Σάββατο 22 Δεκεμβρίου 2018
Efficacy and safety of switching to ixekizumab in secukinumab nonresponder psoriatic patients: results from a multicenter experience
Abstract
Loss of efficacy of biological therapies in psoriatic patients is a well‐known event. Biological switching is common in clinical practice, especially in TNF‐α and IL‐12/23 inhibitors treatment1,2. Recently, anti‐IL‐17A drugs such as secukinumab have provided a new therapeutic opportunity
This article is protected by copyright. All rights reserved.
http://bit.ly/2EJXtqr
Isotretinoin′s paradoxical effects in immortalized sebocytes
Abstract
in their recently published Research Letter, Burney et al.1 reported that the short‐term exposure of cultured SEB‐1 immortalized sebocytes to isotretinoin (13‐cis retinoic acid), the most powerful sebum‐suppressive drug promoting sebocyte apoptosis in acne patients, paradoxically increased lipogenesis and upregulated the expression of sterol regulatory element‐binding protein 1 (SREBP1)
This article is protected by copyright. All rights reserved.
http://bit.ly/2EIDp7j
Masson’s tumor of the kidney: a case report
Intravascular papillary endothelial hyperplasia (known also as Masson's tumor) is a benign vascular lesion that commonly occurs in the skin and is rarely found in solid organs, especially in the kidney. In wha...
http://bit.ly/2A97PMz
Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports
Epidural analgesia has become a common procedure to provide excellent pain relief with few complications. Pneumorrhachis and pneumocephalus are rare complications of unintentional dural puncture and injection ...
http://bit.ly/2Sgjgtb
Pleuropulmonary tuberculosis with spinal lesions due to metastatic malignancy differentiated definitively on imaging
A healthy 31-year-old man presenting with back pain was found to have multiple spinal enhancing lesions on MRI. An incidental asymptomatic large pleural effusion was identified on investigations for the back pain and pleural and pulmonary tuberculosis (TB) was subsequently diagnosed. The radiographical features on MRI spine were not typical of spinal TB and a Ga68 DOTATATE Positron Emission Tomography (PET)/CT confirmed metastatic paraganglioma with multiple bone metastases. Although metastatic paraganglioma is rare, this case highlights that even in young patients dual pathology needs to be considered. Most importantly, it is a reminder to physicians managing TB of the clues that help distinguish spinal TB from important alternative causes, including metastatic malignancy.
http://bit.ly/2EJacK5
Chlamydia ascites: a call for sexually transmitted infection testing
A 26-year-old gravida 2, para 2-0-0-2 woman with a recent uncomplicated vaginal delivery 10 weeks prior presented to our hospital with 5 weeks of abdominal swelling and discomfort. Four weeks after delivery, the patient began having right upper quadrant pain and was found to have cholelithiasis. She underwent an elective laparoscopic cholecystectomy 6 weeks prior to admission, but started to develop worsening abdominal swelling 1 week postoperatively. Abdominal distension and shifting dullness were present on examination. CT of the abdomen and pelvis was remarkable for moderate-volume ascites and mild enhancement of the pelvic peritoneum. Paracentesis removed 2.46 L of ascites fluid with 76% lymphocytic predominance. Results for Chlamydia trachomatis were positive in urine, cervical swab and ascitic fluid. Doxycycline was prescribed for a diagnosis of pelvic inflammatory disease exudative ascites. Since discharge, she has completed her antibiotic course and reports resolution of all symptoms without recurrence of ascites.
http://bit.ly/2ECyDbj
Removing the problem: parathyroidectomy for calciphylaxis
Calcific uremic arteriolopathy (CUA), widely known as calciphylaxis, is a rare and lethal disease that usually affects patients with end-stage renal disease. It is characterised by widespread vascular calcification leading to tissue ischaemia and necrosis and formation of characteristic skin lesions with black eschar. Treatment options include sodium thiosulfate, cinacalcet, phosphate binders and in resistant cases, parathyroidectomy. We report a case of recurrent, treatment-resistant CUA successfully treated with parathyroidectomy. Her postoperative course was complicated by hungry bone syndrome and worsening of her wounds before they completely healed. We then discuss the morbidity of CUA, including the controversy around the use of parathyroidectomy and risk of aggressive management of hungry bone syndrome.
http://bit.ly/2EMkycn
PIBIDS syndrome in two Brazilian siblings
Trichothiodystrophy is a rare condition associated with autosomal recessive or X-linked dominant variants in the ERCC2, ERCC3, GTF2H5, MPLKIP, RNF113A or GTF2E2 genes. The genes associated to photosensitive trichothiodystrophy encode subunits of transcription factor IIH, involved in the nucleotide excision repair pathway. The disease is characterised by cysteine-deficient brittle hair along with other neuroectodermal abnormalities. It has a variable clinical expression and some cases might be associated with photosensitivity, resulting in the acronym PIBIDS (photosensitivity, ichthyosis, brittle hair, intellectual impairment, decreased fertility and short stature). We report clinical findings of two siblings diagnosed with trichothiodystrophy associated with marked photosensitivity.
http://bit.ly/2EFE21q
Early presentation of vertebral osteomyelitis following a transrectal ultrasound-guided prostate biopsy with delayed radiological findings
A transrectal ultrasound-guided (TRUS) prostate biopsy is a common diagnostic procedure which carries an expected risk of iatrogenic infections. These range from simple urinary tract infections to rare but serious infections requiring an admission to hospital. Here we present a rare case of vertebral osteomyelitis following a TRUS biopsy, with normal initial MRI and bone scintigraphy scans and delayed radiological findings on repeat MRI of the spine.
http://bit.ly/2EDNwdm
Multiple melanoma in a burns scar
It is well known that up to 2% of chronic burn scar lesions can transform into malignant tumours, however, melanoma formation at these sites is extremely rare. This case report describes a burns case, which progressed to four melanomas in a 78-year-old male patient's little finger, 40 years after the initial incident. The patient underwent 3 mm punch biopsies, then digital amputation of the finger with pathology-proven melanoma. Histopathology investigation demonstrated three melanoma in situ and one invasive melanoma with a Breslow thickness of 1 mm. These findings are rare with few reports of melanoma in burn scars in the literature. This case report highlights the vigilance required from clinicians when performing skin examinations, and the importance of biopsies to newly pigmented lesions.
http://bit.ly/2ECmCmi
Bishop-Koop jejunostomy in an adult following proximal small bowel anastomotic breakdown
This case involves a proximal penetrating small bowel injury and the use of a Bishop-Koop anastomosis in a 33-year-old man. This case highlights the use of alternative methods used to prevent a proximal small bowel stoma in a rural setting. The Bishop-Koop anastomosis was originally designed for neonates in cases of intestinal anomalies such as atresia, volvulus and apple-peel syndrome. A literature search for the use of the Bishop-Koop anastomosis in adults, although scanty, is included in this article. We believe this article will benefit readers and that this method may be considered in breakdown of proximal small bowel injuries, to prevent a high-output stoma.
