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Lee JJ, Rapoport NA, Pipkorn P, Puram SV, Jackson RS. Airway protection and outcomes after staged versus concurrent bilateral neck dissections with transoral base of tongue cancer resection. Head Neck 2024; 46:1020-1027. [PMID: 38414192 DOI: 10.1002/hed.27696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 12/30/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To assess airway, safety, and resource utilization outcomes between transoral base of tongue (BOT) surgery with staged versus concurrent bilateral neck dissections (BND). METHODS A retrospective cohort study of patients with human papilloma virus (HPV)-related BOT cancer who underwent transoral surgery and BND from January 2015 through June 2022 was conducted. Free flap patients were excluded. RESULTS Of 126 patients (46 [37%] staged and 80 [63%] concurrent BND), there were no significant differences in rates of postoperative intubation, tracheostomy, intensive care admission, operative takebacks, gastrostomy, and 30-day readmission. Total operative time (median difference 1.4 [95% CI 0.9-1.8] hours), length of stay (1.0 [1.0-1.0] day), and time between primary surgery and adjuvant therapy initiation (4.0 [0.0-8.0] days) were lower in the concurrent BND cohort. CONCLUSION Concurrent BND alongside transoral BOT resection is safe with similar airway outcomes and lower total operative time, length of stay, and time to adjuvant therapy initiation compared to staged BND.
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Affiliation(s)
- Jake J Lee
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Damhorst GL, Fujita AW, Fitts E, Szabo B, Bowers HB, Sabino C, Ahmed A, Wang E, Piantadosi A, McLendon K, Sullivan J, Greenleaf M, McCaslin D, Palmore M, Anderson AM, Aldred B, Gunthel C, Martin GS, Colasanti JA, Lam WA, Bassit L, Rao A, Sheth AN, Titanji BK. Multisite Mpox Infection and Viral Dynamics Among Persons With HIV in Metro Atlanta. J Infect Dis 2024; 229:S213-S218. [PMID: 38019187 DOI: 10.1093/infdis/jiad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
The 2022 mpox outbreak primarily involved sexual transmission among men who have sex with men and disproportionately affected persons with human immunodeficiency virus (HIV). We examined viral dynamics and clinical features in a cohort evaluated for mpox infection at a comprehensive HIV clinic in Atlanta, Georgia. Viral DNA was found in 8 oropharyngeal and 5 anorectal specimens among 10 mpox cases confirmed by lesion swab polymerase chain reaction. Within-participant anatomic site of lowest cycle threshold (Ct) value varied, and lower Ct values were found in oropharyngeal and anorectal swabs when corresponding symptoms were present. This provides insight into mpox infection across multiple anatomic sites among people with HIV.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | - A Wendy Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Eric Fitts
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pathology and Laboratory Medicine
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Heather B Bowers
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Courtney Sabino
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | | | - Ethan Wang
- Department of Pathology and Laboratory Medicine
| | - Anne Piantadosi
- Division of Infectious Diseases, Department of Medicine, Emory University
- Department of Pathology and Laboratory Medicine
| | | | - Julie Sullivan
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Morgan Greenleaf
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | | | - Melody Palmore
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Clifford Gunthel
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Greg S Martin
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Wilbur A Lam
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Leda Bassit
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Anuradha Rao
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
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Lu Y, Clifford GM, Fairley CK, Grulich AE, Garland SM, Xiao F, Wang Y, Zou H. Human papillomavirus and p16 INK4a in oropharyngeal squamous cell carcinomas: A systematic review and meta-analysis. Int J Cancer 2024; 154:830-841. [PMID: 37861207 DOI: 10.1002/ijc.34763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
We intended to update human papillomavirus (HPV) prevalence and p16INK4a positivity in oropharyngeal squamous cell carcinomars (SCC), and calculate HPV attributable fraction (AF) for oropharyngeal SCC by geographic region. We searched Medline, Embase, and the Cochrane Library to identify published studies of HPV prevalence and p16INK4a positivity alone or together in oropharyngeal SCC before December 28, 2021. Studies that reported type-specific HPV DNA prevalence using broad-spectrum PCR-based testing methods were included. We estimated pooled HPV prevalence, type-specific HPV prevalence, and p16INK4a positivity. AF of HPV was calculated by geographic region. One hundred and thirty-four studies including 12 139 cases were included in our analysis. The pooled HPV prevalence estimate for oropharyngeal SCC was 48.1% (95% confidence interval [CI] 43.2-53.0). HPV prevalence varied significantly by geographic region, and the highest HPV prevalence in oropharyngeal SCC was noted in North America (72.6%, 95% CI 63.8-80.6). Among HPV positive cases, HPV 16 was the most common type with a prevalence of 40.2% (95% CI 35.7-44.7). The pooled p16INK4a positivity in HPV positive and HPV16 positive oropharyngeal SCC cases was 87.2% (95% CI 81.6-91.2) and 91.7% (84.3-97.2). The highest AFs of HPV and HPV16 were noted in North America at 69.6% (95% CI 53.0-91.5) and 63.0% (48.0-82.7). [Correction added on 31 October 2023, after first online publication: the percentage symbol (%) was missing and has been added to 63.0% (48.0-82.7) in the Abstract and Conclusion.] A significant proportion of oropharyngeal SCC was attributable to HPV. HPV16 accounts for the majority of HPV positive oropharyngeal SCC cases. These findings highlight the importance of HPV vaccination in the prevention of a substantial proportion of oropharyngeal SCC cases.
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Affiliation(s)
- Yong Lu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, The Alfred, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Andrew E Grulich
- Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Suzanne M Garland
- Royal Women's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fei Xiao
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Yuan Wang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- School of Public Health, Southwest Medical University, Luzhou, China
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Lalremtluangi R, Dangore-Khasbage S. Non-Habit-Related Oral Squamous Cell Carcinoma: A Review. Cureus 2024; 16:e54594. [PMID: 38523993 PMCID: PMC10959472 DOI: 10.7759/cureus.54594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a serious and potentially life-threatening condition that can have a profound impact on an individual's health and well-being. Its etiology is commonly known to be habit induced, such as tobacco consumption, smoking, or alcohol abuse. Apart from these etiologies, certain factors that lead to OSCC are also present but are less frequently encountered in hospitals and clinics. However, these non-habitual factors, with their pathogenesis, can lead to OSCC, which may be confusing to certain medical practitioners. This article discusses the various non-habitual causes that can lead to OSCC, as well as their pathophysiology, molecular expression, and related indicators and prognostic factors.
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Affiliation(s)
- Rosalyn Lalremtluangi
- Oral Medicine and Radiology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Semprini J, Reynolds J, Zahnd WE, Wehby G. Eliminating Medicaid dental benefits and early-stage oral cancer diagnoses. Cancer Med 2024; 13:e7061. [PMID: 38457253 PMCID: PMC10923030 DOI: 10.1002/cam4.7061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/25/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Despite the importance of regular dental visits for detecting oral cancer, millions of low-income adults lack access to dental services. In July 2009, California eliminated adult Medicaid dental benefits. We tested if this impacted oral cancer detection for Medicaid enrollees. METHODS We analyzed Surveillance, Epidemiology, and End Results-Medicaid data, which contains verified Medicaid enrollment status, to estimate a difference-in-differences model. Our design compares the change in early-stage (Stages 0-II) diagnoses before and after dropping dental benefits in California with the change in early-stage diagnoses among eight states that did not change Medicaid dental benefits. Patients were grouped by oropharyngeal cancer (OPC) and non-OPC (oral cavity cancer), type, and the length of Medicaid enrollment. We also assessed if the effect of dropping dental benefits varied by the number of dentists per capita. RESULTS Dropping Medicaid dental benefits was associated with a 6.5%-point decline in early-stage diagnoses of non-OPC (95% CI = -14.5, -3.2, p = 0.008). This represented a 20% relative reduction from baseline rates. The effect was highest among beneficiaries with 3 months of continuous Medicaid enrollment prior to diagnosis who resided in counties with more dentists per capita. Specifically, dropping dental coverage was associated with a 1.25%-point decline in the probability of early-stage non-OPC diagnoses for every additional dentist per 5000 population (p = 0.006). CONCLUSIONS Eliminating Medicaid dental benefits negatively impacted early detection of cancers of the oral cavity. Continued volatility of Medicaid dental coverage and provider shortages may be further delaying oral cancer diagnoses. Alternative approaches are needed to prevent advanced stage OPC.
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Affiliation(s)
- Jason Semprini
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Julie Reynolds
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Whitney E. Zahnd
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - George Wehby
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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Bieliński J, Jaśkiewicz F, Timler D. Comparing results of three measurement techniques used to determine the size of oropharyngeal airway in adults. Ann Agric Environ Med 2023; 30:715-720. [PMID: 38153076 DOI: 10.26444/aaem/171023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION AND OBJECTIVE The oropharyngeal airway, also known as the Guedel airway, is a crucial medical device used for over a century as a basic way to maintain a patient's airway open and secure. Although it is easy to use, this can be misleading as incorrect sizing can lead to injuries, bleeding, laryngospasm, and potentially fatal complications. This study aims to compare three techniques for selecting the appropriate oropharyngeal airway size using craniofacial anatomical landmarks. MATERIAL AND METHODS Three facial distances were measured, each one according to the techniques described in the scientific sources. For greater reliability of the test, measurements were made sequentially with two different methods. RESULTS The study included over 500 participants. Depending on the measurement technique used, different results of average lengths and thus approximate sizes of oropharyngeal airway were obtained. This indicated that depending on which technique is used for measuring purposes, differences in the size of the oropharyngeal airway can be up to 2-3 cm, with a high degree of statistical significance. CONCLUSIONS Using different craniofacial anatomical landmarks to select the size of the oropharyngeal airway can yield significantly varied results for the same adult patient, thus posing a potentially fatal threat. To ensure effective and safe airway management, proper ventilation and oxygenation, it is recommended to follow the ISA (Initial Size Approximation) approach when choosing the oropharyngeal airway size in medical education, training, and clinical settings. Further research is needed to explore this matter, also in different populations.
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Affiliation(s)
- Jakub Bieliński
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland
| | - Filip Jaśkiewicz
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland
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Mozaffari MS, Abdelsayed R, Emami S, Kavuri S. Expression profiles of glucocorticoid-inducible proteins in human papilloma virus-related oropharyngeal squamous cell carcinoma. Front Oral Health 2023; 4:1285139. [PMID: 37954869 PMCID: PMC10634427 DOI: 10.3389/froh.2023.1285139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Human papillomavirus virus-related oropharyngeal squamous cell carcinoma (HPV-OPSCC) comprises a significant portion of head and neck cancers. Several glucocorticoid-inducible proteins play important roles in pathogenesis of some cancers but their status and roles in HPV-OPSCC remain elusive; these include the glucocorticoid-induced leucine zipper (GILZ), Annexin-A1 and serum glucocorticoid-regulated kinase-1 (SGK-1). Methods We determined expression profiles of these proteins, using immunohistochemistry, in archived biopsy samples of patients diagnosed with HPV-OPSCC; samples of non-cancer oral lesions (e.g., hyperkeratosis) were used as controls. Results GILZ staining was primarily confined to nuclei of all tissues but, in HPV-OPSCC specimens, neoplastic cells exhibiting mitosis displayed prominent cytoplasmic GILZ expression. On the other hand, nuclear, cytoplasmic and membranous Annexin-A1 staining was observed in suprabasal cell layers of control specimens. A noted feature of the HPV-OPSCC specimens was few clusters of matured and differentiated nonbasaloid cells that showed prominent nuclear and cytoplasmic Annexin-A1 staining while the remainder of the tumor mass was devoid of staining. Cytoplasmic and nuclear staining for SGK-1 was prominent for control than PV-OPSCC specimens while staining for phosphorylated SGK-1 (pSGK-1; active) was prominent for cell membrane and cytoplasm of control specimens but HPV-OPSCC specimens showed mild and patchy nuclear and cytoplasmic staining. Semi-quantitative analysis of GILZ immunostaining indicated increased staining area but similar normalized staining for HPV-OPSCC compared to control specimens. By contrast, staining area and normalized staining were reduced for other proteins in HPV-OPSCC than control specimens. Discussion Our collective observations suggest differential cellular localization and expression of glucocorticoid-inducible proteins in HPV-OPSCC suggestive of different functional roles in pathogenesis of this condition.
