Nevin Manimala

Vestn Otorinolaringol. 2023;88(5):49-57. doi: 10.17116/otorino20238805149.

ABSTRACT

INTRODUCTION: The issues of epidemiology, etiopathogenesis, diagnostics and clinic of acute catarrhal rhinosinusitis are considered, the possibility of using the herbal medicinal product Sinupret extract in the treatment of patients with acute viral rhinosinusitis is substantiated.

OBJECTIVE: To evaluate the efficacy and safety of using the drug Sinupret extract in patients with acute viral rhinosinusitis.

MATERIAL AND METHODS: A comparative study of the efficacy and safety of clinical use in patients of the drug Sinupret extract in patients with acute viral rhinosinusitis was carried out in comparison with symptomatic treatment.

RESULTS AND DISCUSSION: After analyzing and processing the results obtained using statistical methods for the main group, a faster rate of decrease in the severity of complaints (data with the use of the MSS visual analogue scale), the severity of inflammation in the nasal cavity and nasopharynx, the amount of discharge from the nose and its viscosity were confirmed. Restoration of respiratory function according to rhinomanometry and mucociliary transport according to the results of the saccharin test also occurred more quickly in patients of the main group compared to the control group. The effectiveness of using Sinupret extract is also confirmed by the results of photoplethysmography.

CONCLUSIONS: The use of the drug Sinupret extract not only contributes to a more rapid improvement in the general well-being of patients and a decrease in the severity of complaints, but also leads to an improvement in the objective picture of the disease (rhinoscopy, the results of anterior active rhinomanometry, saccharin test) compared with the control group, favorably affects the quality life of patients, causes a decrease in economic and social costs against the background of the development of acute viral rhinosinusitis.

PMID:37970770 | DOI:10.17116/otorino20238805149

Vestn Otorinolaringol. 2023;88(5):41-48. doi: 10.17116/otorino20238805141.

ABSTRACT

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

PMID:37970769 | DOI:10.17116/otorino20238805141

Vestn Otorinolaringol. 2023;88(5):19-22. doi: 10.17116/otorino20238805119.

ABSTRACT

The article is devoted to the problems of binaural cochlear implantation, especially in patients with a long time interval between surgeries. The purpose of the study was to evaluate the effect of the time range between successive interventions in patients with binaural prosthetics using the CI system.

MATERIALS AND METHODS: the study included 50 patients aged 10 to 14 years, divided into 3 study groups: patients with unilateral cochlear implantation (group I), patients with bilateral implantation with a less than 1 year range between operations (group II) and patients with bilateral implantation with a more than 5 year range between interventions (group III). Comparative analysis was carried out using speech audiometry in silence and noise, assessment of sound localization and questionnaires to assess the auditory dynamics and speech development.

RESULTS: Patients in groups II and III showed comparable results in speech intelligibility in noise and sound localization. At the same time, these indicators turned out to be higher than in patients of group I. Patients from all three groups did not show statistically significant differences in speech intelligibility in silence and in the level of speech development.

CONCLUSION: a long interval (more than 5 years) after the first implantation should not be considered as a contraindication to binaural implantation.

PMID:37970765 | DOI:10.17116/otorino20238805119

Ultrasound Obstet Gynecol. 2023 Nov 16. doi: 10.1002/uog.27535. Online ahead of print.

ABSTRACT

OBJECTIVE: A timely and correct preoperative diagnosis of a uterine sarcoma will increase patients’ survival. The primary aim of our study was to describe the ultrasound features in uterine sarcomas compared to uterine leiomyomas based on MUSA (Morphological Uterus Sonographic Assessment) terms and definitions. The secondary aim was to assess the interobserver agreement of the MUSA ultrasound features.

METHODS: This retrospective cohort study assessed uterine sarcomas from 1997 until 2019 and uterine leiomyomas from 2016 until 2019 treated in a single tertiary center. Patients’ demographics, presenting symptoms and outcome were extracted from the patients’ files. The ultrasound images were re-evaluated independently by two sonologists using the MUSA terms and definitions. Descriptive statistics were calculated and interobserver agreement was assessed with Cohen’s Kappa (with squared weights) or intraclass correlation coefficient depending on the type of variable.

