Search

Objective: Coin-shaped button battery foreign bodies have a similar initial presentation to coin ingestion, but delayed retrieval of a battery from the esophagus can have devastating consequences. Variations in timing of retrieval for children with ingestion of coin foreign bodies have been reported. The study assesses the sensitivity and specificity of conventional and digital radiographs to differentiate button batteries from coin foreign bodies. Study Design: 3B case control study. Study Setting: Tertiary academic medical center. Methods: A radiographic study of the 12 most common commercially available button batteries and 66 coins of varying international origins was performed. Foreign bodies were placed at the cervical esophagus of a cadaver, and anteroposterior (AP) and lateral conventional radiographs of the neck were obtained. Digital AP and lateral radiographs of standalone coins and batteries were also obtained. Images were blindly read by 2 otolaryngologists and 2 radiologists. Statistical analysis was performed to determine accuracy in identifying coins vs batteries. Results: Using conventional radiographs to identify button batteries yielded a sensitivity of 0.88 and a specificity of 0.92 (positive predictive value [PPV] = 0.75, negative predictive value [NPV] = 0.97). Digital radiography yielded an overall sensitivity of 0.98 and specificity of 0.97 (PPV = 0.87, NPV = 0.99). Features of button batteries were only seen on AP conventional radiographs using reverse contrast. Conclusions: Neither conventional nor digital radiographic imaging had perfect accuracy in identifying coins vs batteries. Features of common disc batteries were identified, which may aid in diagnosis. With potential devastating consequences from retained battery in the esophagus, emergent removal of any possible disc battery foreign body should be considered. [ABSTRACT FROM AUTHOR]

The extension of the intramolecular Diels-Alder reaction to Strychnos and Aspidospermatan alkaloids enables the synthesis of lagunamine and the alkylation of indoloazine. The intramolecular Diels-Alder reaction are used conventionally for the synthesis of Aspidosperma alkaloids. The reaction are of the secodine-type indoloacrylate-enamine intermidiates.

Total syntheses of strychnos- and aspidospermatan-type alkaloids, (plus or minus)-akuammicine, (plus or minus)-alstogustine, (plus or minus)-echitamidine, (plus or minus)-19-epi-alstogustine involve reductions and quaternization reactions of 19-oxodihydroakuammicine. A three-pot sequence involving condensation-sigmatropic rearrangement sequence helps prepare 19-oxodihydroakuammicine.

A synthetic strategy involving intramolecular Diels-Alder reactions at two stages in the synthetic sequence helps perform the total syntheses of the racemate of the hypotensive alkaloid echitamidine and its C-19,20 and C-20 epimers. Single-crystal X-ray analysis helps assign the stereochemistry of a few intermediates. A comparative study of epimers using NMR data reveals the configuration of echitamidine as 19-epi-20-epi-echitamidine.

Objective: During the COVID-19 pandemic, there has been considerable interest in identifying aerosol- and droplet-generating procedures, as well as efforts to mitigate the spread of these potentially dangerous particulates. This study evaluated the efficacy of a prototype nasolaryngoscopy hood (PNLH) during various clinical scenarios that are known to generate aerosols and droplets.Study Design: Prospective detection of airborne aerosol generation during clinical simulation while wearing an PNLH.Setting: Clinical examination room.Methods: A particle counter was used to calculate the average number of 0.3-µm particles/L detected during various clinical scenarios that included sneezing, nasolaryngoscopy, sneezing during nasolaryngoscopy, and topical spray administration. Experiments were repeated to compare the PNLH versus no protection. During the sneeze experiments, additional measurements with a conventional N95 were documented.Results: There was a significant increase in aerosols detected during sneezing, sneezing during nasolaryngoscopy, and spray administration, as compared with baseline when no patient barrier was used. With the PNLH in place, the level of aerosols returned to comparable baseline levels in each scenario. Of note, routine nasolaryngoscopy did not lead to a statistically significant increase in aerosols.Conclusion: This study demonstrated that the PNLH is a safe and effective form of protection that can be used in clinical practice to help mitigate the generation of aerosols during nasolaryngoscopy. While nasolaryngoscopy itself was not shown to produce significant aerosols, the PNLH managed to lessen the aerosol burden during sneezing episodes associated with nasolaryngoscopy. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to better characterize factors associated with refractory rhinitis in pediatric patients who underwent adenoidectomy compared to those who had symptom resolution. Methods: The authors conducted a case series of patients younger than 18 years old who underwent adenoidectomy at Boston Medical Center from October 2012 to December 2018. Patients who underwent tonsillectomy and adenoidectomy or who underwent adenoidectomy for indications other than rhinitis were excluded. Patients who had refractory rhinitis symptoms postoperatively were compared to those who had resolution of their symptoms using Chi-square analysis and t -tests. Results: One hundred three patients who had refractory symptoms following adenoidectomy were compared to 139 patients who had resolution of symptoms. Patients who had refractory symptoms had significantly higher proportion of use (89.3%, P =.0011) and higher mean number of preoperative (1.50, P =.0226) and postoperative (1.10, P <.0001) medications, including nasal saline, intranasal steroids, antihistamines, and/or antibiotics. They were more likely to receive postoperative allergy evaluations (50%, P =.0068) and repeat surgery (30.1%, P <.0001), and had a higher proportion of reported history of allergies (24.3%, P =.0089). Conclusion: Use and number of preoperative medications, reported history of allergies, and postoperative allergy evaluation were significantly higher in patients with refractory chronic rhinitis following adenoidectomy. This study identified differences in patients who developed refractory symptoms that may help clinical decision making for surgical management. [ABSTRACT FROM AUTHOR]