http://bit.ly/2EIcbOJ
Pars plana vitrectomy in management of giant retinal tear and retinal detachment following iris-fixated anterior chamber phakic intraocular lens implantation
This case report describes a 26-year-old man presenting with a giant retinal tear (GRT) with retinal detachment (RD) following implantation of iris-fixated anterior chamber phakic intraocular lens (AC-PIOL) for high myopia and occurrence of intraoperative aberrations during vitrectomy due to the presence of AC-PIOL in situ. Posterior chamber PIOL have been well reported to be associated with GRT with RD. Very few reports exist of GRT with RD following AC-PIOL. Moreover, the presence of iris-fixated AC-PIOL, in this case, led to the formation of ghost images intraoperatively especially during crucial steps like induction of posterior vitreous detachment which has never been reported.
http://bit.ly/2EJDE2v
IgA nephropathy with diffuse alveolar haemorrhage
Immunoglobulin (Ig)A nephropathy is the most common cause of primary glomerulonephritis worldwide. While IgA nephropathy has been associated with a variety of other diseases, pulmonary complications are extremely rare. A 58-year-old man presented with a 2-week history of fever and exertional dyspnoea. A chest imaging revealed bilateral consolidation predominantly in upper lungs. Laboratory findings showed elevated serum creatinine with proteinuria and haematuria. Flexible bronchoscopy revealed diffuse alveolar haemorrhage, and IgA nephropathy was confirmed on a renal biopsy. He received prednisone with good effect. This case highlights the need to consider IgA nephropathy in the differential diagnosis of pulmonary renal syndrome.
http://bit.ly/2EF3JPp
Unusual presentation of eosinophilic fasciitis (EF) with a raised ALT
Eosinophilic fasciitis (EF) is a syndrome of unknown aetiology characterised by progressive collagenous thickening of the subcutaneous fascia. Limb oedema can precede the skin thickening and induration classically associated with EF. We describe a case of EF in a 31-year-old woman who presented to her general practitioner with lower limb oedema and stiffness. Blood tests in primary care showed a persistently raised alanine transferase (ALT). No hepatic cause for her raised ALT was found despite investigation. The unusual manner of her presentation led to delay in her referral to the autoimmune connective tissue disease (CTD) clinic. This case illustrates the importance of considering autoimmune CTD such as EF in young patients presenting with limb oedema and raised ALT, as early treatment influences prognosis and functional recovery.
http://bit.ly/2EJDyrF
Acute on chronic anaemia with a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%
Anaemia can present with symptoms of fatigue, shortness of breath, weakness, malaise, tachycardia and skin pallor. If left untreated, this can progress to life-threatening complications such as arrhythmias, cardiac hypertrophy and myocardial infarction. In this report, a 43-year-old woman, who was ambulatory with no exertional dysponea, presented with weakness, fatigue, bilateral lower extremity oedema and intermittent right sided chest pain for several months. This patient was subsequently found to have a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%. She was admitted to the hospital and treated with seven units of blood. CT scan showed a 9.6 cm uterine fibroid in addition to a 5.9x5.4 cm mass near the right kidney, which was later diagnosed as metastatic carcinoid tumour. This case deserves attention due to the importance of looking for multiple causes of blood loss and the effects of low haemoglobin levels.
http://bit.ly/2EKkpWv
M-CSF and IL-34 expression as indicators for growth in sporadic vestibular schwannoma
Abstract
Macrophage colony stimulating factor and IL-34 are associated with clinical vestibular schwannoma progression. Investigating the biology behind vestibular schwannoma progression helps understanding tumor growth. Inflammation is important in the microenvironment of neoplasms. Macrophages are major players in the intratumoral infiltrate. These tumor-associated macrophages are known to stimulate angiogenesis and cell growth. M-CSF and IL-34 are cytokines that can regulate tumor-infiltrating macrophages. They are expressed by tumors and form potential targets for therapy. The goal of this study was to investigate these cytokines in vestibular schwannomas and to see if their expression is related to angiogenesis, macrophage numbers, cystic degeneration, and volumetric tumor progression. Immunohistochemical expression of M-CSF and IL-34 was analyzed in ten fast-growing vestibular schwannomas and in ten slow-growing vestibular schwannomas. Expression M-CSF and IL-34 were compared between fast- versus slow-growing and cystic versus non-cystic tumors. Data on macrophage numbers and microvessel density, known from earlier research, was also included. All tumors expressed M-CSF and its expression was higher in fast-growing tumors (p = 0.003) and in cystic tumors (p = 0.035). CD163 expression was higher in tumors with strong M-CSF expression (p = 0.003). All tumors expressed IL-34 as well, but no significant differences were found in relation to clinicopathological characteristics. This study demonstrated the expression of M-CSF and IL-34 in vestibular schwannomas. The results suggest that M-CSF is related to macrophage activity and tumor progression, making it a potential target for therapy. If a similar assumption can be made for IL-34 remains unclear.
http://bit.ly/2BAWRzn
Thomas Muehlberger. Migraine surgery: a clinical guide to theory and practice. Springer
Publication date: Available online 21 December 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): Kaveh Shakib
http://bit.ly/2A8NqHt
Short- and long-term mortality and causes of death after reconstruction of cancers of the head and neck with free flaps
Publication date: Available online 21 December 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): S. Lahtinen, P. Koivunen, T. Ala-Kokko, O. Kaarela, P. Ohtonen, P. Laurila, J.H. Liisanantti
Abstract
The use of free flaps to reconstruct cancers of the head and neck is accompanied by appreciable postoperative morbidity and high long-term mortality, but the causes of death and the impact of postoperative complications on survival have not been well studied. We have therefore analysed retrospectively the causes of death and survival of 146 such patients operated on between 2008 and 2016 of whom a total of 62 (43%) had died by the end of 2016. The cause of death was the primary disease in 45 of the 62. The median survival of those who died with the primary cancer as the cause of death did not differ from that of those who died of other causes. In a multivariate Cox model indicators of five-year mortality were male sex, low body mass index (BMI), American Society of Anesthesiologists (ASA) grade more than II, and late medical complications. Neither the size of the tumour nor any operative factors were independent risks for five-year mortality. Ten patients died within six months of operation, all of whom had higher postoperative C-reactive protein concentrations than those who survived for more than six months. The cause of death of most patients who died after free flap operations for head and neck cancer was the primary diagnosis. According to these results, patient-related factors (male sex, ASA grade more than II, low BMI, and low albumin concentration) have an important role in long-term survival, which highlights the importance of careful selection of patients for operative treatment.
