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1.
Laryngoscope ; 134(5): 2444-2448, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-37983867

RESUMO

OBJECTIVE: Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures. METHODS: This is a cross-sectional study performed at a tertiary care academic center. Extracapsular or intracapsular tonsillectomy was performed in 60 patients using four techniques and in 10 additional patients using mitigation measures. Two nanoparticle counters were used to measure particulate concentrations: CPC™ and DiSCmini™. Tonsillectomy techniques included: (1) microdebrider (MD), (2) Bovie with manual suctioning by an assistant (B), (3) Bovie with built-in smoke evacuation system (BS), and (4) Coblator™ (CB). An additional Yankauer suction was used in the mitigation groups (BSY) and (CBY). Comparative analysis was performed using one-way ANOVA on ranks and pairwise comparisons between the groups. RESULTS: The mean concentrations (particles/cm3) and coefficient of variants for the DiSCmini particulate counter were MD: 5140 (1.6), B: 30700 (1.5), BS: 25001 (0.8), CB: 54814 (1.7), CBY: 2395 (1.3) and BSY: 11552 (1.0). Mean concentrations for the CPC particulate counter were MD: 1223 (1.4), B: 3405 (0.7), BS: 5002 (0.9), CB: 13273 (1.0), CBY: 1048 (1.2) and BSY: 3046 (0.6). The lowest mean concentrations were noted in cases using MD and the highest in cases using CB. However, after mitigation, CBY had the lowest overall levels. CONCLUSION: Tonsillectomy technique does impact the levels of nanoparticles emitted within the surgical plume, which may present an occupational hazard for operating room personnel. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2444-2448, 2024.


Assuntos
Tonsilectomia , Criança , Humanos , Tonsilectomia/métodos , Estudos Transversais , Adenoidectomia , Eletrocirurgia , Eletrocoagulação/métodos , Poeira
2.
Medicina (Kaunas) ; 60(1)2023 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-38256342

RESUMO

Background and Objectives: The use of non-invasive ventilation (NIV) for community-acquired pneumonia (CAP) remains controversial. NIV failure in the setting of acute hypoxemic respiratory failure is associated with increased mortality, highlighting the need for careful patient selection. Methods and Methods: This is a retrospective observational cohort study. We included 140 patients with severe CAP, treated with either NIV or invasive mechanical ventilation (IMV) as their primary oxygenation strategy. Results: The median PaO2/FiO2 ratio and SOFA score upon ICU admission were 151 mmHg and 6, respectively. We managed 76% of patients with NIV initially and report an NIV success rate of 59%. Overall, the 28-day mortality was 25%, whilst for patients with NIV success, the mortality was significantly lower at 13%. In the univariate analysis, NIV failure was associated with the SOFA score (OR 1.33), the HACOR score (OR 1.14) and the presence of septic shock (OR 3.99). The SOFA score has an AUC of 0.75 for NIV failure upon ICU admission, whilst HACOR has an AUC of 0.76 after 2 h of NIV. Conclusions: Our results suggest that a SOFA ≤ 4 and an HACOR ≤ 5 are reasonable thresholds to identify patients with severe CAP likely to benefit from NIV.


Assuntos
Ventilação não Invasiva , Pneumonia , Humanos , Respiração Artificial , Estudos de Coortes , Pneumonia/complicações , Pneumonia/terapia , Unidades de Terapia Intensiva
3.
Chromosoma ; 131(3): 175-191, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35916925

RESUMO

Aneuploidy is a pervasive feature of cancer cells that results from chromosome missegregation. Several transcription factors have been associated with aneuploidy; however, no studies to date have demonstrated that mammalian transcription factors directly regulate chromosome segregation during mitosis. Here, we demonstrate that the ubiquitously expressed transcription factor specificity protein 1 (Sp1), which we have previously linked to aneuploidy, has a mitosis-specific role regulating chromosome segregation. We find that Sp1 localizes to mitotic centromeres and auxin-induced rapid Sp1 degradation at mitotic onset results in chromosome segregation errors and aberrant mitotic progression. Furthermore, rapid Sp1 degradation results in anomalous mitotic chromosome assembly characterized by loss of condensin complex I localization to mitotic chromosomes and chromosome condensation defects. Consistent with these defects, Sp1 degradation results in reduced chromosome passenger complex activity and histone H3 serine 10 phosphorylation during mitosis, which is essential for condensin complex I recruitment and chromosome condensation. Together, these data provide the first evidence of a mammalian transcription factor acting specifically during mitosis to regulate chromosome segregation.


Assuntos
Segregação de Cromossomos , Mitose , Fator de Transcrição Sp1 , Aneuploidia , Animais , Centrômero , Humanos , Mamíferos/genética , Fator de Transcrição Sp1/genética , Fatores de Transcrição/genética
4.
Oxf Med Case Reports ; 2018(9): omy058, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30159152

RESUMO

Abnormal liver function tests are often seen in patients with inflammatory arthritis. These are commonly associated with disease-modifying anti-rheumatic drugs, however, clinicians must hold a high index of suspicion for less common causes. This article details two of such cases where hereditary haemochromatosis and acute hepatitis E infection were actually responsible for deranged serum liver enzymes. Correct identification of these conditions leads to disease specific management and improved patient outcomes.

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