RESULTS: Hundred and seven patients were included, of whom 16 had a uterine sarcoma and 91 a uterine leiomyoma. Abnormal uterine bleeding was the most frequent presenting symptom (69/107, 65%). Compared to leiomyoma cases, uterine sarcoma patients were older (mean age of 65 years (IQR 60-70 years) versus (vs.) 48 years (IQR 43-52 years)) and mostly postmenopausal (13/16 (81%) vs. 15/91 (16%)). In the uterine sarcoma cohort, leiomyosarcoma was the most frequent histological type (6/16 (38%) followed by adenosarcoma (4/16 (25%). On ultrasound evaluation, according to observer 1 and 2, the tumor border was irregular in most sarcomas (in 11/16 (69%) and 13/16 (81%), respectively), whereas leiomyomas were most frequently regular (in 65/91 (71%) and 82/91 (90%), respectively). The observers classified the lesion echogenicity as non-uniform, in 68/91 (75%) and 51/91 (56%) of leiomyomas and 15/16 (94%) of uterine sarcoma. More than 60% of the uterine sarcomas showed acoustic shadows (in 11/16 (69%) and 10/16 (62%) respectively) whereas calcifications were reported in a small minority of them (in 0/16 (0%) and 2/16 (13%) respectively). In uterine sarcomas, the intralesional vascularity was reported as moderate to abundant in 13/16 (81%) and 15/16 (94%) respectively while circumferential vascularity was scored as high in 6/16 (38%) by both observers. The interobserver agreement for presence of cystic areas, calcifications, acoustic shadow and central necrosis, color score (overall, intralesional and circumferential), and maximal diameter of the lesion, was moderate. The agreement for lesion tumor border and echogenicity was fair.

CONCLUSIONS: A postmenopausal patient, presenting with abnormal uterine bleeding and a new or growing mesenchymal mass with irregular tumor borders at ultrasonography, moderate to abundant intralesional vascularity, presence of cystic areas and absence of calcifications, carries a higher risk of having a uterine sarcoma. The interobserver agreement for most MUSA terms and definitions is moderate. Future studies should validate the above clinical and ultrasound findings in a prospective multicenter collection of uterine mesenchymal tumors. This article is protected by copyright. All rights reserved.

PMID:37970762 | DOI:10.1002/uog.27535

J Med Virol. 2023 Nov;95(11):e29224. doi: 10.1002/jmv.29224.

ABSTRACT

Previous studies have demonstrated strong associations between host genetic factors and Epstein-Barr virus (EBV) VCA-IgA with the risk of nasopharyngeal carcinoma (NPC). However, the specific interplay between host genetics and EBV VCA-IgA on NPC risk is not well understood. In this two-stage case-control study (N = 4804), we utilized interaction and mediation analysis to investigate the interplay between host genetics (genome-wide association study-derived polygenic risk score [PRS]) and EBV VCA-IgA antibody level in the NPC risk. We employed a four-way decomposition analysis to assess the extent to which the genetic effect on NPC risk is mediated by or interacts with EBV VCA-IgA. We consistently found a significant interaction between the PRS and EBV VCA-IgA on NPC risk (discovery population: synergy index [SI] = 2.39, 95% confidence interval [CI] = 1.85-3.10; replication population: SI = 3.10, 95% CI = 2.17-4.44; all p_interaction < 0.001). Moreover, the genetic variants included in the PRS demonstrated similar interactions with EBV VCA-IgA antibody. We also observed an obvious dose-response relationship between the PRS and EBV VCA-IgA antibody on NPC risk (all p_trend < 0.001). Furthermore, our decomposition analysis revealed that a substantial proportion (approximately 90%) of the genetic effects on NPC risk could be attributed to host genetic-EBV interaction, while the risk effects mediated by EBV VCA-IgA antibody were weak and statistically insignificant. Our study provides compelling evidence for an interaction between host genetics and EBV VCA-IgA antibody in the development of NPC. These findings emphasize the importance of implementing measures to control EBV infection as a crucial strategy for effectively preventing NPC, particularly in individuals at high genetic risk.

PMID:37970759 | DOI:10.1002/jmv.29224

Acta Paediatr. 2023 Nov 16. doi: 10.1111/apa.17040. Online ahead of print.

ABSTRACT

AIM: To investigate cerebral blood volume (CBV) in preterm neonates using time-resolved near-infrared spectroscopy.

METHODS: In this prospective observational study, time-resolved near-infrared spectroscopy measurements of CBV using tNIRS-1 were performed in 70 preterm neonates. For measurements, a sensor was placed for a duration of 1 min, followed by four further reapplications of the sensor, overall five measurements.

RESULTS: In this study, 70 preterm neonates with a mean ± SD gestational age of 33.4 ± 1.7 weeks and a birthweight of 1931 ± 398 g were included with a postnatal age of 4.7 ± 2.0 days. Altogether, 2383 CBV values were obtained with an overall mean of 1.85 ± 0.30 mL/100 g brain. A total of 95% of the measured CBV values varied in a range from -0.31 to 0.33 from the overall individual mean. Taking the deviation of the mean of each single application for each patient, this range reduced from -0.07 to 0.07. The precision of the measurement defined as within-variation in CBV was 0.24 mL/100 g brain.