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Affiliation(s)
- Mahmood S. Mozaffari
- Departmentof Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta University, Augusta, GA, United States
| | - Rafik Abdelsayed
- Departmentof Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta University, Augusta, GA, United States
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Sahar Emami
- Departmentof Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta University, Augusta, GA, United States
| | - Sravan Kavuri
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, United States
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赵 九, 李 珂, 韩 晓, 石 照, 曾 宪, 张 相. [Misdiagnosis of adenoid cystic carcinoma of oropharynx: a case report]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:837-839. [PMID: 37828891 PMCID: PMC10803242 DOI: 10.13201/j.issn.2096-7993.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Indexed: 10/14/2023]
Abstract
Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.
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Affiliation(s)
- 九洲 赵
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
| | - 珂 李
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
| | - 晓东 韩
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院影像科Department of Imaging, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital
| | - 照辉 石
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院鼻颅底外科Department Nasal Skull Base Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital
| | - 宪海 曾
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
| | - 相民 张
- 深圳市耳鼻咽喉研究所 深圳市龙岗区耳鼻咽喉医院头颈外科(广东深圳,518172)Department of Head and Neck Surgery, Shenzhen Otolaryngology Research Institute, Shenzhen Longgang ENT Hospital, Shenzhen, 518172, China
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Yin LX, Rivera M, Garcia JJ, Bartemes KR, Lewis DB, Lohse CM, Routman DM, Ma DJ, Moore EJ, Van Abel KM. Impact of Tumor-Infiltrating Lymphocytes on Disease Progression in Human Papillomavirus-Related Oropharyngeal Carcinoma. Otolaryngol Head Neck Surg 2023; 169:539-547. [PMID: 36939471 DOI: 10.1002/ohn.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/13/2022] [Accepted: 12/17/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We aim to explore the prognostic value of tumor-infiltrating lymphocytes (TILs) in the primary tumor and metastatic lymph nodes of patients with HPV(+)OPSCC. We hypothesize that TILS density at both sites is associated with disease-free survival in HPV(+)OPSCC. STUDY DESIGN Matched case-control study among HPV(+)OPSCC patients who underwent intent-to-cure surgery. Cases developed locoregional or distant recurrence. Controls were matched based on age, sex, pathologic T, N, and overall stage, year of surgery, type of adjuvant treatment received, and the Adult Comorbidity Evaluation-27 (ACE-27) score. SETTING Single tertiary care center, May 2007 to December 2016. METHODS Tumoral TILs (tTILs) density was defined as % TILs; stromal TILs (sTILs) density was defined as absent/sparse or moderate/dense crowding. Associations between TILs and time to disease progression were assessed using Cox regression models. RESULTS Forty-four case-control pairs (N = 88) were included: 42 (48%) AJCC pStage I, 39 (44%) pStage II, and 7 (8%) pStage III. tTILs density ≥10% (hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.17-0.99, p = .048) and a moderate/dense sTILs density (HR 0.21, 95% CI 0.06-0.75, p = .016) in the primary tumor were significantly associated with decreased risk of progression. TILs density in the lymph node was associated with decreased risk of progression but did not reach statistical significance. The tTILs and sTILs density correlated strongly between the primary tumor and lymph node. Concordance between the pathologists' was moderate (60%-70%). CONCLUSIONS In HPV(+)OPSCC, a higher density of tumoral and stromal TILs in the primary tumor and possibly the lymph node may predict a lower risk of disease progression.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen R Bartemes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Derrick B Lewis
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Sidam S, Sahoo AK, Gupta V, Khurana U. Varied Presentation of Oropharyngeal Tuberculosis: Review of Cases. Cureus 2023; 15:e43636. [PMID: 37719636 PMCID: PMC10504869 DOI: 10.7759/cureus.43636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Tuberculosis (TB) is a chronic granulomatous infectious disease with 25% morbidity due to extrapulmonary form. Hence, knowledge about varied presentations of extrapulmonary oropharyngeal type may help in early diagnosis and management in acute as well as chronic settings. This article describes immunocompetent patients' presentation with varied oropharyngeal manifestations and later diagnosed with tuberculous tonsillitis and tuberculous abscesses with Pott's spine. The varied manifestation of oropharyngeal TB, which is supposed to be a chronic condition, may help in early diagnosis in acute and chronic settings.
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Affiliation(s)
- Shaila Sidam
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | - Anjan K Sahoo
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | - Vikas Gupta
- Otorhinolaryngology, All India Institute of Medical Sciences, Bhopal, IND
| | - Ujjawal Khurana
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, IND
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Farber NI, Li Y, Solis RN, Chen J, Masheeb Z, Wilson M, Bewley AF, Abouyared M, Rao S, Rong Y, Birkeland AC. Tumor and Nodal Disease Growth Rates in Patients with Oropharyngeal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:3865. [PMID: 37568681 PMCID: PMC10416867 DOI: 10.3390/cancers15153865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Though specific growth rate (SGR) has potential prognostic value for oropharyngeal squamous cell carcinoma (OPSCC), there is sparse literature defining these rates. Our aims were to establish the SGRs of primary tumors (PTs) and lymph nodes (LNs) in OPSCC and to correlate SGR with oncologic outcome. A pilot study was designed with a retrospective analysis examining 54 patients from the University of California, Davis with OPSCC (diagnosed 2012-2019). Radiation oncology software and pretreatment serial CT scans were used to measure PT and LN volumes to calculate SGR and doubling time (DT). The mean PT-SGR was 1.2 ± 2.2%/day and the mean LN-SGR was 1.6 ± 1.9%/day. There was no statistically significant difference between slow-growing and fast-growing cohorts in terms of age, gender, smoking status, tumor subsite, HPV status (as determined with p16 staining), initial volume, or overall stage. SGR had no impact on 2-year overall survival, disease-free survival, or disease-specific survival. We found the average daily growth rates for OPSCC to be 1.2%/day and 1.6%/day. Our findings suggest PT- and LN-SGR are independent factors, not heavily influenced by known biomarkers and patient characteristics, without a statistical impact on prognosis. This information has value in patient counseling regarding tumor growth and in providing patients worried about fast-growing tumors the appropriate reassurance.
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Affiliation(s)
- Nicole I. Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Yimin Li
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361005, China
| | - Roberto N. Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Joy Chen
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Zahrah Masheeb
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Machelle Wilson
- Davis-School of Medicine, University of California, Sacramento, CA 94720, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, Mayo Clinic, Pheonix, AZ 85054, USA
| | - Andrew C. Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
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12
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Teng ZP, Zhang JY, Huang Q. Oropharyngeal microbiome in children with adenotonsillar hypertrophy and after adenotonsillectomy. Acta Otolaryngol 2023:1-7. [PMID: 37394784 DOI: 10.1080/00016489.2023.2219285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND The microbiome of tonsils and adenoid in adenotonsillar hypertrophy (ATH) has been profiled. Adenotonsillectomy (AT) is widely used for ATH in children. The variation of the oropharyngeal microecology in children with ATH or after AT have never been studied. OBJECTIVES Here we aimed to evaluate the change in oropharyngeal microbiome in ATH Children after AT. MATERIALS AND METHODS In this cross-sectional study, throat swabs for microbiome analysis were collected from ATH, AT and control groups. Using 16s rDNA sequencing, this study investigated the characteristics of oropharyngeal microbiome. RESULTS The α-diversity showed a statistical difference in richness and the β-diversity was significantly different among the three groups. The relative abundance of Haemophilus (member of Proteobacteria) increased but that of Actinomyces (member of Actinobacteriota) decreased in the ATH group compared to those in the AT and control groups, but their abundances showed no statistical difference between the AT and control groups. CONCLUSIONS The oropharyngeal microbial diversity and composition are disrupted in children with ATH and can be restored after AT. This microbiome analysis provides a new understanding about the pathogenesis of ATH in children.SummaryIn this study, we aimed to evaluate the change in oropharyngeal microbiome in ATH Children after AT. The oropharyngeal microbial diversity and composition are disrupted in children with ATH and can be restored after AT.
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Affiliation(s)
- Zhi-Pan Teng
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jian-Ya Zhang
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qun Huang
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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13
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Bishev D, Malone M, Best D, Bazikian Y. A case report of carbamazepine-induced oropharyngeal dysphagia in a patient with primary progressive multiple sclerosis. Clin Case Rep 2023; 11:e7185. [PMID: 37151936 PMCID: PMC10155505 DOI: 10.1002/ccr3.7185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 05/09/2023] Open
Abstract
Seventy-year-old male with primary progressive multiple sclerosis that had a severe episode of oropharyngeal dysphagia following initiation of carbamazepine. He was being treated for trigeminal neuralgia. Four days after discontinuation of carbamazepine resulted in a complete resolution of the patient's dysphagia, and he returned to baseline.
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Affiliation(s)
- Daniel Bishev
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalInternal Medicine Residency ProgramGainesvilleFloridaUSA
| | - Mercedes Malone
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalInternal Medicine Residency ProgramGainesvilleFloridaUSA
| | - Devon Best
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalInternal Medicine Residency ProgramGainesvilleFloridaUSA
| | - Yvette Bazikian
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalGainesvilleFloridaUSA
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14
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Chu ECP. Remission of cervicogenic dysphagia associated with biomechanical dysfunction following chiropractic therapy. J Med Life 2023; 16:794-798. [PMID: 37520480 PMCID: PMC10375352 DOI: 10.25122/jml-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/09/2023] [Indexed: 08/01/2023] Open
Abstract
Cervicogenic dysphagia is a complex condition that can arise from biomechanical dysfunction in the cervical spine. Conventional treatment outcomes are not always guaranteed. Chiropractic treatment is considered an alternative treatment for dysphagia, yet there is a lack of evidence supporting its effectiveness. We present the case of a 48-year-old male who had difficulty swallowing for eight months. He had a feeling of food stuck in his throat when eating hard food but without any pain when swallowing, and eventually, he could not swallow any dry food. He was diagnosed with dysphagia associated with an anxiety disorder and was treated with medication, but there was no improvement in his condition. A full-spine radiograph revealed biomechanical dysfunction, including reduced cervical lordosis and levoscoliosis of the upper thoracic spine. After nine months of conventional physiotherapy, the patient completely recovered from his symptoms, with significantly improved biomechanical parameters. This study highlights the potential mechanism of cervicogenic dysphagia and the effect of chiropractic treatment in managing it. Applying chiropractic treatment, including spinal manipulative therapy, instrument-assisted soft tissue manipulation, and mechanical traction, might bring a positive outcome for dysphagia patients with careful consideration.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong, China
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15
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Aguayo F, Perez-Dominguez F, Osorio JC, Oliva C, Calaf GM. PI3K/AKT/mTOR Signaling Pathway in HPV-Driven Head and Neck Carcinogenesis: Therapeutic Implications. Biology (Basel) 2023; 12:biology12050672. [PMID: 37237486 DOI: 10.3390/biology12050672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
High-risk human papillomaviruses (HR-HPVs) are the causal agents of cervical, anogenital and a subset of head and neck carcinomas (HNCs). Indeed, oropharyngeal cancers are a type of HNC highly associated with HR-HPV infections and constitute a specific clinical entity. The oncogenic mechanism of HR-HPV involves E6/E7 oncoprotein overexpression for promoting cell immortalization and transformation, through the downregulation of p53 and pRB tumor suppressor proteins, among other cellular targets. Additionally, E6/E7 proteins are involved in promoting PI3K/AKT/mTOR signaling pathway alterations. In this review, we address the relationship between HR-HPV and PI3K/AKT/mTOR signaling pathway activation in HNC with an emphasis on its therapeutic importance.