http://bit.ly/2Sh07Hk
Abstract withdrawn 12 June 2018
Publication date: December 2018
Source: British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 10
Author(s):
http://bit.ly/2AbifeO
Clear Aligner Orthognathic Splints
Publication date: Available online 22 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Marco Caminiti, Tiangtong Lou
Abstract
Orthodontic treatment has been transformed by the introduction and overwhelming adoption of Clear Aligner Therapy (CAT). Many patients are now demanding esthetic and metal-free treatment alternatives, including those requiring orthognathic surgery (OGS) to correct their dentofacial deformities. The adoption of performing OGS for CAT has been cautious and challenging for many reasons. Maxillomandibular fixation, postoperative occlusal control, preoperative decompensation management and long-term stability all need to be tested and assessed. We present an accurate 3D printed hard acrylic splint, specifically for patients without any orthodontic attachment to be used in the positioning and fixation of osteotomized jaws. It is simple to manufacture and its use intraoperatively is efficient, easy and accurate. This paper introduces the Clear Aligner Orthognathic Splint (CAOS) for surgery and the steps required for 3D planning with recommendations for perioperative orthodontic support.
http://bit.ly/2T8ii2b
The Rate of Submandibular Gland Involvement in Oral Squamous Cell Carcinoma
Publication date: Available online 22 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Shuang Yang, Xiao Wang, Jia-Zeng Su, Guang-Yan Yu
Abstract
Purpose
Whether the submandibular gland (SMG) can be preserved during neck dissection in surgical treatment of oral squamous cell carcinoma (OSCC) is controversial. Here, we investigate the SMG involvement rate and provide a basis for preserving the submandibular gland during neck dissection in appropriate cases of OSCC.
Methods
A comprehensive systematic review was conducted on the PubMed/MEDLINE, Embase, and Cochrane Library databases for studies on SMG involvement in OSCC published prior to December 2017 with data analysis technique. The predictor variables were the number of subjects and resected SMG, primary site and tumor-node-metastasis (TNM) stage. The outcome variables were the number of involved SMGs and the mode of involvement. Other variables, i.e., first author, publication year, mean age, the condition of neck lymph nodes at level Ib, were also extracted. A random effect model was used to analyze the rate of SMG involvement in OSCC.
Results
Twelve studies involving a total of 2126 patients with oral squamous cell carcinoma who underwent neck dissection were included in the study. Fifty-two SMGs were involved, and the pooled involvement rate was 2% (I2 = 73%, 95% confidence interval [CI]: 1–3%). Forty-eight SMGs were involved via direct spread from the primary site and/or extracapsular spread of positive lymph nodes, and the pooled involvement rate was 1.9% (I2 = 72%, 95% CI: 0.9–3.1%). Except for direct spread, four SMGs were involved via intraglandular lymph node or carcinoma growing along Wharton ducts, and the pooled involvement rate was only 0.1% (I2 = 0%, 95% CI: 0–0.2%).
Conclusions
The rate of SMG involvement in OSCC is very low, and the most common mode of involvement is by direct spread. The SMG might be preserved during neck dissection in OSCC when it is unlikely be involved through direct spread.
http://bit.ly/2CvuGnr
Comparison of CT, MRI, and PET/CT for the evaluation bone invasion in upper and lower gingival cancers
Publication date: Available online 22 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Young Chan Lee, Ah Ra Jung, Oh Eun Kwon, Eui-Jong Kim, Il Ki Hong, Jung-Woo Lee, Young-Gyu Eun
Abstract
Purpose
Preoperative detection of bone invasion is important in cases of gingival cancer. The aim of this study was to compare the diagnostic value of three imaging methods for the detection of bone invasion in upper and lower gingival cancer: computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT.
Material and methods
This retrospective cohort study enrolled patients who had undergone a maxillectomy or mandibulectomy for gingival cancer. Each preoperative image (CT, MRI, or PET/CT) was reviewed for the presence of bone invasion, and the possibility for bone invasion was graded. These results were verified with pathology reports. Sensitivity, specificity, positive predictive value, and negative predictive value for the detection of mandibular involvement in alveolar bone were calculated, and a receiver operating characteristic (ROC) curve analysis was performed.
Results
Forty patients (27 men and 13 women) were enrolled. Pathologic examination revealed bone invasion in 25 of the 40 patients. Among them, 13 patients had maxillary and 12 had mandibular alveolus involvement. The diagnostic accuracy of CT (90.0%) was highest among the three modalities for the detection of bone invasion. In the ROC curve analysis, the area-under-the-curve values in upper gingival cancer were lower than those for lower gingival cancer.
Conclusion
The three imaging methods were less sensitive for the detection of bone invasion in upper gingival cancer than in lower gingival cancer. Cases of upper gingival cancer should be evaluated more carefully for bone invasion before surgery.
http://bit.ly/2Ctd0IR
Surface conditioning with cold argon plasma and its effect on the osseointegration of dental implants in miniature pigs
Publication date: Available online 22 December 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Hendrik Naujokat, Sönke Harder, Lara Yasemin Schulz, Jörg Wiltfang, Christian Flörke, Yahya Açil
Summary
Purpose
Successful implant therapy is based on fast, safe, and predictable osseointegration. Several surface modifications have been introduced to improve the bone-to-implant interaction. This in vivo study evaluates the impact of plasma surface conditioning on early wound healing and osseointegration.
Materials and Methods
A total of 16 dental implants with a sand-blasted and acid-etched surface were conditioned with cold atmospheric plasma prior to insertion in the frontal bone of four miniature pigs. Sequential fluorescence labeling was administered to label bone metabolism, and after 8 weeks, bone blocks were harvested for radiological, histological, and histomorphometrical evaluation.
Results
The plasma conditioning had no impact on the morphology of the implant surface. The bone-to-implant contact ratio was 90.4% and 86.5%, the interthread bone density 72.5% and 63.4%, and the periimplant bone density 60.5% and 61.1%, in the plasma conditioned group and control group, respectively. Concentric bands of fluorescence enrichment indicated a chronological and homogenous mineralization of newly formed bone. No unwanted periimplant side effects were detected.