Objectives: Evidence shows that scribes can improve provider efficiency and satisfaction in several settings, but is mixed on whether scribes improve patient satisfaction. We studied whether scribes improved patient satisfaction in an academic otolaryngology clinic. Methods: The authors performed a retrospective review of patient responses to the Press Ganey survey between 12/2016 and 12/2017. Their responses about satisfaction with the provider and wait times were examined. Three providers worked with scribes during this year; each spent six months with a scribe and six without. The authors compared survey responses from periods with and without scribes using the Fischer exact test. Average overall provider ratings were compared using the Student's t -test. Results: A total of 87 patients filled out Press Ganey surveys for the 3 providers over the year: 54 for visits without scribes, and 33 for visits with scribes. Fischer exact analysis demonstrated no significant difference in satisfaction with providers and wait times for both individual providers and all providers combined (all P >.05). There was also no difference in patients' likelihood of recommending the provider's office (P =.91). Overall provider rating (0-10 scale) was high without scribes (9.48 ± 1.06) and was unchanged by the presence of scribes (9.53 ± 0.8) (P =.97). Conclusion: Patient satisfaction with wait times and providers was high overall and was not affected by the presence of a medical scribe. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine whether patients with rhinitis medicamentosa (RM) have an increased odds of having an opioid use disorder (OUD) and which characteristics may predict this association. Methods: The authors conducted a retrospective case control study of patients 18 years and older who presented to the otolaryngology clinic at an academic medical center from January 2013 through December 2017. Cases, defined as patients who presented with excessive decongestant nasal spray usage based on history, were matched to control patients who presented with chronic rhinitis and did not report regular nasal decongestant usage. The charts were reviewed for patients that carried a problem of opioid abuse, identified using ICD-9 codes 304.XX or ICD-10 codes F11.XX. The primary outcome of this study was the odds of having an OUD. Secondary outcomes were assessed by summary statistics. Results: One hundred and thirty-one cases of RM were matched to 1871 controls of chronic rhinitis. Seven cases (5.3%) and 24 (1.3%) controls had a diagnosis of OUD, consistent with an odds ratio of 3.98 for opioid abuse in patients with RM (95% CI: 1.47-9.71). Oxymetazoline was used by 85.5% (n = 112) of patients with RM. Thirty-six patients (27.1%) with RM underwent nasal surgery following a diagnosis of RM, of which twenty patients (55.6%) were prescribed opioids following the procedure. Conclusions: RM is associated with increased odds of having an OUD. [ABSTRACT FROM AUTHOR]

Background Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy, the decision to offer surgery in resistant cases is becoming more widely practiced. In the pediatric population, turbinate reduction can be achieved with turbinectomy, electrocautery, lasers, submucous microdebridement, and radiofrequency volumetric tissue reduction (RVTR). However, there remains a lack of consensus on the preferred approach to treatment. Objective To compare how the efficacy, duration, and complications of different surgical methods has changed the management of inferior turbinate hypertrophy in children over time. Methods In March 2018, a comprehensive literature search was performed in PubMed for all inferior turbinate hypertrophy management-related studies in children. Inclusion criteria included children (age, 1–17 years). Exclusion criteria included reviews and abstracts. Results Each technique has experienced a period of popularity over the last 30 years in parallel with the technology available at the time as well as evidence from studies in adults. The literature for ITH management in children has largely followed these trends, with a recent improvement in the quality of studies mirroring the overall increase in surgical practice. Of all methods currently used, RVTR and submucous microdebridement offer the least invasive and most efficacious relief of nasal obstruction. Conclusion This review provides an overview of the evolution of ITH management in children and, based on historic and current evidence, proposes the following graduated recommendation to treatment: (1) a 3-month trial of medical management, (2) evaluation for adenoid hypertrophy for consideration of concurrent adenoidectomy, and (3) RVTR or submucous microdebridement as the first-line surgical approach. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to determine if total serum immunoglobulin E (IgE) could predict monosensitization compared to polysensitization in patients with allergic rhinitis (AR). Methods This was a retrospective study of a cohort of 1073 patients who underwent allergy testing. Differences in total IgE level between unsensitized, monosensitized, and polysensitized subjects were calculated. Pearson correlation coefficient was calculated to determine whether there was a relationship between total IgE level and the number of positive allergen sensitizations. In addition, allergen sensitization class was calculated for each allergen sensitization and totaled for each patient. Pearson correlation coefficient was calculated to determine the relationship between total IgE level and weighted allergen sensitization by class. Results There were 159 patients who were monosensitized compared to 492 patients who were polysensitized. Of the monosensitized patients, almost 50% (74) were sensitized to one or both dust mites. Total IgE was higher in polysensitized patients compared to monosensitized compared to controls ( p < 0.001). Pearson correlation coefficient between total IgE and number of positive allergen sensitizations was 0.465 ( p ≤ 0.001). Pearson correlation coefficient between total IgE and allergen class-weighted sensitizations was 0.529 ( p ≤ 0.001). Conclusion IgE level can be used to predict monosensitization vs polysensitization. There is a moderate correlation between total IgE sensitization and the number of positive allergen sensitizations, as well as allergen class-weighted sensitizations. [ABSTRACT FROM AUTHOR]