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Affiliation(s)
- Francisco Aguayo
- Departamento de Biomedicina, Facultad de Medicina, Universidad de Tarapacá, Arica 1000000, Chile
| | - Francisco Perez-Dominguez
- Laboratorio de Oncovirología, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Julio C Osorio
- Laboratorio de Oncovirología, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Carolina Oliva
- Laboratorio de Oncovirología, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Gloria M Calaf
- Instituto de Alta Investigación, Universidad de Tarapacá, Arica 1000000, Chile
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Naegele S, Efthymiou V, Hirayama S, Zhao BY, Das D, Chan AW, Richmon JD, Iafrate AJ, Faden DL. Double trouble: Synchronous and metachronous primaries confound ctHPVDNA monitoring. Head Neck 2023; 45:E25-E30. [PMID: 37080924 DOI: 10.1002/hed.27378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Human papillomavirus-associated head and neck squamous cell carcinoma (HPV + HNSCC) occurs in the oropharynx (HPV + OPSCC), sinonasal cavity (HPV + SNSCC), and nasopharynx (HPV + NPC). Circulating tumor HPV DNA (ctHPVDNA) is an accurate tool for diagnosis, treatment monitoring, and recurrence detection. An emerging challenge with ctHPVDNA is that ~7.4% of HPV + HNSCC patients develop synchronous or metachronous HPV+ primaries, which could confound ctHPVDNA monitoring. METHODS We describe a 65-year-old patient with T2N1M0 HPV16 + OPSCC and a 55-year-old patient with T2N2M0 HPV16 + OPSCC. Both patients were enrolled in our prospective observational ctHPVDNA study with longitudinal blood collections throughout treatment. Both patients developed multiple HPV+ primaries. RESULTS Detailed discussion of the patients' treatment courses, the subsequent diagnoses of their second HPV+ primaries, and their ctHPVDNA monitoring is presented. CONCLUSIONS As ctHPVDNA use becomes more prevalent, it is important to recognize that an increase in ctHPVDNA can come not only from the primary tumor or metastatic clones, but also from synchronous or metachronous second primaries.
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Affiliation(s)
- Saskia Naegele
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Vasileios Efthymiou
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | | | - Brian Y Zhao
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dipon Das
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Annie W Chan
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - A John Iafrate
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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17
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Rumianek B, Hillman R, Jeoffreys N, Ghazanfar S, Schifter M, Ajwani S. Prevalence of oral HPV in the adult sample population in Sydney. Aust Dent J 2023; 68:19-25. [PMID: 36281543 DOI: 10.1111/adj.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oropharyngeal squamous cell carcinomas are increasing in incidence. Risk factors include sexual behaviour, high-risk oral HPV infection and poor oral hygiene. We aimed to provide initial information on the prevalence and assess the feasibility of testing in dental settings. METHODS Patients ≥18 years old attending dental clinics in Sydney, Australia, were recruited, oral hygiene assessed, and 10 mL saline oral rinses obtained. Rinses were tested for HBG and HPV by PCR. Participants completed demographic and behavioural questionnaires. RESULTS The mean age was 48 years, of whom 131 (43.6%) were male. HPV genotypes, one each of 16, 66, 51, 35 and 58 in five participants, and 18 and 52 in one participant, were detected in six samples (2.0%), all men. Oral sex was reported by 89 (67.9%) male participants. One participant (4.3%) of the 23 with poor OH had at least one HPV genotype detected. DISCUSSION With dental patients willing to provide rinse samples and disclose potentially sensitive information, we found the hrHPV prevalence of 2%. Given large proportions of the general population attending dental clinics regularly, dentists may be ideally placed to screen for oropharyngeal carcinoma and contribute to the currently limited knowledge of oral HPV prevalence in Australian adults. © 2022 Australian Dental Association.
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Affiliation(s)
- B Rumianek
- The University of Sydney, Camperdown, Australia
| | - R Hillman
- University of New South Wales, Sydney, Australia
| | - N Jeoffreys
- Westmead Institute for Medical Research, Westmead, Australia
| | - S Ghazanfar
- The University of Sydney, Camperdown, Australia
| | - M Schifter
- The University of Sydney, Camperdown, Australia
| | - S Ajwani
- The University of Sydney, Camperdown, Australia
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18
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Namiki K, Okada K, Shindo R, Kagawa Y. A case of immature teratoma with nephroblastic components in the oral cavity of a cat. J Vet Med Sci 2023; 85:420-424. [PMID: 36843018 PMCID: PMC10139784 DOI: 10.1292/jvms.23-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
A 2-month-old female mixed cat was emaciated due to dysphagia, and inspection of the mouth revealed a 2 cm pedunculated mass elongated from the palate, which occupied the oral cavity. The mass was surgically removed, and histopathological examination revealed that the tumor was composed of three germ cell layers: ectodermal (skin and skin appendages), mesodermal (cartilaginous and osseous structures), and endodermal (glandular and respiratory mucosa) tissues. An immature teratoma was diagnosed because of the presence of immature neuroectodermal tissues, and the presence of nephroblastic components was a characteristic finding in this case. This is the first report of an oropharyngeal teratoma in cats and the first case of an immature teratoma with nephroblastic components in a domestic species.
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19
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Charushin AO, Elovikov AM, Charushina IP. [New opportunities for complex treatment of oropharyngeal candidiasis in HIV-infected patients in the later stages of the disease]. TERAPEVT ARKH 2023; 95:52-56. [PMID: 37167115 DOI: 10.26442/00403660.2023.01.202064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 05/13/2023]
Abstract
Treatment of recurrent oropharyngeal candidiasis (OPC) in HIV-infected patients is a serious clinical problem due to the emergence of resistant Candida strains, the risk of invasive disease, and high economic costs, which warrants the need for new treatment regimens. AIM To improve the treatment regimen of OPC in the later stages of HIV infection by combining the complex herbal medicinal product Tonsilgon® N with fluconazole and evaluate the effectiveness of this combination. MATERIALS AND METHODS A comparative randomized clinical study included 65 patients divided into observation and comparison groups, receiving fluconazole plus Tonsilgon® H and fluconazole monotherapy, respectively, for 7 days. On days 1 and 8, the severity of OPC clinical signs was assessed using a visual analog scale. The secretory immunoglobulin A in saliva was measured as a criterion for changing the level of local mucosal protection of the oral cavity and pharynx. CONCLUSION This treatment regimen for oropharyngeal candidiasis in patients with HIV infection in the later stages of the disease (IVB-IVC) with fluconazole and Tonsilgon® N is effective, which is confirmed by a significantly more pronounced regression of clinical signs (pM-U<0.01), as well as an increase in the level of secretory immunoglobulin A in the oral fluid (from 0.62±0.33 g/L to 0.81±0.18 g/L; p<0.05).
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20
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Gunning A, Kumar S, Williams CK, Berger BM, Naber SP, Gupta PB, Del Vecchio Fitz C, Kuperwasser C. Analytical Validation of NavDx, a cfDNA-Based Fragmentomic Profiling Assay for HPV-Driven Cancers. Diagnostics (Basel) 2023; 13:diagnostics13040725. [PMID: 36832208 PMCID: PMC9955790 DOI: 10.3390/diagnostics13040725] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
The NavDx® blood test analyzes tumor tissue modified viral (TTMV)-HPV DNA to provide a reliable means of detecting and monitoring HPV-driven cancers. The test has been clinically validated in a large number of independent studies and has been integrated into clinical practice by over 1000 healthcare providers at over 400 medical sites in the US. This Clinical Laboratory Improvement Amendments (CLIA), high complexity laboratory developed test, has also been accredited by the College of American Pathologists (CAP) and the New York State Department of Health. Here, we report a detailed analytical validation of the NavDx assay, including sample stability, specificity as measured by limits of blank (LOBs), and sensitivity illustrated via limits of detection and quantitation (LODs and LOQs). LOBs were 0-0.32 copies/μL, LODs were 0-1.10 copies/μL, and LOQs were <1.20-4.11 copies/μL, demonstrating the high sensitivity and specificity of data provided by NavDx. In-depth evaluations including accuracy and intra- and inter-assay precision studies were shown to be well within acceptable ranges. Regression analysis revealed a high degree of correlation between expected and effective concentrations, demonstrating excellent linearity (R2 = 1) across a broad range of analyte concentrations. These results demonstrate that NavDx accurately and reproducibly detects circulating TTMV-HPV DNA, which has been shown to aid in the diagnosis and surveillance of HPV-driven cancers.
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21
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Erratum: Presumptive bacteriological diagnosis of spondylodiscitis in infants less than 4 years by detecting K. kingae DNA in their oropharynx: Data from a preliminar two centers study. Front Pediatr 2023; 11:1170911. [PMID: 36937982 PMCID: PMC10020632 DOI: 10.3389/fped.2023.1170911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.1046254.].
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22
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Galán-Ortíz JR, Andino del Valle KA, Pérez-Rosario AA, Castañón Pereira DL, Díaz-Rivera J, Merheb-Finianos PA, Dorta-Estremera SM. B cells as modulators of HPV+ oropharyngeal cancer in a preclinical model. Front Oncol 2023; 13:1145724. [PMID: 37035195 PMCID: PMC10076859 DOI: 10.3389/fonc.2023.1145724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Among the different immune cells present within tumors, B cells also infiltrate human papillomavirus-positive (HPV+) oropharyngeal tumors. However, the role of B cells during programmed death-1 (PD-1) blockade in HPV+ oropharyngeal cancer needs to be better defined. By using the preclinical mouse model for HPV+ oropharyngeal cancer (named mEER), we characterized B cells within tumors and determined their functional role in vivo during PD-1 blockade. We determined that treatment naïve tongue-implanted tumors, which we have previously demonstrated to be sensitive to PD-1 blockade, contained high infiltration of CD8+ T cells and low infiltration of B cells whereas flank-implanted tumors, which are resistant to PD-1 blockade, contain a higher frequency of B cells compared to T cells. Moreover, B cell-deficient mice (µMt) and B cell-depleted mice showed a slower tumor growth rate compared to wild-type (WT) mice, and B cell deficiency increased CD8+ T cell infiltration in tumors. When we compared tongue tumor-bearing mice treated with anti-PD-1, we observed that tumors that responded to the therapy contained more T cells and B cells than the ones that did not respond. However, µMt mice treated with PD-1 blockade showed similar tumor growth rates to WT mice. Our data suggest that in untreated mice, B cells have a more pro-tumorigenic phenotype potentially affecting T cell infiltration in the tumors. In contrast, B cells are dispensable for PD-1 blockade efficacy. Mechanistic studies are needed to identify novel targets to promote the anti-tumorigenic function and/or suppress the immunosuppressive function of B cells in HPV+ oropharyngeal cancer.