Conclusion
The increased parameters for osseointegration in this in vivo study merit further investigation in prospective clinical trials.
http://bit.ly/2QKGmLz
Investigating the role of octamer binding transcription Factor-4 (Oct-4) in oral cavity squamous cell carcinoma: A systematic review and meta-analysis
Publication date: Available online 21 December 2018
Source: American Journal of Otolaryngology
Author(s): Vasiliki Gliagias, Michael Wotman, Saori Wendy Herman, Peter Costantino, Dennis Kraus, Tristan Tham
http://bit.ly/2SlQDLf
Radiotherapy for parapharyngeal space tumors
Publication date: Available online 21 December 2018
Source: American Journal of Otolaryngology
Author(s): William M. Mendenhall, Primoz Strojan, Jonathan J. Beitler, Johannes A. Langendijk, Carlos Suarez, Anne W. Lee, Alessandra Rinaldo, Juan P. Rodrigo, Robert Smee, Avraham Eisbruch, Louis B. Harrison, June Corry, Alfio Ferlito
Abstract
A wide variety of tumors, both benign and malignant, occur in the parapharyngeal space. Depending on histology and extent, treatment may include surgery and/or radiotherapy (RT). Herein we discuss the role of RT in the management of some of the more commonly encountered neoplasms, including salivary gland tumors, paragangliomas, schwannomas, and soft-tissue sarcomas.
http://bit.ly/2Aex6Fh
Free thyroid transfer to anterolateral thigh for prevention of radiation induced hypothyroidism: An initial experience
Publication date: Available online 21 December 2018
Source: American Journal of Otolaryngology
Author(s): Rakesh Katna, Nikhil Kalyani, Akshay Deshpande, Mumbai Oncology Group – Head and Neck
Abstract
Aim
Radiation induced hypothyroidism (RIHT) is one of the commonest late side effects of radiation therapy and is seen in more than half of patients and affects quality of life significantly. We report our initial experience on feasibility of free microvascular transfer of thyroid gland out of radiation field to prevent development of RIHT.
Material and methods
A prospective pilot study was undertaken during August 2017 to May 2018. Six Patients with stage III/IV patients of oral cavity cancers who required wide excision/composite resections with microvascular free flap (ALT) reconstruction and adjuvant radiation therapy were enrolled. A written informed consent was obtained from all patients prior to the procedure.
Results
The mean age of cohort was 51 years with tongue most common site of primary cancer. The free transfer of thyroid gland to anterolateral thigh was done using microvascular technique. The mean additional time for procedure was 51 min. All patients had successful transfer with no associated immediate complications. Patients were followed up with Tc99 scan, USG Doppler and biochemical assay at routine intervals in peri and postoperative period to assess the anatomical and physiological function of the transferred gland. At median follow up of 8 months, 5 patients were euthyroid and remaining one had biochemical hypothyroidism. All patients had functional thyroid gland in anetrolateral thigh. Five patient were alive, one patient died due to disease.
Conclusion
This is a small and early feasibility study for free thyroid gland transfer and validates the previously published data. The selected group of patients who have high chances of developing RIHT may benefit from this strategy. Further validation of the technique may be explored in a larger cohort.
http://bit.ly/2Aex2W3
Blood eosinophils may predict radiographic sinus opacification in patients with chronic rhinitis
Background
The association between chronic rhinosinusitis (CRS) and chronic rhinitis remains unclear. The aim of this study was to estimate the predictive factors for sinus opacification in chronic rhinitis patients without obvious CRS.
Methods
We retrospectively studied a total of 332 adult patients with chronic rhinitis who visited our clinic from January 2015 to December 2017. All of the patients underwent endoscopic examination, allergy test, and osteomeatal‐unit computed tomography. The subjects were assigned to the normal sinus (NS) group (Lund‐Mackay score [LMS] <5) and sinus opacification (SO) group (LMS ≥5).
Results
A total of 288 patients were eligible for this study. Of them, 183 (63.5%) were classified in the NS group and 105 (36.5%) in the SO group. Total immunoglobulin E (IgE) level and peripheral blood eosinophil count were significantly higher in the SO than NS group (p = 0.031 and p < 0.0001, respectively). Using Pearson correlation coefficients, we determined that eosinophil count had a positive correlation with the LMS (r = 0.282). In logistic analysis, the interquartile range increase (0.19 × 109/L) of the eosinophil count was significantly associated with SO (odds ratio [OR] 1.76; 95% confidence interval [CI], 1.30 to 2.39). After adjusting for age, gender, smoking, drinking, and underlying disease, the interquartile range increase of the eosinophil count increased the odds of SO to 1.69‐fold; this increase was statistically significant (p = 0.007; 95% CI, 1.17 to 2.43).
Conclusion
Peripheral blood eosinophil count is an independent predictor of CRS in patients with chronic rhinitis.
http://bit.ly/2EHRKl7
Analysis of anterior and posterior maneuvers to enhance intraconal exposure
Background
The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA).
Methods
Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and after each maneuver.
Results
Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal‐rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. After EOM control, mean caudal‐rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral‐caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal‐rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001).
Conclusion
Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required.
http://bit.ly/2EFghqg
Tonsillectomy using the BiZact: A pilot study in 186 children and adults
Abstract
1.The BiZact tonsillectomy device, produced by Medtronic (Minneapolis, MN, USA), was approved for market use in Australia by the Therapeutics Good Administration (TGA) in 2016 and is a new device for tonsillectomy
2.Results from this pilot study of 186 patients demonstrate a post‐operative hemorrhage rate of 4.3% similar to rates described by other studies.
3.BiZact tonsillectomy allows for a shortened operative time in the hands of both experienced and training surgeons with a median time of 5.1 minutes (range 1.5 – 26.5 minutes).
4.BiZact tonsillectomy is associated with reduced intraoperative blood loss with less than 1mL of blood loss observed in 71 (38.2%) cases and between 1‐10mL loss observed in 81 (43.5%) cases in this report.
5.This study demonstrates safety and feasibility of this device as a pilot study towards undertaking a prospective randomized trial comparing it to other tonsillectomy techniques.
This article is protected by copyright. All rights reserved.
http://bit.ly/2rZkf5z
Pathogen reservoir hypothesis investigated by analyses of the adenotonsillar and middle ear microbiota
Publication date: Available online 21 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): James Johnston, Michael Hoggard, Kristi Biswas, Carmen Astudillo‐García, Fiona J. Radcliff, Murali Mahadevan, Richard G. Douglas
Abstract
Introduction
Adenotonsillar and middle ear diseases result in some of the most frequently performed operations in the pediatric population worldwide. The pathogen reservoir hypothesis (PRH) suggests that the adenoids act as a reservoir of bacteria which play a potential pathogenic role in otitis media. Evidence supporting this hypothesis is limited. This study sought to comprehensively determine and compare associations between the adenotonsillar and middle ear bacterial microbiota within individual patients via next-generation sequencing and microbial network analyses.
Methods
Bacterial 16S rRNA gene-targeted amplicon sequencing was used to determine the bacterial composition of ten pediatric patients undergoing adenotonsillectomy and ventilation tube insertion for otitis media with effusion. At the time of surgery, swabs were taken from the adenoid surface, tonsil crypts and middle ear clefts (through the myringotomy incision).