CONCLUSION: The overall mean CBV in stable preterm neonates was 1.85 ± 0.30 mL/100 g brain. The within-variation in CBV was 0.24 mL/100 g brain. Based on the precision obtained by our data, CBV of 1.85 ± 0.30 mL/100 g brain may be assumed as normal value for this cohort.

PMID:37970733 | DOI:10.1111/apa.17040

Mol Genet Genomic Med. 2023 Nov 16:e2302. doi: 10.1002/mgg3.2302. Online ahead of print.

ABSTRACT

BACKGROUND: Major sickle cell syndromes are the most common hemoglobinopathy in the world. The sickle cell patients are subjected to several factors causing inflammation, and the genetic identification of each individual allows to focus the possibility of allelic variations influence of a specific gene and then the polymorphism. This study aims at determining the distribution of HP gene (OMIM#140100) and their involvement on hematological parameters and the iron profile in the sickle cell patients presenting an inflammation condition during major sickle cell syndromes in Cameroun.

METHODS: A case-control analytical study has been conducted over a period of 6 months. Cases consisting of sickle cell patients in a situation of inflammation and control of non-inflamed sickle cell patients. The patients presenting major sickle cell syndromes, interned and/or followed at the Hematology Department of the Regional Hospital of Bafoussam and the Central Hospital of Yaoundé have been recruited. HP genotyping was carried out at the Laboratory for Public Health Research Biotechnologies (LAPHER-Biotech) in Yaoundé using allele-specific PCR. Also, inflammatory, hematological parameters and martial assessment were explored by standard methods. Statistical analysis of the data was performed using the statistical tool R version 4.1.1. The comparison of proportions of alleles was made with the chi-square test, and the Wilcoxon test was used to compare the median between different groups using the statistical tool R version 4.1.1.

RESULTS: We analyzed the samples of 149 patients. The HP polymorphism describes a significant frequency of the “1F” allele (69.8%) followed by the “2” allele (46.31%). In addition, 80 patients (53.69%), 48 (32.21%), and 21 (14.09%) presented the genotype HP 1-1, HP 2-1, and HP 2-2, respectively. And eighty-one percent (81%) patients with genotype HP 2-2 showed a significant higher relative frequency of thrombocytosis compared with the genotype HP 1-1 and HP 2-1, respectively (51.2% and 68.8%, p = 0.087). The proportion of inflammation in the HP 2-2 group was higher (57.1%) compared with the other groups (respectively 42.5% and 35.4% in the HP 1-1 and HP 2-1 groups). Furthermore, the median CRP was significantly higher in the HP 2-2 group compared with the other groups (p = 0.039). Moreover, the entire population of the HP 2-2 group showed an elevation of ferritin and IL6 unlike the HP 1-1 and HP 2-1 groups.

CONCLUSION: This study demonstrates a higher frequency of genotype HP 1-1 followed by the HP 2-2 genotype in patients with major sickle cell syndromes. However, a larger proportion of patients with genotype HP 2-2 are associated with hematological profile disorders, inflammation, and dysregulation of iron metabolism. Then, the haptoglobin polymorphism contributes to the severity of major sickle cell syndromes.

PMID:37970725 | DOI:10.1002/mgg3.2302

J Pediatr Orthop. 2023 Nov 16. doi: 10.1097/BPO.0000000000002564. Online ahead of print.

ABSTRACT

BACKGROUND: Printed educational materials (PEMs) have been used for patient education in various settings. The purpose of this study was to determine the readability, understandability, and actionability of trauma-related educational material from the Pediatric Orthopaedic Society of North America (POSNA, Orthokids), as well as determine its efficacy in educating pediatric orthopaedic trauma patients and caregivers.

METHODS: The readability, understandability and actionability of PEMs was assessed using the Patient Education materials Assessment Tool (PEMAT). Five reviewers ranging in experience independently evaluated the educational materials. The efficacy of PEMs was assessed prospectively by randomizing patients into 2 groups. The first group (Education) received the OrthoKids educational material related to the patient’s fracture. The second group (No Education) did not receive the educational material. At the first follow-up visit, parents/guardians in both groups completed surveys. Statistical analyses included descriptive and univariate statistics.

RESULTS: The understandability of PEMs was similar (68% to 74%); however, the educational materials had varying actionability scores ranging from 20% for femoral shaft fractures to 60% for elbow fractures. In total, 101 patients were randomized to assess the efficacy of educational materials (Education=51, No Education=50). There were no significant differences in sex, age, race/ethnicity, and level of education between caregivers in both groups (P > 0.05). Only 61% (31/51) participants in the Education group reported using the educational material; however, 67% to 68% of participants in either group reported wanting PEMs. Participants in the group that did not receive PEMs were significantly more likely to use the internet to find more information (74% vs. 51%, P < 0.05).