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Affiliation(s)
- Jorge R. Galán-Ortíz
- Cancer Biology Division, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
| | - Kamila A. Andino del Valle
- Microbiology and Medical Zoology Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | - Jennifer Díaz-Rivera
- Microbiology and Medical Zoology Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Stephanie M. Dorta-Estremera
- Cancer Biology Division, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico
- Microbiology and Medical Zoology Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- *Correspondence: Stephanie M. Dorta-Estremera,
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23
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Zoschke IN, Bennis SL, Wilkerson JM, Stull CL, Nyitray AG, Khariwala SS, Nichols CM, Rosser BRS, Flash C, Ross MW. HPV-related oropharyngeal cancer early detection in gay and bisexual men is an "orphan" practice: A qualitative analysis among healthcare providers. Front Public Health 2023; 11:1165107. [PMID: 37151584 PMCID: PMC10162013 DOI: 10.3389/fpubh.2023.1165107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Among US men, oropharyngeal cancer (cancer of the back of the mouth and throat) is the 8th most common cancer. If detected early, human papillomavirus (HPV)-16-associated oropharyngeal cancer has a high 5-year survival rate. Risk factors such as high numbers of oral sex partners, disparities in smoking and drinking, and low rates of HPV vaccination may put gay and bisexual men at even higher risk for oropharyngeal cancer. Methods We recruited 21 healthcare providers in Minneapolis-St. Paul, Minnesota and Houston, Texas to participate in semi-structured interviews. Nurses, physician assistants, dental hygienists, and dentists were asked about their clinical experiences serving gay and bisexual men and opinions on potential interventions for the early detection of oropharyngeal cancer. Results Providers typically did not tailor health screenings and examinations for gay and bisexual men. Participants lacked confidence in their ability to effectively implement routine screening for oropharyngeal cancer. The extent to which oropharyngeal cancer screening was incorporated into clinical practice varied by specialty, and practices necessary to detect it were scattered across clinical environments. HIV- and LGBTQ-focused healthcare providers were more aware of HPV-associated oropharyngeal cancer in gay and bisexual men, and appeared readier to act and lead on this issue. Discussion Further studies should (1) evaluate protocols for oropharyngeal cancer detection; (2) identify and assess the acceptability of screening in the community; and (3) study how to best close gaps in health services for gay and bisexual men which might contribute to low early detection rates of oropharyngeal cancer.
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Affiliation(s)
- I. Niles Zoschke
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sarah L. Bennis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - J. Michael Wilkerson
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cynthia L. Stull
- Department of Primary Dental Care, Division of Dental Hygiene, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Alan G. Nyitray
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Samir S. Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, United States
| | | | - B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Charlene Flash
- Avenue 360 Health and Wellness, Houston, TX, United States
- Baylor College of Medicine, Division of Infectious Disease, Houston, TX, United States
- Tilman J. Fertitta Family College of Medicine at the University of Houston, Houston, TX, United States
| | - Michael W. Ross
- Department of Family Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Michael W. Ross
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Seo S, Rooper L, Seiwert TY, Fakhry C. Spontaneous regression of an human papillomavirus-positive oropharyngeal squamous cell carcinoma. Head Neck 2023; 45:E1-E4. [PMID: 36256583 DOI: 10.1002/hed.27226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Spontaneous regression (SR) of cancer is an exceedingly rare phenomenon. While SR is well-documented for some cancers, very few reports exist in oropharyngeal squamous cell carcinomas (OPSCCs) and none in human papillomavirus (HPV)-positive OPSCCs. METHODS A 67-year old man presented with a left-sided neck mass. Neck CT, PET, and biopsies showed a SCC in a left-sided lymph node without a primary lesion. Immunohistochemistry confirmed HPV16. Six weeks after biopsy, the patient underwent left selective tonsillectomy and neck dissection. RESULTS Surgery revealed a left tonsillar SCC and no lymph nodes with tumor. Histology revealed homogenous fibrosis and intermixed immune cells indicative of tumor regression analogous to reports of immune-related pathologic responses. AE1/AE3 immunostain was also negative for tumor. All lymph nodes remained negative at 1 year follow-up. CONCLUSION We described a spontaneously regressed lymph node in a tonsillar HPV-positive SCC. The unique immune environment of HPV-positive OPSCCs, and unknown environmental or host factors, may have played a role in our patient's SR which requires future studies to elucidate.
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Affiliation(s)
- Stefanie Seo
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa Rooper
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Tanguy Y Seiwert
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carole Fakhry
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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25
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Rivas MJ, D'Elía K, Bianconi I, Novelli Poisson P. [Anticoagulation in a patient with Lemierre syndrome and pulmonary septic embolisms]. Medicina (B Aires) 2023; 83:315-318. [PMID: 37094204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Lemierre's syndrome, also called septic thrombophlebitis of the internal jugular vein, necrobacillosis or postanginal sepsis, is an infection that begins in the oropharyngeal space, is complicated by septic thrombophlebitis of the internal jugular vein and infectious metastases. The rapid progression to serious clinical conditions that compromise the patient's life and its low frequency justify the disclosure of clinical cases. We present the case of a 27-year-old woman who developed facial edema and trismus 48 hours after completing treatment with phenoxymethylpenicillin for an odontogenic infection. An angio-CT of the craniofacial massif revealed an extensive thrombus in the internal jugular vein and a computed tomography of the chest showed septic pulmonary emboli. Treatment consisted of broad-spectrum intravenous antibiotics and early anticoagulation.
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Affiliation(s)
- María José Rivas
- Servicio de Clínica Médica, Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina. E-mail:
| | - Kevin D'Elía
- Servicio de Clínica Médica, Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina
| | - Ignacio Bianconi
- Servicio de Clínica Médica, Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina
| | - Paola Novelli Poisson
- Servicio de Clínica Médica, Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina
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26
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Wagner AS, Vogel AK, Lumsdaine SW, Phillips EK, Willems HME, Peters BM, Reynolds TB. Mucosal Infection with Unmasked Candida albicans Cells Impacts Disease Progression in a Host Niche-Specific Manner. Infect Immun 2022; 90:e0034222. [PMID: 36374100 DOI: 10.1128/iai.00342-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Shielding the immunogenic cell wall epitope β(1, 3)-glucan under an outer layer of mannosylated glycoproteins is an essential virulence factor deployed by Candida albicans during systemic infection. Accordingly, mutants with increased β(1, 3)-glucan exposure (unmasking) display increased immunostimulatory capabilities in vitro and attenuated virulence during systemic infection in mice. However, little work has been done to assess the impact of increased unmasking during the two most common manifestations of candidiasis, namely, oropharyngeal candidiasis (OPC) and vulvovaginal candidiasis (VVC). We have shown previously that the expression of a single hyperactive allele of the MAP3K STE11ΔN467 induces unmasking via the Cek1 MAPK pathway, attenuates fungal burden, and prolongs survival during systemic infection in mice. Here, we expand on these findings and show that infection with an unmasked STE11ΔN467 mutant also impacts disease progression during OPC and VVC murine infection models. Male mice sublingually infected with the STE11ΔN467 mutant showed a significant reduction in tongue fungal burden at 2 days postinfection and a modest reduction at 5 days postinfection. However, we find that selection for STE11ΔN467 suppressor mutants that no longer display increased unmasking occurs within the oral cavity and is likely responsible for the restoration of fungal burden trends to wild-type levels later in the infection. In the VVC infection model, no attenuation in fungal burden was observed. However, polymorphonuclear cell recruitment and interleukin-1β (IL-1β) levels within the vaginal lumen, markers of immunopathogenesis, were increased in mice infected with unmasked STE11ΔN467 cells. Thus, our data suggest a niche-specific impact for unmasking on disease progression.
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27
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Thorsen J, Stokholm J, Rasmussen MA, Roggenbuck-Wedemeyer M, Vissing NH, Mortensen MS, Brejnrod AD, Fleming L, Bush A, Roberts G, Singer F, Frey U, Hedlin G, Nordlund B, Murray CS, Abdel-Aziz MI, Hashimoto S, van Aalderen W, Maitland-van der Zee AH, Shaw D, Fowler SJ, Sousa A, Sterk PJ, Chung KF, Adcock IM, Djukanovic R, Auffray C, Bansal AT, Wagers S, Chawes B, Bønnelykke K, Sørensen SJ, Bisgaard H. Asthma and Wheeze Severity and the Oropharyngeal Microbiota in Children and Adolescents. Ann Am Thorac Soc 2022; 19:2031-43. [PMID: 35904980 DOI: 10.1513/AnnalsATS.202110-1152OC] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: There is a major unmet need for improving the care of children and adolescents with severe asthma and wheeze. Identifying factors contributing to disease severity may lead to improved diagnostics, biomarkers, or therapies. The airway microbiota may be such a key factor. Objectives: To compare the oropharyngeal airway microbiota of children and adolescents with severe and mild/moderate asthma/wheeze. Methods: Oropharyngeal swab samples from school-age and preschool children in the European U-BIOPRED (Unbiased BIOmarkers in the PREDiction of respiratory disease outcomes) multicenter study of severe asthma, all receiving severity-appropriate treatment, were examined using 16S ribosomal RNA gene sequencing. Bacterial taxa were defined as amplicon sequence variants. Results: We analyzed 241 samples from four cohorts: A) 86 school-age children with severe asthma; B) 39 school-age children with mild/moderate asthma; C) 65 preschool children with severe wheeze; and D) 51 preschool children with mild/moderate wheeze. The most common bacteria were Streptococcus (mean relative abundance, 33.5%), Veillonella (10.3%), Haemophilus (7.0%), Prevotella (5.9%), and Rothia (5.5%). Age group (school-age vs. preschool) was associated with the microbiota in β-diversity analysis (F = 3.32, P = 0.011) and in a differential abundance analysis (28 significant amplicon sequence variants). Among all children, we found no significant difference in the microbiota between children with severe and mild/moderate asthma/wheeze in univariable β-diversity analysis (F = 1.99, P = 0.08, N = 241), but a significant difference in a multivariable model (F = 2.66, P = 0.035), including the number of exacerbations in the previous year. Age was also significant when expressed as a microbial maturity score (Spearman Rho, 0.39; P = 4.6 × 10-10); however, this score was not associated with asthma/wheeze severity. Conclusions: There was a modest difference in the oropharyngeal airway microbiota between children with severe and mild/moderate asthma/wheeze across all children but not in individual age groups, and a strong association between the microbiota and age. This suggests the oropharyngeal airway microbiota as an interesting entity in studying asthma severity, but probably without the strength to serve as a biomarker for targeted intervention.
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28
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Haller TJ, Van Abel KM, Yin LX, Lohse CM, Douse D, Badaoui JN, Price DL, Kasperbauer JL, Moore EJ. Ultrasound Guided Biopsy in Patients With HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 132:2396-2402. [PMID: 35275423 DOI: 10.1002/lary.30105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify the differences in sensitivity and accuracy between ultrasound-guided and palpation-guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006-12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi-square and Fisher exact tests. RESULTS A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation-guided FNAs, 160 (77%) ultrasound-guided FNAs, and 18 (9%) ultrasound-guided FNA + core biopsies. Sensitivity was significantly different among palpation-guided FNA, ultrasound-guided FNA, and ultrasound-guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound-guided FNA versus ultrasound-guided FNA + core biopsies (P = .31). CONCLUSION The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2396-2402, 2022.
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Affiliation(s)
- Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dontre' Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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29
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Jensen D, Bendsen BB, Westmark S, Riis J, Krarup AL, Westergren A, Melgaard D. Effect of Chin Tuck against Resistance Exercise in Citizens with Oropharyngeal Dysphagia-A Randomised Controlled Study. Geriatrics (Basel) 2022; 7. [PMID: 36412618 DOI: 10.3390/geriatrics7060129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
Oropharyngeal dysphagia (OD) impacts the safety and efficacy of the swallowing function. The aim was to uncover the effect of chin tuck against resistance (CTAR) exercises compared to standard care in relation to the swallowing function in citizens with OD. Ninety-two citizens (46% male, median age 78 years (IQR 71, 84)) with OD confirmed by the Volume-Viscosity Swallow Test and/or Minimal Eating Observation Form version II were randomised to standard care with the addition of CTAR daily for six weeks or standard care only. The participants were included from seven Danish municipalities from March 2019 to October 2020. A nonsignificant effect on dysphagia of CTAR training combined with standard care versus standard care alone was documented. Both CTAR training combined with standard care and standard care alone had a significant effect on the swallowing function in citizens with OD, with the best effect in the group receiving CTAR training combined with standard care. A significant effect compared to baseline was observed in all participants (p = 0.03) after 12 weeks. Participants in both groups had a significant reduction in problems with manipulating food in the mouth (p = 0.005), swallowing (p = 0.005), and chewing (p = 0.03) but an increased appetite (p = 0.01). The reported quality of life scored with DHI-DK was significantly improved in both groups.