Results
The most abundant sequences within the bacterial community at genus level across all anatomical sites were Fusobacterium, Haemophilus, Neisseria, and Porphyromonas. There was an observable difference in the relative abundance of bacterial communities, with a higher proportion of Haemophilus and Moraxella in the adenoid when compared with the middle ear. Furthermore, only one module (consisting of 4 bacterial OTUs) from one patient was identified through microbial network analyses to be significantly associated between middle ear and adenoid. In addition, microbial network analysis revealed that the adenoid and tonsil microbiota share greater similarity than do the adenoid and middle ear.
Conclusion
The results of this study suggest that the adenoid microenvironment does not correlate to the middle ear microenvironment. A future study at the species level, and over time, is required to further investigate whether the differing relationship between the microbiota of the adenoid and middle ear rejects the pathogen reservoir hypothesis.
http://bit.ly/2rOsfGn
Transcriptomic and lipidomic profiling of eicosanoid / docosanoid signalling in affected and non‐affected skin of human atopic dermatitis patients
Abstract
Lipoxygenases (LOX) and cycloxygenase (COX) are the main enzymes for PUFA‐metabolism to highly bio‐active prostaglandins, leukotrienes, thromboxanes, lipoxines, resolvins and protectins. LOX and COX pathways are important for the regulation of pro‐inflammatory or pro‐resolving metabolite synthesis and metabolism for various inflammatory diseases such as atopic dermatitis (AD). In this study we determined PUFAs and PUFA‐metabolites in serum as well as affected and non‐affected skin samples from AD‐patients and the dermal expression of various enzymes, binding proteins and receptors involved in these LOX and COX pathways. Decreased EPA and DHA levels in serum and reduced EPA level in affected and non‐affected skin were found; in addition n3/n6‐PUFA ratios were lower in affected and non‐affected skin and serum. Mono‐hydroxylated PUFA‐metabolites of AA, EPA, DHA and the sum of AA, EPA and DHA metabolites were increased in affected and non‐affected skin. COX1 and ALOX12B expression, COX and 12/15‐LOX metabolites as well as various lipids, which are known to induce itch (12‐HETE, LTB4, TXB2, PGE2 and PGF2) and the ratio of pro‐inflammatory vs pro‐resolving lipid mediators in non‐affected and affected skin as well as in the serum of AD patients were increased, while n3/n6‐PUFAs and metabolite ratios were lower in non‐affected and affected AD‐skin. Expression of COX1 and COX‐metabolites were even higher in non‐affected AD‐skin. To conclude, 12/15‐LOX and COX pathways were mainly upregulated, while n3/n6‐PUFA and metabolite ratios were lower in AD‐patients skin. All these parameters are a hallmark of a pro‐inflammatory and non‐resolving environment in affected and partly in non‐affected skin of AD‐patients.
This article is protected by copyright. All rights reserved.
http://bit.ly/2Ab8vB4
Predictors of cisplatin-induced ototoxicity and survival in chemoradiation treated head and neck cancer patients
Publication date: February 2019
Source: Oral Oncology, Volume 89
Author(s): Wendy A. Teft, Eric Winquist, Anthony C. Nichols, Sara Kuruvilla, Suzanne Richter, Christina Parker, Peggy Francis, Maureen Trinnear, Jelena Lukovic, Nedal Bukhari, Yun-Hee Choi, Stephen Welch, David A. Palma, John Yoo, Richard B. Kim
Abstract
Objectives
Cisplatin-induced ototoxicity is a common permanent consequence of curative chemoradiation for locally advanced head and neck squamous cell carcinoma (HNSCC). Predictors of ototoxicity in HNSCC were examined.
Materials and methods
In this prospective, observational cohort study, 206 adult HNSCC patients underwent audiometric testing at baseline, during and after treatment with cisplatin-based chemoradiation. Ototoxicity was defined as ≥grade 2 audiometric change from baseline (CTCAE v4.02). Relationships between clinical and pharmacogenetic (TPMT, COMT, ACYP2, CTR1, OCT2, MATE1, ABCC2, ABCC3, and ABCG2) covariates and ototoxicity, progression-free (PFS) and overall survival (OS) were assessed by Cox regression.
Results
Weekly cisplatin resulted in lower ototoxicity risk while PFS and OS were similar compared to high dose cisplatin (P = 0.00035; HR = 0.18; 95% CI, 0.07–0.46). COMT (rs9332377) carriers had higher ototoxicity risk (P = 0.00556; HR = 1.72; 95% CI, 1.17–2.52) while MATE1 (rs2289669) A/A carriers were protected from ototoxicity (P = 0.01062; HR = 0.46; 95% CI, 0.26–0.84). Absence of the protective MATE1 allele among those who carry the risk allele in COMT predicted increased ototoxicity risk, (P = 0.00414; HR = 3.22; 95% CI, 1.45–7.17 and P = 0.00022; HR = 4.89; 95% CI, 2.11–11.36). Survival outcomes did not differ between carriers of protective or risk alleles.
Conclusions
Weekly cisplatin dosing, COMT and MATE1 are predictors of ototoxicity without affecting treatment efficacy. COMT and MATE1 genotyping and weekly dosing may be a potential strategy for mitigating cisplatin-induced ototoxicity in HNSCC.
http://bit.ly/2PWMTNZ
Five-year outcomes of sparing level IB in node-positive, human papillomavirus–associated oropharyngeal carcinoma: A safety and efficacy analysis
Publication date: February 2019
Source: Oral Oncology, Volume 89
Author(s): R.B. Ross, A. Juloori, V. Varra, M.C. Ward, S. Campbell, N.M. Woody, E. Murray, P. Xia, J.F. Greskovich, S.A. Koyfman, N.P. Joshi
Abstract
Introduction
The conformality of modern intensity modulated radiation therapy (IMRT) allows avoidance of the submandibular glands (SMG) in select patients, potentially improving late xerostomia. This study explores the safety and efficacy of this approach in select oropharyngeal carcinoma (OPC) patients.
Methods
Patients with T1-2N+ human papillomavirus (HPV)-associated OPC treated with definitive IMRT at one institution from 2009 to 2014 were identified. Patients were divided into 3 groups: bilateral level IB targeted (A, n = 16), a single level IB targeted (B, n = 61), and bilateral IB spared (C, n = 9). Outcomes were reviewed to identify the rate of level IB regional recurrence. Odds ratios were calculated for xerostomia between groups.
