survival according to GRADE was low for pre-treatment sarcopenia and moderate for post-treatment sarcopenia.
CT-defined sarcopenia is independently associated with reduced overall survival in patients with HNC and holds a clinically meaningful prognostic value. Consensus regarding sarcopenia assessment and definitions is warranted in order to substantiate these findings and support implementation of body composition assessment as a clinically meaningful prognostic tool into practice.
CT-defined sarcopenia is independently associated with reduced overall survival in patients with HNC and holds a clinically meaningful prognostic value. Consensus regarding sarcopenia assessment and definitions is warranted in order to substantiate these findings and support implementation of body composition assessment as a clinically meaningful prognostic tool into practice.
Crude diagnostic parameters such as BMI limit recognition of malnutrition in overweight and obese patients. This study applied a robust malnutrition diagnostic measure to investigate whether malnutrition impacts clinical outcomes in overweight or obese hip fracture inpatients.
A prospective, consecutive 12-month audit of inpatients admitted to a dedicated hip fracture unit with a BMI of ≥25 for surgical intervention. Univariate and logistic regression analyses were performed to investigate the relationship of demographics (age, gender), comparative measures (type of fracture, Charlson Comorbidity Index (CCI) on admission, time to surgery, type of surgery and anaesthesia, nutrition status) and outcome measures (delirium, time to mobilise post-operatively, length of stay, 12-month mortality). Malnutrition was defined using the International Classification of Diseases, Tenth Revision - Australian Modification protein-energy malnutrition criteria.
127 overweight or obese hip fracture patients for surgical iure inpatients to ensure appropriate clinical nutrition care is appropriately directed.
Hip fracture patients who are both overweight or obese, and malnourished, have significantly and substantially worse clinical outcomes than their well-nourished, albeit overweight or obese, counterparts. Comprehensive nutrition assessment measures should be applied to all hip fracture inpatients to ensure appropriate clinical nutrition care is appropriately directed.
To study the association between usual dietary factors (dietary energy density, nutrient intake, food group consumption, and dietary pattern) and brown adipose tissue (BAT) volume/
F-fluorodeoxyglucose (
F-FDG) uptake after personalized cold exposure in young healthy adults.
A total of 122 young adults (n=82 women; 22.0±2.1 years old; 24.8±4.8kg/m
) took part in this cross-sectional study. Dietary factors were measured via a food frequency questionnaire and three non-consecutive 24h recalls. Dietary energy density (foods and caloric beverages included) and macronutrient intakes were subsequently estimated using EvalFINUT® software, food group consumption was estimated from the food frequency questionnaire, and different dietary patterns and quality indices were determined according to the reference methods. BAT volume, BAT
F-FDG uptake, and skeletal muscle
F-FDG uptake were assessed by static
F-FDG positron-emission tomography and computed tomography (PET-CT) scans after a 2h personalized exposursure in young adults. Our results provide an overall picture of the potential relationships between dietary factors and BAT-related variables in humans.
Dietary factors are slightly associated with BAT volume and/or 18F-FDG uptake after a personalized cold exposure in young adults. Our results provide an overall picture of the potential relationships between dietary factors and BAT-related variables in humans.
The influence of dietary calcium intake in childhood on adult cardiovascular health is unknown, particularly in those with long-term high intake. Cabotegravir To examine both linear and non-linear associations of childhood and long-term (between childhood and adulthood) dietary calcium intake with adult cardiovascular risk outcomes.
A population-based prospective cohort study in Finland (n=1029, aged 3-18yearsat baseline). Dietary calcium intake was assessed in childhood (1980, baseline) and adulthood (mean of available data from 2001, 2007 and 2011). Long-term dietary calcium intake was calculated as the mean between childhood and adulthood. Outcomes were measured in 2001, 2007, and/or 2011, and the latest available data were used for analyses, including high carotid intima-media thickness, hypertension, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and triglycerides, arterial pulse wave velocity (PWV), carotid artery compliance (CAC), Young's elastic modulus (YEM), and stiffness index (SI).