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30
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Sharkey Ochoa I, O’Regan E, Toner M, Kay E, Faul P, O’Keane C, O’Connor R, Mullen D, Nur M, O’Murchu E, Barry-O’Crowley J, Kernan N, Tewari P, Keegan H, O’Toole S, Woods R, Kennedy S, Feeley K, Sharp L, Gheit T, Tommasino M, O’Leary JJ, Martin CM. The Role of HPV in Determining Treatment, Survival, and Prognosis of Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:4321. [PMID: 36077856 PMCID: PMC9454666 DOI: 10.3390/cancers14174321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Human papillomavirus (HPV) infection has been identified as a significant etiological agent in the development of head and neck squamous cell carcinoma (HNSCC). HPV's involvement has alluded to better survival and prognosis in patients and suggests that different treatment strategies may be appropriate for them. Only some data on the epidemiology of HPV infection in the oropharyngeal, oral cavity, and laryngeal SCC exists in Europe. Thus, this study was carried out to investigate HPV's impact on HNSCC patient outcomes in the Irish population, one of the largest studies of its kind using consistent HPV testing techniques. A total of 861 primary oropharyngeal, oral cavity, and laryngeal SCC (OPSCC, OSCC, LSCC) cases diagnosed between 1994 and 2013, identified through the National Cancer Registry of Ireland (NCRI), were obtained from hospitals across Ireland and tested for HPV DNA using Multiplex PCR Luminex technology based in and sanctioned by the International Agency for Research on Cancer (IARC). Both overall and cancer-specific survival were significantly improved amongst all HPV-positive patients together, though HPV status was only a significant predictor of survival in the oropharynx. Amongst HPV-positive patients in the oropharynx, surgery alone was associated with prolonged survival, alluding to the potential for de-escalation of treatment in HPV-related OPSCC in particular. Cumulatively, these findings highlight the need for continued investigation into treatment pathways for HPV-related OPSCC, the relevance of introducing boys into national HPV vaccination programs, and the relevance of the nona-valent Gardasil-9 vaccine to HNSCC prevention.
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Affiliation(s)
- Imogen Sharkey Ochoa
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Esther O’Regan
- Trinity St James Cancer Institute, Trinity College Dublin, D08 NHY1 Dublin, Ireland
- Discipline of Histopathology, St. James’ University Hospital, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Mary Toner
- Discipline of Histopathology, St. James’ University Hospital, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Elaine Kay
- Department of Pathology, Beaumont University Hospital, D09 V2N0 Dublin, Ireland
| | - Peter Faul
- Department of Pathology, University Hospital Limerick, V94 F858 Limerick, Ireland
| | - Connor O’Keane
- Department of Pathology, Mater University Hospital, D07 R2WY Dublin, Ireland
| | - Roisin O’Connor
- Discipline of Histopathology, St. James’ University Hospital, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Dorinda Mullen
- Discipline of Histopathology, St. James’ University Hospital, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Mataz Nur
- Discipline of Histopathology, St. James’ University Hospital, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Eamon O’Murchu
- National Cancer Registry of Ireland, T12 CDF7 Cork, Ireland
| | - Jacqui Barry-O’Crowley
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Niamh Kernan
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Prerna Tewari
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Helen Keegan
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Sharon O’Toole
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Robbie Woods
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
| | - Susan Kennedy
- Department of Pathology, St Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Kenneth Feeley
- Department of Pathology, University Hospital Kerry, V92 NX94 Tralee, Ireland
| | - Linda Sharp
- Faculty of Medical Sciences, Newcastle University, Newcastle NE1 7RU, UK
| | - Tarik Gheit
- Infections and Cancer Biology Laboratory, International Agency for Research on Cancer, 69008 Lyon, France
| | - Massimo Tommasino
- Dipartimento di Farmacia-Scienze del Farmaco, University of Bari, 70121 Bari, Italy
| | - John J. O’Leary
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, D08 NHY1 Dublin, Ireland
- Discipline of Histopathology, St. James’ University Hospital, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Cara M. Martin
- TCD CERVIVA Molecular Pathology Laboratory, The Coombe Women and Infants University Hospital, D08 XW7X Dublin, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, D08 NHY1 Dublin, Ireland
- Discipline of Histopathology, St. James’ University Hospital, Trinity College Dublin, D08 NHY1 Dublin, Ireland
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31
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Radhakrishnan S, Afsal EM, Anitha PM, Perumbally HA, Ajitha BK, Pulloor NK, Rafeeq Ali KP, Ajayan KV, Kanyadath AM, Verkoli AS, Sukumaran C, Nazeer HA, Sherif M, Navya V, Nishitha NK, Sabir VT, Kottayi S, Suchina EK, Thashreefa TK, Vaheed KA, Kulooth F, Suvanish Kumar VS, Chandran P, Thekkedath U, Radhakrishnan C. Performance & clinical utility of oropharyngeal versus nasopharyngeal swabs in COVID-19. Indian J Med Res 2022; 156:478-483. [PMID: 36510889 PMCID: PMC10101371 DOI: 10.4103/ijmr.ijmr_2275_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background & objectives The oropharyngeal (OP) and nasopharyngeal (NP) swab samples are the most recommended clinical specimens for detecting SARS-CoV-2 in an individual through the quantitative real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) method. The primary objective of this study was to compare the performance of NP and OP swabs for the diagnosis of COVID-19 among 2250 concomitant samples (1125 NP + 1125 OP) using rRT-PCR test. Methods This study was conducted at a tertiary care hospital in southern India. The study compared the specificity and efficacy of the two samples (NP & OP swabs) in 1125 individuals suspected having COVID-19 infection. The rRT-PCR values from all the samples were compared based on gender, age group and viral load. The differences between unmatched proportion and matched proportion were analysed. Agreement between the two methods was assessed using Kappa statistic. Absolute sensitivity, specificity, positive and negative predictive values (PPV and NPV) for OP and NP swabs were analysed. Results The study identified a fair degree of agreement between OP and NP swabs in diagnosis of COVID-19 (kappa = 0.275, P <0.001). There was also a fair degree of agreement between NP and OP swabs irrespective of gender, age or duration of symptoms. NP swabs had better sensitivity and NPV as compared to OP swabs, however, specificity and PPV were 100 per cent for both. Interpretation & conclusions The present study showed that both OP and NP swabs had similar sensitivity and specificity for predicting the presence of SARS-CoV-2.
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Affiliation(s)
- Suma Radhakrishnan
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - E Muhammed Afsal
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - P M Anitha
- Microbiology, Government Medical College, Manjeri, Kerala, India
| | | | - B K Ajitha
- Department of Statistics, Government Medical College, Kozhikode, Kerala, India
| | | | - K P Rafeeq Ali
- Department of Otorhinolaryngology, General Hospital, Manjeri, Kerala, India
| | - K V Ajayan
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | | | | | - Chinchu Sukumaran
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - Hafeefa Abdul Nazeer
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - Mohammed Sherif
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - V Navya
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - N K Nishitha
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - V T Sabir
- Department of Otorhinolaryngology, General Hospital, Manjeri, Kerala, India
| | - Shakeeber Kottayi
- Department of Otorhinolaryngology, General Hospital, Manjeri, Kerala, India
| | - E K Suchina
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - T K Thashreefa
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | - K Abdul Vaheed
- Department of Otorhinolaryngology, General Hospital, Manjeri, Kerala, India
| | - Fathima Kulooth
- Department of Otorhinolaryngology, Government Medical College, Manjeri, Kerala, India
| | | | - Praseeda Chandran
- Community Medicine, Government Medical College, Manjeri, Kerala, India
| | - Usha Thekkedath
- UCSF Surgical Innovation, University of California, San Francisco, California, USA
| | - Chandni Radhakrishnan
- Department of Emergency Medicine, Government Medical College, Kozhikode, Kerala, India
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32
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Okhakhu AL, Onyeagwara NC. Oropharyngeal teratoma: A case presentation and review of literature. Afr J Paediatr Surg 2022; 19:179-182. [PMID: 35775522 PMCID: PMC9290371 DOI: 10.4103/ajps.ajps_68_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Teratomas are true neoplasms derived from the three germ layers. They are relatively rare tumours. They present in the sacrococcygeal region, gonads and retroperitoneum commonly. We present the report of a 5-month-old infant who presented with a prolapsing oropharyngeal teratoma and literature review.
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Affiliation(s)
- Amina Lami Okhakhu
- Department of Ear, Nose and Throat Head and Neck Surgery, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
| | - Ngozi Carol Onyeagwara
- Department of Ear, Nose and Throat Head and Neck Surgery, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
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33
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Patriquin G, LeBlanc JJ, Gillis HA, McCracken GR, Pettipas JJ, Hatchette TF. Combined oropharyngeal/nares and nasopharyngeal swab sampling remain effective for molecular detection of SARS-CoV-2 Omicron variant. J Med Microbiol 2022; 71. [PMID: 35671206 DOI: 10.1099/jmm.0.001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The world has experienced several waves of SARS-CoV-2 variants of concern (VoCs) throughout the COVID-19 pandemic since the first cases in December 2019. The Omicron VoC has increased transmission, compared to its predecessors, and can present with sore throat and other cold-like symptoms. Given the predominance of throat symptoms, and previous work demonstrating better sensitivity using antigen-based rapid detection tests when a throat swab is included in the standard nasal sampling, this quality improvement project sought to ensure ongoing suitability of both combined oropharyngeal/nares (OPN) and nasopharyngeal (NP) swab sampling used throughout the pandemic. Consenting participants meeting Public Health testing criteria (mostly symptomatic or a close contact of a known case) were enrolled, and paired NP and OPN swabs were subjected to nucleic acid amplification testing (NAAT). Comparing paired specimens from 392 participants sensitivity of NP swabs was 89.1 % (95 % CI, 78.8-94.9), and that of OPN was 98.4 % (95 % CI: 90.9->99.9) (P-value 0.052). This project demonstrated that both NP and combined OPN swabs detected the Omicron variant with similar sensitivity by NAAT, supporting the continued use of either swab collection for SARS-CoV-2 molecular detection.
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Affiliation(s)
- Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason J LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly A Gillis
- Public Health, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Gregory R McCracken
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Janice J Pettipas
- Nova Scotia Provincial Public Health Laboratory Network (PPHLN), Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
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Ajiya A, Shuaibu IY, Yahuza MA. Advance oropharyngeal mucoepidermoid carcinoma in a 9-year-old boy: A case report and review of literature. Afr J Paediatr Surg 2022; 19:105-108. [PMID: 35017381 PMCID: PMC8809470 DOI: 10.4103/ajps.ajps_133_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary malignant salivary gland tumours are uncommon among the paediatric population, accounting for <10% of all head-and-neck tumours in childhood. Less than 5% of all salivary gland cancers occur during childhood, most of them are diagnosed over the age of 10 years and are histologically low or intermediate grade. Mucoepidermoid carcinoma (MEC) occurring in the oropharynx of children and arising from the posterior pharyngeal wall is rare and probably never reported. We hereby report a case of advanced MEC arising from the posterior wall of the oropharynx in a 9-year-old boy, managed via a transcervical excision in a resource-poor setting.