Results
Level Ib was targeted in 93 instances (54.1%) and avoided in 79 instances (45.9%). Mean SMG doses were significantly lower when level IB was spared compared to when targeted (37.5 Gy vs 67.5 Gy; P < 0.0001). Median doses to oral cavity decreased with increasing level Ib sparing (40.7 Gy [A] vs 35.4 Gy [B] vs 30.7 [C]; P = 0.002). The rate of late grade ≥2 xerostomia was significantly lower in patients with bilateral 1b sparing (53% in A vs 0% in C; P = 0.007). Sparing 1b unilaterally resulted in a non-significant decrease in late grade ≥2 xerostomia (P = 0.181). No regional failures were identified in levels IB (median follow up = 59.3 months).
Conclusion
Sparing level IB is safe in T1-2N+ HPV+ OPC. Avoiding level Ib translates into significantly lower SMG and oral cavity doses. Larger studies are needed to validate these findings and the impact of this technique.
http://bit.ly/2V4bgx5
Basophil activation testing in occupational respiratory allergy to low molecular weight compounds
Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use. Correspondence to Johanna Feary, Department of Occupational Lung Disease, Royal Brompton Hospital, London SW3 6LR. Tel: +44 20 7594 7968; e-mail: j.feary@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2T2XAR9
http://bit.ly/2T2XAR9
Systemic comorbidities associated with rosacea: a multicentric retrospective observational study
Abstract
Background
Once considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities.
Methods
This retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician‐administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities.
Results
The study included 1,195 rosacea patients and 621 controls without rosacea aged 18–85 years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity‐ and duration‐dependent manner.
Conclusion
Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.
http://bit.ly/2AbdKkx
Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis
Abstract
Background
This systematic review and meta‐analysis aims to evaluate the effectiveness of palatine tonsillectomy in patients with cervical metastasis from squamous cell carcinoma of unknown primary (SCCUP) origin.
Methods
A systematic review including studies that encompassed palatine tonsillectomy in the SSCUP diagnostic evaluation was conducted. A single arm meta‐analysis was then made to obtain the overall identification rate of tonsillectomy.
Results
Fourteen studies were included, comprising 673 patients who underwent 416 palatine tonsillectomies, 338 preformed during examination under anesthesia (EUA) and 78 managed with transoral robotic surgery (TORS). A total of 140 occult tonsillar malignancies were identified; of these, 124 (89%) were ipsilateral, 2 (1%) contralateral, and 14 (10%) synchronous bilateral. Meta‐analysis of 11 studies showed an overall detection rate of tonsillectomy of 0.34 (99% confidence interval 0.23‐0.46).
Conclusion
Palatine tonsillectomy is a valuable diagnostic tool in the management of patients with head and neck SCCUP. Bilaterality of tonsillectomy should be taken into consideration.
http://bit.ly/2UZYsbb
Construct validity of a low‐cost medium‐fidelity endoscopic sinus surgery simulation model
Objective
Assess construct validity of a low‐cost medium‐fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training.
Methods
Fellowship‐trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist.
Results
Thirty‐two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task‐specific checklist.
Conclusions
This study demonstrated the construct validity of the low‐cost medium‐fidelity ESS model.
Level of Evidence
NA. Laryngoscope, 2018
http://bit.ly/2PY3FMO
Evaluation of spin in the abstracts of otolaryngology randomized controlled trials
Objective
Spin, the misrepresentation and distortion of research findings, has been shown to affect clinical decision making. Spin has been found in randomized controlled trials (RCTs) published in various fields of medicine, but no study has tested for the presence of spin in otolaryngology RCTs. The purpose of this study is to evaluate the abstracts of RCTs found in the otolaryngology literature for spin.
Methods
In this cross‐sectional analysis, we analyzed the abstracts of RCTs for spin using a pilot‐tested form. Double data extraction was performed by two blinded authors, and discrepancies were resolved using mutual discussion.
Results
Out of the 534 PubMed citations retrieved by our search string, 162 parallel‐group RCTs with clearly defined primary and secondary endpoints were identified. Further analysis identified 47 trials with nonsignificant primary outcomes, which were then evaluated for spin. Spin was identified in 33 of the 47 (70%) abstracts. Spin was found in the results sections of 25 (53%) of the included abstracts and was found in the conclusion section of 27 (57%) of the abstracts. Spin was not present in the titles of any of the included studies.
Conclusion
Spin was common in our sample of otolaryngology RCTs. Spin may potentially create false impressions about the true validity of a drug or intervention. Further research needs to test for potential clinical implications of spin in the otolaryngology literature.
Level of Evidence
NA. Laryngoscope, 2018
http://bit.ly/2V2CrIu
Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption
Objectives
To compare long‐term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM).
Study Design
A retrospective analysis of the National Cancer Database (2010–2014).
Methods
Patients with clinical tumor (T)1 and T2 oropharyngeal squamous cell carcinomas (OPSCC) were classified into those receiving TORS versus nonrobotic surgery versus TLM. Univariate and multivariate survival analyses were conducted with chi‐square tests; Kaplan‐Meier log‐rank test; and Cox multivariate, logistic regression, and multinomial regression modeling.
Results
We identified 2,224 OPSCC TORS patients; 6,697 nonrobotic surgery patients; and 333 TLM patients. The majority of patients were white males with a mean age of approximately 59 years. No significant difference was noted between the cohorts in tumor stage; however, TORS patients were more likely to have nodal (N)1 to N3 disease than nonrobotic surgery and TLM patients, respectively (69.8% vs. 62.0% vs. 59.7%, P < 0.001).
TORS was associated with a lower likelihood of positive margins when compared to nonrobotic surgery, although not TLM (nonrobotic surgery: hazard ratio [HR] 1.51, P < 0.001, TLM: HR 1.13, P = 0.582). TORS was associated with lower likelihood of postsurgical chemoradiotherapy (TLM: HR 2.07, P < 0.001, nonrobotic surgery: 1.65, P < 0.001) but not adjuvant radiotherapy alone (TLM: HR 1.06, P = 0.569, nonrobotic surgery: 0.96, P = 0.655). On multivariate Cox analysis of overall survival, the use of TORS was not associated with increased survival (TLM: HR 1.31, P = 0.233, nonrobotic surgery: HR 1.12, P < 0.303).
Conclusion
The advantages of TORS for early‐stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy.
Level of Evidence
NA. Laryngoscope, 2018
http://bit.ly/2PSPCId
Endoscope‐assisted resection of intravestibular Schwannoma: A video case report
Intravestibular schwannomas are a rare cause of unilateral sensorineural hearing loss. Management of these tumors involves translabyrinthine resection, for which complete visualization around the angles of the vestibule may be limited under an operating microscope. We present the first reported case of an endoscope‐assisted resection of an intravestibular schwannoma, along with the operative video recording. Using additional information gained from endoscopic examination of the tumor and its resection site, we also propose a mechanism by which this patient's intravestibular schwannoma caused hearing loss. Use of the endoscope in resection of intravestibular schwannomas may have advantages over the traditional operating microscope in improving visualization of the narrow and angled vestibule, confirming the integrity of surrounding structures, and ensuring complete tumor removal. Laryngoscope, 2018
http://bit.ly/2V004l4
Polysomnography outcomes in children with small tonsils undergoing drug‐induced sleep endoscopy–directed surgery
Objectives/Hypothesis
The optimal surgical treatment to improve sleep apnea in children with small tonsils is not known. Drug‐induced sleep endoscopy (DISE) may be useful in selecting effective surgical procedures for this patient population. This study compared polysomnography (PSG) measures before and after DISE‐directed surgery in children with small tonsils. We hypothesize that DISE‐directed surgery improves PSG measures in children with small tonsils. We also aimed to identify the most common surgery performed in this population.
Study Design
Retrospective chart review.
Methods
A retrospective review was performed of subjects who underwent DISE at a single pediatric tertiary care center over a 6‐year period. Inclusion criteria were 1+ tonsils and PSG performed before and after DISE‐directed surgery. Exclusion criteria were previous tonsillectomy and tonsils score 2+ or greater. Pre‐ and postoperative PSG parameters were compared using paired t tests.
Results
Average age was 7 ± 4 years old at the time of surgery. The most common DISE‐directed intervention was supraglottoplasty (n = 23). DISE‐directed surgery significantly improved mean apnea‐hypopnea index (AHI) from 14.4 to 8.0 (P = .02). Although improvements were seen in mean obstructive AHI (12.5 to 5.5), O2 nadir (87.0 to 88.3), and ODI (10.6 to 5.8), these measures did not reach statistical significance.
Conclusions
DISE‐directed surgery significantly improves AHI in children with small tonsils. The most common intervention performed on these children was supraglottoplasty. Interestingly, adenotonsillectomy was rarely performed in this cohort. Additionally, supraglottic collapse, prompting supraglottoplasty, is difficult to accurately assess in an awake child, supporting use of a DISE‐directed approach in this patient population.
Level of Evidence
4 Laryngoscope, 2018
http://bit.ly/2PW4rdk
In‐office procedures for the treatment of benign vocal fold lesions in the awake patient: A contemporary review
Objectives
To review available information regarding in‐office procedures for benign vocal fold lesions (BVFL).
Methods
PubMed term search on office/awake laryngeal procedures for any of the following specific lesions: Reinke's edema (RE), polyps, nodules, varices, vocal process granuloma, and vocal fold (VF) scar.
Results
In‐office ablative and nonablative laser procedures have been described for BVFL, including RE, polyps, varices, and granuloma. Fiber‐based lasers used include potassium titanyl phosphate, pulsed dye laser, and more recently CO2. In‐office intralesional steroid injection (ISI) for BVFL targets the inflammatory process involved with the lesion and may induce regression of polyps, nodules, RE, and granuloma. Botulinum toxin‐induced "voice rest" has been described as adjunctive treatment for refractory VF nodules or vocal process granuloma. Most in‐office techniques for treating BVFL rely on induction of lesion regression rather than complete lesion removal, as in conventional operative microsurgery. When treating VF scarring, in‐office procedures aim to alter the wound‐healing process; ISI targets the inflammatory phase and angiolytic lasers target the proliferative phase.
Conclusion
In‐office procedures for BVFL apply new technology that can potentially lower risk and cost. Although numerous case series have shown the potential of these procedures, data that thoroughly compares outcomes with those of microlaryngoscopic techniques is needed. Laryngoscope, 2018
http://bit.ly/2V42kaU
Oral tongue squamous cell carcinoma survival as stratified by age and sex: A surveillance, epidemiology, and end results analysis
Objectives/Hypothesis
To utilize the Surveillance, Epidemiology, and End Results (SEER) database to elucidate differences in predictors of survival in oral tongue squamous cell carcinoma (OTSCC) as stratified by age and sex.
Study Design
Retrospective, population‐based database analysis.
Methods
The SEER registry was utilized to calculate survival trends for patients with OTSCC between 1973 and 2012. Patient data were then stratified by age (≤40 years vs. >40 years) and sex, then analyzed with respect to race, stage, grade, and treatment modalities. Overall survival (OS) and disease‐specific survival (DSS) were calculated and compared.
Results
There were 16,423 cases of OTSCC identified, with 526 and 706 young female and male patients, respectively. Young female patients had improved OS and DSS as compared to young male patients (75% vs. 67% at 5 years), which is better than older patients (P < .001). Younger patients were more likely to receive surgery (P < .001) and combination surgery and radiation (P < .001) as compared to older patients. On multivariate analysis, tumor stage was uniformly associated with worse OS and DSS (P < .05), with surgery predicting improved OS and DSS in all groups except young females (P < .05). Higher tumor grade predicted worse OS and DSS in older patients, but not younger patients (P < .05).
Conclusions
OTSCC appears to present with relatively heterogeneous characteristics across different age groups and sexes. Despite the rising incidence of OTSCC in young individuals, our study demonstrates that young patients have improved survival rates compared to older patients.
Level of Evidence
NA Laryngoscope, 2018
http://bit.ly/2PYCEch
Nasal obstruction symptom evaluation score outcomes after septorhinoplasty
Objectives/Hypothesis
The time interval at which Nasal Obstruction Symptom Evaluation (NOSE) scores stabilize after functional septorhinoplasty has not been determined. Our goal was to characterize longitudinal trends of patient‐reported outcomes of nasal obstruction using the NOSE survey instrument following functional septorhinoplasty.
Study Design
Prospective longitudinal cohort study.
Methods
Adult patients (≥18 years) with nasal obstruction who underwent functional septorhinoplasty by three different surgeons at a single academic, tertiary referral center were identified. NOSE scores were obtained preoperatively and prospectively during three postoperative intervals defined as early (1–3 months), middle (4–6 months), and late (≥10 months.) Longitudinal analysis included repeated measures analysis of variance and adjustments for multiple comparisons.
Results
A total of 49 patients met inclusion criteria. For the total cohort, mean NOSE scores significantly improved between preoperative and early postoperative evaluations (71.4, standard deviation [SD] ± 17.0 vs. 24.2, SD ± 19.5; P < .001) but did not significantly change between early and middle (20.6, SD ± 19.1; P = .543) or middle and late (23.1, SD ± 24.9; P > .999) time intervals.
Conclusions
Patients with nasal obstruction who undergo functional septorhinoplasty can be expected to have significant improvement in self ‐reported nasal obstruction as early as 1 to 3 months postoperatively with a continued, durable, long‐standing benefit lasting at least 10 months after surgery. Future studies can consider the 3‐month time frame as a proxy for 1 year outcomes to help reduce survey burden.