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Affiliation(s)
- Abdulrazak Ajiya
- Department of Otorhinolaryngology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Iliyasu Yunusa Shuaibu
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Mansur Adamu Yahuza
- Department of Radiology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
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Stevens MN, Gallant JN, Feldman MJ, Sermarini AJ, Cmelak A, Murphy B, Langerman A, Kim Y, Rohde SL, Mannion K, Sinard RJ, Netterville JL, Chitale R, Topf MC. Management of postradiation late hemorrhage following treatment for HPV-positive oropharyngeal squamous cell carcinoma. Head Neck 2022; 44:1079-1085. [PMID: 35150023 DOI: 10.1002/hed.27001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Acute oropharyngeal hemorrhage is a serious complication for patients with oropharyngeal squamous cell carcinoma (OPSCC), particularly in patients with a history of radiation therapy (RT). METHODS Retrospective case series from at a tertiary care center for treated patients with HPV-positive OPSCC presenting with oropharyngeal hemorrhage. RESULTS Median time from completion of chemoradiation to first hemorrhagic event was 186 days (range 66-1466 days). Seven patients (58%) required intervention to secure their airway. All patients were evaluated for endovascular intervention, six (50%) were embolized. Eight patients (67%) had a second hemorrhagic event; median time to second bleed was 22 days (range 3-90 days). CONCLUSIONS Acute oropharyngeal hemorrhage is a sequelae following treatment for HPV-positive OPSCC. The majority of bleeds occurred within a year of completion of treatment. While more research is needed to determine optimal treatment paradigms, endovascular intervention should be considered, even if noninvasive imaging does not demonstrate active bleeding.
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Affiliation(s)
- Madelyn N Stevens
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Nicolas Gallant
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J Feldman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Anthony Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Barbara Murphy
- Department of Medical Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Alexander Langerman
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Young Kim
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah L Rohde
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Mannion
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Sinard
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James L Netterville
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rohan Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael C Topf
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Badaoui JN, Yin LX, Sauer AB, Moore EJ, Lohse CM, Price DL, Kasperbauer JL, Noel DB, Olsen KD, Van Abel KM. Transpharyngeal Approaches for Management of Oropharyngeal Squamous Cell Carcinoma: Mayo Clinic Institution Experience. Otolaryngol Head Neck Surg 2022; 167:509-516. [PMID: 35041566 DOI: 10.1177/01945998211071000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Investigate oncologic and functional outcomes associated with transhyoid and lateral pharyngotomy (transpharyngeal) approaches in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective review. SETTING Single institution (tertiary care center). METHODS This is a retrospective case series of patients with OPSCC undergoing transpharyngeal resection from 1990 to 2017 at Mayo Clinic. Oncologic outcomes, postoperative complications, objective swallowing data, and rates of tracheostomy and percutaneous gastrostomy tube dependence were recorded. RESULTS Of 83 patients meeting inclusion criteria, 56 (68%) were human papillomavirus positive. Overall survival rates at 5 and 10 years following surgery were 85% and 80%, respectively. Cancer-specific survival rates at these same time points were 90% and 88%. Following treatment, 35 of 49 patients (71%) had a Functional Oral Intake Scale score ≥5, indicating total oral intake of multiple consistencies; 79 of 82 (96%) were without tracheostomy or laryngectomy; and 71 of 81 (88%) were on a full oral diet. CONCLUSION Transpharyngeal approaches provide adequate functional and oncologic outcomes in the majority of patients with OPSCC. These results may have important implications for patients who are not candidates for, or are unwilling to undergo, nonoperative therapy or for those without access to radiation therapy.
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Affiliation(s)
- Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam B Sauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B Noel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D Olsen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
BACKGROUND Human papillomavirus (HPV) is one of the most common sexually transmitted infection in the United States and can lead to cervical, vulvovaginal, anal, penile, and oropharyngeal cancers. Compared with the general population, US military members are at a higher risk of HPV-related conditions, yet vaccination rates are relatively low in this population. As many service members may not be diagnosed with HPV-related cancers until after they leave active service, the objective of this study was to determine the incidence, prevalence, and economic burden of HPV-related cancers among US veterans. METHODS The study used the 2014-2018 Veterans Health Administration (VHA) database to identify newly diagnosed adult patients (cases) with HPV-related cancers, including cervical, vulvovaginal, anal, penile, and oropharyngeal cancers. Cases were matched by age, race, and sex to patients without HPV related cancer (controls). Outcome measures included annual incidence, prevalence, health care resource utilization (HCRU), and costs. These outcomes were calculated from the index date (first cancer diagnosis) through the earliest of 24 months, death, or end of study period. Adjusted results were examined using generalized linear models. RESULTS The annual prevalence and incidence rates of HPV-related cancers ranged from 43 (anal) to 790 (oropharyngeal) cases per million (CPM), and four (anal) to 131 (cervical) CPM, respectively. Compared with controls, cases had significantly higher annual HCRU. Mean numbers of annual inpatient hospitalizations were several times higher compared to controls (cervical: 6.7-times (×); vulvovaginal: 2.7×; penile: 6.6×; oropharyngeal: 10.2×; and anal: 14.9×; all p < 0.01). Similarly, cases had significantly higher all-cause healthcare costs vs. matched controls across all cancer types: cervical ($24,252 vs. $10,402), vulvovaginal ($34,801 vs. $10,913), penile ($42,772 vs. $9,139), oropharyngeal ($82,763 vs. $10,017), and anal ($98,146 vs. $8,339); (all p < 0.01). CONCLUSIONS HPV-related cancers may cause significant clinical and economic burden within the VHA system. Given the consequences of HPV-related cancers among veterans who did not have access to the vaccine, HPV vaccination of active military and eligible veterans should be considered a healthcare priority.
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Chargui M, Krzysztofiak A, Bernaschi P, De Marco G, Coulin B, Steiger C, Dayer R, Ceroni D. Presumptive bacteriological diagnosis of spondylodiscitis in infants less than 4 years by detecting K. kingae DNA in their oropharynx: Data from a preliminar two centers study. Front Pediatr 2022; 10:1046254. [PMID: 36568420 PMCID: PMC9780474 DOI: 10.3389/fped.2022.1046254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Most cases of spondylodiscitis in children aged between 6 and 48 months old could be caused primarily by K. kingae. The present prospective study aimed to determine whether an innovative and indirect diagnosis approach - based on detection of K. kingae DNA in the oropharynx of children with suspected spondylodiscitis - provides sufficient evidence that this microorganism is responsible for the infection. Methods We prospectively analysed infants admitted for spondylodiscitis, considering above all the results of PCR realized in oropharyngeal swabs and in blood samples. Results Four of the 29 performed K. kingae-specific real-time PCR assay in blood were positive (13.8%), whereas 28 of the 32 K. kingae-specific real-time PCR assay realized on throat swabs were positive (87.5%). Conclusions This study demonstrates that performing oropharyngeal swab PCR is able to detect K. kingae in almost 90% of the toddlers with confirmed spondylodiscitis. That provides strong arguments for the hypothesis that K. kingae should be considered as the main aetiological pathogen to suspect in children between 6 and 48 months old with spondylodiscitis. Finally, it seems to us reasonable that oropharyngeal swab may become an early decision-making tool for the indirect identification of K. kingae in spondylodiscitis.
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Affiliation(s)
- Moez Chargui
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Andrzej Krzysztofiak
- Infectious Diseases Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Paola Bernaschi
- Microbiology Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Giacomo De Marco
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Benoit Coulin
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Christina Steiger
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Romain Dayer
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Dimitri Ceroni
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
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Alfaro-Núñez A, Crone S, Mortensen S, Rosenstierne MW, Fomsgaard A, Marving E, Nielsen SH, Jørgensen MGP, Polacek C, Cohen AS, Nielsen C. SARS-CoV-2 RNA stability in dry swabs for longer storage and transport at different temperatures. Transbound Emerg Dis 2021; 69:189-194. [PMID: 34609793 PMCID: PMC8662091 DOI: 10.1111/tbed.14339] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/30/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
During the current COVID-19 pandemic, different methods have been used to evaluate patients with suspected SARS-CoV-2 infection. In this study, we experimentally evaluate the ability of spiked saliva-moist swabs and spiked swabs without any transport medium to retain SARS-CoV-2 for storage and transport at different environmental settings during different incubation time periods. Our results show that at ambient temperature of 20°C, SARS-CoV-2 RNA remains stable for up to 9 days allowing a long-time span for transport and storage without compromising clinical results. Additionally, this study demonstrates that saliva-moist swabs can also be stored at -20°C and +4°C for up to 26 days without affecting RT-qPCR results. Our data are relevant for low-and middle-income countries, which have limited access to rapid refrigerated transport and storage of samples representing an economical alternative. Finally, our study demonstrates the practical and economic advantage of using swabs without transport medium.
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Affiliation(s)
- Alonzo Alfaro-Núñez
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark.,Section for Evolutionary Genomics, GLOBE Institute, University of Copenhagen, Copenhagen K, Denmark
| | | | - Shila Mortensen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
| | - Maiken Worsøe Rosenstierne
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
| | - Anders Fomsgaard
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
| | - Ellinor Marving
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
| | | | | | - Charlotta Polacek
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
| | - Arieh S Cohen
- TestCenter Danmark, Statens Serum Institut, Copenhagen S, Denmark
| | - Claus Nielsen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen S, Denmark
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Aggarwal R, Plakkal N, Bhat V. Does oropharyngeal administration of colostrum reduce morbidity and mortality in very preterm infants? A randomised parallel-group controlled trial. J Paediatr Child Health 2021; 57:1467-1472. [PMID: 33908117 DOI: 10.1111/jpc.15529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
AIM To evaluate whether a strategy of oropharyngeal administration of colostrum reduces morbidity and mortality in very preterm infants. METHODS A total of 260 neonates with gestational age 26-31 weeks at birth were randomised between August 2017 and August 2018 to receive 0.2 mL of human milk or placebo respectively via the oropharyngeal route, beginning within 24 h after birth, and continued every 3 h until oral feeds were initiated. The primary outcome was a composite of death, late-onset sepsis (LOS) or necrotising enterocolitis (NEC) in the neonatal period. RESULTS A total of 260 infants (mean gestational age 29.5 weeks, and mean birthweight 1201.7 g) were included in the primary analysis. The composite primary outcome occurred in 43 (33.6%) infants in the colostrum group and 38 infants (29.7%) in the placebo group, and the difference was not statistically significant (P = 0.50). Secondary outcomes including the incidence of death, NEC, LOS, probable sepsis, intraventricular haemorrhage, ventilator-associated pneumonia, retinopathy of prematurity, bronchopulmonary dysplasia, time to full feeds, time to regain birthweight, duration of hospital stay and survival to 6 months without major neurosensory impairment were also comparable between the two groups. CONCLUSION A strategy of oropharyngeal administration of colostrum in very preterm and extremely preterm neonates did not decrease the composite primary outcome of death, LOS or NEC. This finding is consistent with most published literature in the area.