Level of Evidence
2c Laryngoscope, 2018
http://bit.ly/2V42lvu
Analysis of patients with drug‐induced pemphigoid using the Japanese Adverse Drug Event Report database
Abstract
To clarify the incidence of drug‐induced pemphigoid in Japan, we conducted a database search and analysis using the Japanese Adverse Drug Event Report database (JADER). Among the cases recorded in JADER between April 2004 and November 2017, we targeted "pemphigoid" and analyzed the patients' backgrounds, drug involvement, time of pemphigoid onset, outcomes and year reported. For cases where three or more drugs were reportedly involved, the signal index was calculated using the reporting odds ratio (ROR) method. The total number of reported pemphigoid cases was 769. Males accounted for 58% (446 cases) and patients over the age of 60 years accounted for 82% (630 cases). The most frequently reported causative drug was vildagliptin (288 cases), followed in order by sitagliptin phosphate hydrate (102 cases), teneligliptin hydrobromide hydrate (86 cases), linagliptin (64 cases) and furosemide (46 cases). For the 27 causative drugs, the safety signal was detected by the ROR method. The median time to onset tended to be long for these drugs. For vildagliptin with the largest reported number, the value was 508 days (range, 2–1871). Analysis of outcomes demonstrated recovery or improvement in 66.3% of cases. Analysis of the years in which reports had been published revealed that the number of pemphigoid cases has increased rapidly in recent years. Our survey was able to reveal useful data on the incidence of drug‐induced pemphigoid. We expect that these results will aid the early detection and treatment of this condition.
http://bit.ly/2SZuBxE
Basophil activation testing in occupational respiratory allergy to low molecular weight compounds
Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use. Correspondence to Johanna Feary, Department of Occupational Lung Disease, Royal Brompton Hospital, London SW3 6LR. Tel: +44 20 7594 7968; e-mail: j.feary@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2T2XAR9
http://bit.ly/2T2XAR9
Microbial keratitis: Significant increase in Gram-positive bacterial infection
Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years p. 49
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y
Giant cell arteritis related arteritic anterior ischemic optic neuropathy
http://www.ijo.in/viewimage.asp?img=IndianJOphthalmol_2019_67_1_142_248176_f1.jpg
A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.[4],[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
: Clinico-pathological correlation
Mohit Dogra, Ramandeep Singh, Mangat R Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence Address:
Dr. Mohit Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
DOI: 10.4103/ijo.IJO_881_18
A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.[4],[5]
 | Figure 1: (a) showing pale disc edema (blue arrows) with an inferotemporal branch retinal artery occlusion, (b and c) showing "wedge shaped" equatorial choroidal infarcts on fluorescein angiogram, and (d) right side temporal artery biopsy at 200× magnification showing intimal proliferation with breaks in the internal elastic lamina (yellow arrows) with extravasation of red blood cells in the tunica media (black arrow) with minimal inflammatory cells, suggestive of vasculitis Click here to view |
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References |  |
| 1. | Hayreh SS, Podhasky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998;125:509-20.  |
| 2. | Wayand CM, Bartley GB. Giant cell arteritis: New concepts inpathogenesis and implications of management. Am J Ophthalmol1997;123:392-5. |
| 3. | Guevara M, Kollipara CS. Recent advances ingiant cell arteritis. CurrRheumatol Rep 2018;20:25. |
| 4. | HayrehSS. Management of ischaemic optic neuropathy. Indian J Ophthalmol 2011;59:123-36. |
| 5. | Attaseth T, Vanikieti K, Poonyathalang A, Preechawat P, Jindahra P, Wattanatranon D. Anterior ischemic optic neuropathydue tobiopsy-provengiant cell arteritisin Thai patients. ClinOphthalmol 2015;9:1071-5. |
Ophthalmology
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| Indian Journal of Ophthalmology – On the right path Santosh G Honavar Indian Journal of Ophthalmology 2019 67(1):1-2 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Artificial intelligence (AI) in healthcare and biomedical research: Why a strong computational/AI bioethics framework is required? Jatinder Bali, Rohit Garg, Renu T Bali Indian Journal of Ophthalmology 2019 67(1):3-6 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypopigmented fundus in a young male Nawazish Fatma Shaikh, Vinod Kumar Indian Journal of Ophthalmology 2019 67(1):7-7 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Current concepts in crosslinking thin corneas Rashmi Deshmukh, Farhad Hafezi, George D Kymionis, Sabine Kling, Rupal Shah, Prema Padmanabhan, Mahipal S Sachdev Indian Journal of Ophthalmology 2019 67(1):8-15 Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Management of Duane retraction syndrome: A simplified approach Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):16-22 Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement Manca Tekavcic Pompe, Alki Liasis, Richard Hertle Indian Journal of Ophthalmology 2019 67(1):23-30 Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Commentary: "Current" consensus: Electrodiagnostics in eye Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):30-31 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns Ka Wai Kam, Chaitali N Patel, Neda Nikpoor, Marco Yu, Sayan Basu Indian Journal of Ophthalmology 2019 67(1):32-36 Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Commentary: Assessment of limbal ischemia in ocular burns Naveen Radhakrishnan, N Venkatesh Prajna Indian Journal of Ophthalmology 2019 67(1):37-37 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dopamine levels in human tear fluid Niyati Seshagiri Sharma, Suraj Kumar Acharya, Archana Padmanabhan Nair, Jyoti Matalia, Rohit Shetty, Arkasubhra Ghosh, Swaminathan Sethu Indian Journal of Ophthalmology 2019 67(1):38-41 Purpose: To determine the levels of dopamine in tear fluid and demonstrate the use of tear fluid as a non-invasive source for dopamine measurements in humans. Methods: The study cohort included 30 clinically healthy individuals without any pre-existing ocular or systemic conditions. Matched tear fluid (using Schirmer's strips and capillary tubes) and plasma were collected from the subjects. Dopamine levels were evaluated using direct competitive chemiluminescent enzyme-linked immunosorbent assay (ELISA), dopamine kit (Cloud Clone Corp, TX, USA). Results: Significantly higher dopamine levels were found in the tear fluid compared to plasma in the study subjects. The level of dopamine was 97.2 ± 11.80 pg/ml (mean ± SEM), 279 ± 14.8 pg/ml (mean ± SEM), and 470.4 ± 37.64 pg/ml (mean ± SEM) in the plasma and in the tears collected using Schirmer's strips and capillary tubes, respectively. Conclusion: Dopamine was detectable in all the tear fluid samples tested and was also found to be at a higher concentration than in plasma samples. Tear fluid can be used as a non-invasive sample source to monitor dopamine levels.
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