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Affiliation(s)
- Rahul Aggarwal
- Department of Neonatology, Apollo Cradle, Gurgaon, India.,Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.,Department of Neonatology, Division of Research, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation, Pondicherry, India
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Lau AS, Milinis K, Roode M, Williams SP, Cook C, Walijee H, Zammit M, Siau R, Emerson H, Wright R, Hampton T. The prevalence of oropharyngeal squamous cell carcinoma in patients admitted with symptoms of peritonsillar abscess or cellulitis: A retrospective multicentre study. Clin Otolaryngol 2021; 46:1362-1367. [PMID: 34407287 DOI: 10.1111/coa.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Anecdotal evidence suggests that oropharyngeal squamous cell carcinoma (OPSCC) should be suspected in patients presenting with symptoms of peritonsillar abscess (PTA) or cellulitis (PTC). The aim of this study was to estimate the prevalence of OPSCC in patients presenting with symptoms of PTA/PTC. METHOD, SETTING AND PARTICIPANTS We retrospectively identified all adults with a coded diagnosis of PTA or PTC who presented between 2012 and 2016 inclusive, across six ENT units in Merseyside. Records were compared to that of the centralised regional head and neck cancer database. The clinical records of a subset of patients were reviewed for the purposes of data validation. RESULTS A total of 1975 patients with PTA/PTC were identified. Three patients were subsequently diagnosed with OPSCC. None of the three actually had an objective underlying diagnosis of PTA/PTC on the same side. The prevalence of OPSCC in patients admitted with symptoms of PTA/PTC was 0.15% or approximately 1:650 admissions. The records of 510 patients who presented over a one-year period (2016) were reviewed in even greater detail. There were 298 patients with PTA (59.4%) and 151 with PTC (29.1%) and 61 had an alternative diagnosis (11.9%). High-risk features (age ≥40, tonsillar asymmetry or tonsillar lesion) were present in 106 patients (24%). Urgent follow-up was expedited for 77 patients (73%). CONCLUSION This study estimates the risk of OPSCC in patients with peritonsillar symptoms. The prevalence is low, even in a region with a relatively heavy disease burden. Clinicians should, however, retain a high level of suspicion in patients with persistent symptoms.
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Affiliation(s)
- Andrew S Lau
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Liverpool, UK
| | - Kristijonas Milinis
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Liverpool, UK
| | - Mila Roode
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Mersey ENT Research Collaborative, Liverpool, UK
| | - Stephen P Williams
- Mersey ENT Research Collaborative, Liverpool, UK.,Arrowe Park Hospital, Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, UK
| | - Colette Cook
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Hussein Walijee
- Mersey ENT Research Collaborative, Liverpool, UK.,Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | - Matthew Zammit
- Mersey ENT Research Collaborative, Liverpool, UK.,Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Richard Siau
- Mersey ENT Research Collaborative, Liverpool, UK.,Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Hannah Emerson
- Mersey ENT Research Collaborative, Liverpool, UK.,Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Rosanna Wright
- Mersey ENT Research Collaborative, Liverpool, UK.,Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
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Mathews F, Irizarry R, Rosenfeld R, Sundaram K. Systematic Review and Meta-Analysis of Post-Treatment PET/CT in HPV-Associated Oropharyngeal Cancer. Ann Otol Rhinol Laryngol 2021; 131:595-603. [PMID: 34353135 DOI: 10.1177/00034894211036842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a systematic review with meta-analysis to investigate the utility of post-treatment PET/CT specifically in HPV-associated oropharyngeal squamous cell carcinoma following curative intent treatment. METHODS Random-effects meta-analysis was used to pool data from 7 observational studies (2013-2019) obtained from a database search of PubMed, Web of Science, and EMBASE using an a priori protocol with dual independent evaluation for inclusion, risk of bias assessment for acceptable methodology, and extraction of data for analysis. PET/CT results, treatment failure, imaging and interventions subsequent to PET/CT findings, and efficacy of salvage therapy were extracted. RESULTS Of the 907 post-treatment scans, PET/CT results were largely negative (76.2%; 95% CI, 63.4-85.6) and least often positive (11.3%; 95% CI, 8.8-14.4). PET/CT results were equivocal for 22.5% (95% CI, 12.5-36.9) and equivocal/positive for 34.2% of patients (95% CI, 25.1-44.5). Patients with an initial positive scan had the highest treatment failure rates (43.1%; 95% CI, 21.4-67.7) and those with an initial negative scan had the lowest rates (7.4%; 95% CI, 5.7-9.7). The equivocal and equivocal/positive scans had intermediate prevalence of 16.5% (95% CI, 9.4-27.6) and 16.7% (95% CI, 9.1-28.7), respectively. CONCLUSION The low treatment failure rate following a negative PET/CT scan is reassuring, but the data are consistent with treatment failure rates up to 9.7% suggesting follow-up of these patients is prudent. Additionally, the low positive predictive value for treatment failure observed alludes to use of post-treatment PET/CT in HPV-associated disease frequently leading to unnecessary subsequent imaging and intervention.
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Affiliation(s)
- Fasil Mathews
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Rachel Irizarry
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Richard Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Krishnamurthi Sundaram
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Otolaryngology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Grobman M, Rindt H, Reinero CR. Proteomic Characterization of Canine Gastric Fluid by Liquid Chromatography-Mass Spectrometry for Development of Protein Biomarkers in Regurgitation, Vomiting, and Cough. Front Vet Sci 2021; 8:670007. [PMID: 34307522 PMCID: PMC8292676 DOI: 10.3389/fvets.2021.670007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 12/21/2022] Open
Abstract
Reflux and aspiration in people cause and exacerbate respiratory diseases in the absence of gastrointestinal signs. Protein biomarkers in humans detect extraesophageal reflux (EER) from oropharyngeal (OP) and bronchoalveloar lavage samples. Reflux likely contributes to respiratory disease in dogs. The objectives of this study were to analyze the canine gastric fluid (GF) proteome and compare this to the OP proteome in normal, vomiting/regurgitating, and coughing dogs to identify biomarkers for EER/aspiration. Twenty-three client-owned dogs were enrolled. Canine GF samples (n = 5) and OP swabs in normal (n = 6), vomiting/regurgitating (n = 7), and coughing (n = 5) dogs were within 2 weeks of sample collection. Protein digests were analyzed by liquid chromatography–mass spectrometry. Differential abundance (DA) of proteins between groups was evaluated by Fisher's exact test with p < 0.0004 significance level after correction for multiple comparisons. DA was found between all groups (p < 0.0001): GF vs. normal (n = 130 proteins), coughing vs. normal (n = 22 proteins), and vomiting/regurgitating vs. normal (n = 20 proteins). Protein abundance was highly variable between dogs. Gastrointestinal-specific proteins were found in OP swabs from vomiting/regurgitating and coughing dogs but not from healthy dogs. In conclusion, the proteomic composition of the OP varies between health and disease. The presence of gastrointestinal-specific proteins in OP of coughing dogs may suggest reflux and/or aspiration as contributing factors. The variable protein abundance warrants investigation into biomarker panels.
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Affiliation(s)
- Megan Grobman
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States.,Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Hansjörg Rindt
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Carol R Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
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Berry SA, Ghanem KG. Licensing Nucleic Acid Amplification Tests for Extragenital Gonorrhea and Chlamydia: Innovative Science and a Call to Arms. Clin Infect Dis 2021; 71:2323-2325. [PMID: 31872856 DOI: 10.1093/cid/ciz1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/09/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen A Berry
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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van Liere GAFS, Dukers-Muijrers NHTM, Kuizenga-Wessel S, Götz HM, Hoebe CJPA. What Is the Optimal Testing Strategy for Oropharyngeal Neisseria gonorrhoeae in Men Who Have Sex With Men? Comparing Selective Testing Versus Routine Universal Testing From Dutch Sexually Transmitted Infection Clinic Data (2008-2017). Clin Infect Dis 2021; 71:944-951. [PMID: 31556949 DOI: 10.1093/cid/ciz964] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Most oropharyngeal Neisseria gonorrhoeae infections are asymptomatic, and many infections remain undetected, creating a reservoir for ongoing transmission and potential drug resistance. It is unclear what the optimal testing policy is in men who have sex with men (MSM), as routine universal testing data are lacking. METHODS Surveillance data from all Dutch sexually transmitted infection (STI) clinics between 2008 and 2017 were used (N = 271 242 consultations). Oropharyngeal testing policy was defined as routine universal testing when ≥85% of consultations included oropharyngeal testing or as selective testing (<85% tested). Independent risk factors for oropharyngeal N. gonorrhoeae were assessed among MSM routinely universally screened using backward multivariable logistic regression analyses. RESULTS Routine universal testing was performed in 90% (238 619/265 127) of consultations. Prevalence was higher using routine universal testing (5.5%; 95% CI, 5.4-5.6; 12 769/233 476) than with selective testing (4.7%; 95% CI, 4.4-5.0; 799/17 079; P < .001). Proportions of oropharyngeal-only infections were 55% and 47%, respectively. Independent risk factors were age <31 years (OR, 2.1; 95% CI, 1.9-2.3), age 31-43 years (OR, 1.7; 95% CI, 1.6-1.9, compared with >43 years), being notified for any STI (OR, 2.0; 95% CI, 1.9-2.1), concurrent urogenital N. gonorrhoeae (OR, 2.4; 95% CI, 2.1-2.7), and concurrent anorectal N. gonorrhoeae (OR, 11.4; 95% CI, 10.6-12.3). When using any of the risk factors age, notified, or oral sex as testing indicators, 98.4% (81 022/82 332) of MSM would be tested, finding 99.5% (4814/4838) of infections. CONCLUSIONS Routine universal testing detected more oropharyngeal N. gonorrhoeae infections than selective testing, of which more than half would be oropharyngeal only. Using independent risk factors as testing indicator is not specific. Therefore, routine universal oropharyngeal testing in MSM is feasible and warranted, as currently advised in most guidelines.
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Affiliation(s)
- Geneviève A F S van Liere
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Sophie Kuizenga-Wessel
- Department of Sexual Health, Public Health Service Haaglanden, The Hague, The Netherlands
| | - Hannelore M Götz
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Lambert A, Nees L, Nuyts S, Clement P, Meulemans J, Delaere P, Vander Poorten V. Photodynamic Therapy as an Alternative Therapeutic Tool in Functionally Inoperable Oral and Oropharyngeal Carcinoma: A Single Tertiary Center Retrospective Cohort Analysis. Front Oncol 2021; 11:626394. [PMID: 33747943 PMCID: PMC7970031 DOI: 10.3389/fonc.2021.626394] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Head and neck cancer is typically treated with surgery, radiotherapy, chemoradiation, or a combination of these treatments. This study aims to retrospectively analyse oncological outcomes, adverse events and toxicity of treatment with temoporfin-mediated photodynamic therapy at a single tertiary referral center. More specifically, in a selected group of patients with otherwise (functionally) inoperable oral or oropharyngeal head and neck squamous cell carcinoma. Methods: Twenty-six consecutive patients who received photodynamic therapy for oral or oropharyngeal squamous cell carcinoma from January 2002 until July 2019 at the University Hospitals Leuven were included. These were (1) patients with an accessible recurrent or new primary tumor in an extensively treated area of the head and neck, not suitable for standard treatment, or (2) patients that were judged medically unfit to undergo standard treatment modalities. Results: Complete tumor response immediately after PDT was obtained in 76.9% of cases. During follow-up, a proportion of CR patients did recur, to reach recurrence-free rates at six months, one year and two years of 60.6%, 48.5% and 32.3%. Local control at the PDT treated area was 42.3% with a median recurrence free interval time of 9 months. Recurrence-free interval was statistically more favorable for oropharyngeal squamous cell carcinoma (with or without oral cavity extension) in comparison to oral cavity squamous cell carcinoma alone (p < 0.001). During a median follow-up period of 27 months, we report new tumor activity in 80.8% of patients. Median overall and disease-specific survival time was 31 and 34 months, respectively. Most reported adverse events were pain after treatment and facial edema. At the end of follow-up, swallowing and upper airway functionality were preserved in 76.9 and 95.7% of patients, respectively. Conclusion: Photodynamic therapy is a valuable treatment option in highly selected patients with oral and/or oropharyngeal (functionally) inoperable head and neck squamous cell carcinoma. Treatment with this alternative modality can induce durable local control in an important fraction of treated patients, with an acceptable toxicity profile.
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Affiliation(s)
- Arnaud Lambert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology-Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Lotte Nees
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Department of Oncology-Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium.,Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Paul Clement
- Department of Oncology-Section Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Delaere
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology-Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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47
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Patel MR, Carroll D, Ussery E, Whitham H, Elkins CA, Noble-Wang J, Rasheed JK, Lu X, Lindstrom S, Bowen V, Waller J, Armstrong G, Gerber S, Brooks JT. Performance of Oropharyngeal Swab Testing Compared With Nasopharyngeal Swab Testing for Diagnosis of Coronavirus Disease 2019-United States, January 2020-February 2020. Clin Infect Dis 2021; 72:482-485. [PMID: 33527126 PMCID: PMC7337670 DOI: 10.1093/cid/ciaa759] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/12/2020] [Indexed: 11/26/2022] Open
Abstract
Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected ≤7 days after illness onset, Real-Time Reverse Transcriptase Polymerase Chain Reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 RT-PCR) diagnostic results were 95.2% concordant. However, NP swab cycle threshold values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect the amount of SARS-CoV-2.
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Affiliation(s)
- Monita R Patel
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Darin Carroll
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Emily Ussery
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Hilary Whitham
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Christopher A Elkins
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Judith Noble-Wang
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - James Kamile Rasheed
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Xiaoyan Lu
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Stephen Lindstrom
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Virginia Bowen
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Jessica Waller
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Gregory Armstrong
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Susan Gerber
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - John T Brooks
- Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
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van Niekerk JM, van der Veer BMJW, Hoebe CJPA, van de Bovenkamp J, van Herk C, van Loo IHM, van Alphen LB, Wolffs PFG. Despite Excellent Test Characteristics of the cobas 4800 CT/NG Assay, Detection of Oropharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae Remains Challenging. J Clin Microbiol 2021; 59:e02137-20. [PMID: 33148708 DOI: 10.1128/JCM.02137-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/01/2020] [Indexed: 11/20/2022] Open
Abstract
Oropharyngeal Chlamydia trachomatis (CT) infections and, especially, Neisseria gonorrhoeae (NG) infections are common, but few commercial nucleic acid amplification tests (NAATs) specify extragenital samples for intended use. The test characteristics of the cobas 4800 CT/NG assay were evaluated for oropharyngeal swabs. The technical validation included analysis of the specificity, sensitivity, dynamic range, linearity, efficiency, and precision. The probability of detection curve combined with historical data enabled the estimation of potentially missed diagnoses. A clinical evaluation was performed on a subset of 2,798 clinical samples available from routine diagnostics. Results of the cobas 4800 were compared with those from in-house C. trachomatis/N. gonorrhoeae PCR assays. Discrepant samples were tested with resolver assays, and these results were considered decisive. No cross-reactivity was seen in the analytical specificity analysis. High linearity (R 2 ≥ 0.983), efficiency (89% to 99%), and precision (cycle threshold [CT ] value of 0.1 to 0.9) were seen for both C. trachomatis and N. gonorrhoeae The limit of detection in oropharyngeal samples was 3.2 × 102 inclusion-forming units (IFU)/ml for C. trachomatis and 6.7 × 102 CFU/ml for N. gonorrhoeae Estimates on potentially missed diagnoses were up to 7.2% for C. trachomatis and up to 24.7% for N. gonorrhoeae Clinical sensitivity and specificity were evaluated with 25 C. trachomatis-positive, 86 N. gonorrhoeae-positive, and 264 negative samples, resulting in 100% and 99.6% for C. trachomatis and 100% and 96.7% for N. gonorrhoeae, respectively. The findings in this study demonstrate the utility of the cobas 4800 CT/NG assay for oropharyngeal samples. Despite its being a highly accurate test, the range of reported CT values, especially for N. gonorrhoeae, suggests relatively low oropharyngeal loads. Hence, consistent detection over the full range of oropharyngeal loads could be impaired.
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Kariithi HM, Ferreira HL, Welch CN, Ateya LO, Apopo AA, Zoller R, Volkening JD, Williams-Coplin D, Parris DJ, Olivier TL, Goldenberg D, Binepal YS, Hernandez SM, Afonso CL, Suarez DL. Surveillance and Genetic Characterization of Virulent Newcastle Disease Virus Subgenotype V.3 in Indigenous Chickens from Backyard Poultry Farms and Live Bird Markets in Kenya. Viruses 2021; 13:v13010103. [PMID: 33451125 PMCID: PMC7828601 DOI: 10.3390/v13010103] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/20/2022] Open
Abstract
Kenyan poultry consists of ~80% free-range indigenous chickens kept in small flocks (~30 birds) on backyard poultry farms (BPFs) and they are traded via live bird markets (LBMs). Newcastle disease virus (NDV) was detected in samples collected from chickens, wild farm birds, and other domestic poultry species during a 2017–2018 survey conducted at 66 BPFs and 21 LBMs in nine Kenyan counties. NDV nucleic acids were detected by rRT-PCR L-test in 39.5% (641/1621) of 1621 analyzed samples, of which 9.67% (62/641) were NDV-positive by both the L-test and a fusion-test designed to identify the virulent virus, with a majority being at LBMs (64.5%; 40/62) compared to BPFs (25.5%; 22/62). Virus isolation and next-generation sequencing (NGS) on a subset of samples resulted in 32 complete NDV genome sequences with 95.8–100% nucleotide identities amongst themselves and 95.7-98.2% identity with other east African isolates from 2010-2016. These isolates were classified as a new sub-genotype, V.3, and shared 86.5–88.9% and 88.5–91.8% nucleotide identities with subgenotypes V.1 and V.2 viruses, respectively. The putative fusion protein cleavage site (113R-Q-K-R↓F 117) in all 32 isolates, and a 1.86 ICPI score of an isolate from a BPF chicken that had clinical signs consistent with Newcastle disease, confirmed the high virulence of the NDVs. Compared to genotypes V and VI viruses, the attachment (HN) protein of 18 of the 32 vNDVs had amino acid substitutions in the antigenic sites. A time-scaled phylogeographic analysis suggests a west-to-east dispersal of the NDVs via the live chicken trade, but the virus origins remain unconfirmed due to scarcity of continuous and systematic surveillance data. This study reveals the widespread prevalence of vNDVs in Kenyan backyard poultry, the central role of LBMs in the dispersal and possibly generation of new virus variants, and the need for robust molecular epidemiological surveillance in poultry and non-poultry avian species.
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Affiliation(s)
- Henry M. Kariithi
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
- Biotechnology Research Institute, Kenya Agricultural and Livestock Research Organization, Kaptagat Road, Loresho, Nairobi P.O. Box 57811-00200, Kenya; (L.O.A.); (Y.S.B.)
| | - Helena L. Ferreira
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
- Department of Veterinary Medicine, FZEA-USP, University of Sao Paulo, Pirassununga 13635900, Brazil
| | - Catharine N. Welch
- Florida Department of Environmental Protection, Division of Recreation and Parks 33104 NW 192nd Ave, Okeechobee, FL 34972, USA;
| | - Leonard O. Ateya
- Biotechnology Research Institute, Kenya Agricultural and Livestock Research Organization, Kaptagat Road, Loresho, Nairobi P.O. Box 57811-00200, Kenya; (L.O.A.); (Y.S.B.)
| | - Auleria A. Apopo
- Directorate of Veterinary Services, State Department for Livestock, Ministry of Agriculture, Livestock, Fisheries and Cooperatives, Nairobi P.O. Box 34188-00100, Kenya;
| | - Richard Zoller
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
| | | | - Dawn Williams-Coplin
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
| | - Darren J. Parris
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
| | - Tim L. Olivier
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
| | - Dana Goldenberg
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
| | - Yatinder S. Binepal
- Biotechnology Research Institute, Kenya Agricultural and Livestock Research Organization, Kaptagat Road, Loresho, Nairobi P.O. Box 57811-00200, Kenya; (L.O.A.); (Y.S.B.)
| | - Sonia M. Hernandez
- Warnell School of Forestry and Natural Resources and The Southeastern Cooperative Wildlife Disease Study at the College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA;
| | - Claudio L. Afonso
- BASE2BIO, Oshkosh, WI 54904, USA;
- Correspondence: (C.L.A.); (D.L.S.); Tel.: +1-770-500-8071 (C.L.A.); +1-706-546-3433 (D.L.S.)
| | - David L. Suarez
- Exotic and Emerging Avian Viral Diseases Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, USDA-ARS, 934 College Station Road, Athens, GA 30605, USA; (H.M.K.); (H.L.F.); (R.Z.); (D.W.-C.); (D.J.P.); (T.L.O.); (D.G.)
- Correspondence: (C.L.A.); (D.L.S.); Tel.: +1-770-500-8071 (C.L.A.); +1-706-546-3433 (D.L.S.)
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50
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Abt NB, Holcomb AJ, Feng AL, Suresh K, Mokhtari TE, McHugh CI, Parikh AS, Faden DL, Deschler DG, Varvares MA, Lin DT, Richmon JD. Opioid Usage and Prescribing Predictors Following Transoral Robotic Surgery for Oropharyngeal Cancer. Laryngoscope 2020; 131:E1888-E1894. [PMID: 33210756 DOI: 10.1002/lary.29276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS Pain management following transoral robotic surgery (TORS) varies widely. We aim to quantify opioid usage following TORS for oropharyngeal squamous cell carcinoma (OPSCC) and identify prescribing predictors. STUDY DESIGN Retrospective cohort study. METHODS A consecutive series of 138 patients undergoing TORS for OPSCC were reviewed from 2016 to 2019. Opioid usage (standardized to morphine milligram equivalents [MME]) was gathered for 12 months post-surgery via prescribing record cross-check with the Massachusetts Prescription Awareness Tool. RESULTS Of 138 OPSCC TORS patients, 92.8% were human papillomavirus (HPV) positive. Adjuvant therapy included radiation (XRT;67.4%) and chemoradiation (cXRT;6.5%). Total MME usage from start of treatment averaged 1395.7 MMEs with 76.4% receiving three prescriptions or less. Categorical analysis showed age <65, male sex, overweight BMI, lower frailty, former smokers, HPV+, higher T stage, and BOT subsite to be associated with increased MMEs. Adjuvant therapy significantly increased MMEs (TORS+XRT:1646.2; TORS+cXRT:2385.0; TORS alone:554.7 [P < .001]) and 12-month opioid prescription totals (TORS+XRT:3.2; TORS+cXRT:5.5; TORS alone:1.6 [P < .001]). Adjuvant therapy increased time to taper (total MME in TORS alone versus TORS+XRT/cXRT: 0 to 3 months:428.2 versus 845.5, 4 to 6 months:46.8 versus 541.8, 7 to 9 months:12.4 versus 178.6, 10 to 12 months:11.0 versus 4.4,[P < .001]). Positive predictors of opioid prescribing at the 4- to 6-month and 4- to 12-month intervals included adjuvant therapy (odds ratio [OR]:5.56 and 4.51) and mFI-5 score ≥3 (OR:36.67 and 31.94). Following TORS at 6-, 9-, and 12-month, 15.7%, 6.6%, and 4.1% were still using opioids. CONCLUSIONS In OPSCC treated with TORS, opioid use tapers faster for surgery alone versus with adjuvant therapy. Opioid prescribing risks include adjuvant therapy and higher frailty index. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1888-E1894, 2021.
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Affiliation(s)
- Nicholas B Abt
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Andrew J Holcomb
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Allen L Feng
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Krish Suresh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tara E Mokhtari
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Christopher I McHugh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel L Faden
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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