CONCLUSIONS: This study suggests that participants that did not receive PEMs were significantly more likely to search the internet for more information. Improving the quality and actionability of educational resources on electronic platforms is needed to improve patient education. A multi-modal approach using PEMs that includes a list of high-quality online sources would likely be most effective in educating pediatric trauma patients and caregivers.

LEVEL OF EVIDENCE: I.

PMID:37970651 | DOI:10.1097/BPO.0000000000002564

J Magn Reson Imaging. 2023 Nov 16. doi: 10.1002/jmri.29129. Online ahead of print.

ABSTRACT

BACKGROUND: Three-dimensional (3D) ventilation flow-weighted (VFW) maps together with 3D ventilation-weighted (VW) maps may help to better assess pulmonary function.

PURPOSE: To investigate the use of 3D VFW and VW maps for evaluating pulmonary ventilation function.

STUDY TYPE: Prospective.

POPULATION: Two patients (one male, 85 years old; one female, 64 years old) with chronic obstructive pulmonary disease (COPD) and nine healthy subjects (all male; 23-27 years).

FIELD STRENGTH/SEQUENCE: 3-T, 3D radial UTE imaging.

ASSESSMENT: 3D VFW and VW maps were calculated from 3D UTE MRI by voxel-wise subtraction of respiratory phase images. Their validation was tested in nine healthy volunteers using slow/deep and fast/shallow breathing conditions. Additional validation was performed by comparison with single photon emission computed tomography (SPECT) ventilation maps of one healthy participant. For comparison, gravity dependence of anterior-posterior regional ventilation was assessed by one-dimensional plot of the mean signal intensity for each coronal slice. Structural similarity index measure was also calculated. Finally, VW maps and VFW maps of two COPD patients were evaluated for emphysema lesions with reference to CT images.

STATISTICAL TESTS: Wilcoxon sign-rank tests for regional Ventilation and Ventilation flow, analysis of variance, post-hoc t-tests and Bonferroni correction, coefficient of variation, Kullback-Liebler divergence. A P-value <0.05 was considered statistically significant.

RESULTS: The validation of 3D VFW and VW maps was shown by statistically significant differences in ventilation flow and ventilation between the breathing conditions. Additionally, UTE-MRI and SPECT-based ventilation maps showed gravitational dependence in the anteroposterior direction. When applied to patients with COPD, the use of 3D VFW and VW maps was able to differentiate between two patients with different phenotypes.

DATA CONCLUSION: The use of 3D VFW and VW maps can provide regional information on ventilation function and potentially contribute to assessment of COPD subtypes and disease progression.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.

PMID:37970646 | DOI:10.1002/jmri.29129

World J Orthop. 2023 Oct 18;14(10):755-762. doi: 10.5312/wjo.v14.i10.755. eCollection 2023 Oct 18.

ABSTRACT

BACKGROUND: Flexible flatfoot (FFF) is a very common condition in children, but no evidence-based guidelines or assessment tools exist. Yet, surgical indication is left to the surgeon’s experience and preferences.

AIM: To develop a functional clinical score for FFF [Catania flatfoot (CTF) score] and a measure of internal consistency; to evaluate inter-observer and intra-observer reliability of the CTF Score; to provide a strong tool for proper FFF surgical indication.

METHODS: CTF is a medically compiled score of four main domains for a total of twelve items: Patient features, Pain, Clinical Parameters, and Functionality. Each item refers to a specific rate. Five experienced observers answered 10 case reports according to the CTF. To assess inter- and intra-observer reliability of the CTF score, the intra-class correlation coefficients’ (ICCs) statistics test was performed, as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication. Values of 75% were chosen as the score cut-off for surgical indication. Sensitivity, specificity, positive likelihood ratio (PLHR), negative likelihood ratio (NLHR), positive predictive value (PPV), and negative predictive value (NPV).

RESULTS: Overall interobserver reliability ICC was 0.87 [95% confidence interval (CI): 0.846-0.892; P < 0.001]. Overall intra-observer reliability ICC was 0.883 (95%CI: 0.854-0.909; P < 0.001). A direct correlation between the CTF score and surgical treatment indication [Pearson correlation coefficient = 0.94 (P < 0.001)] was found. According to the 75% cut-off, the sensitivity was 100% (95%CI: 83.43%-100%), specificity was 85.71% (95%CI: 75.29%-92.93%), PLHR was 7 (95%CI: 3.94-12.43), NLHR was 0 (95%CI: 0-0), PPV was 75% (95%CI: 62.83%-84.19%) and NPV was 100% (95%CI: 100%-100%).

CONCLUSION: CTF represents a useful tool for orthopedic surgeons in the FFF evaluation. The CTF score is a quality questionnaire to reproduce suitable clinical research, survey studies, and clinical practice. Moreover, the 75% cut-off is an important threshold for surgical indication and helps in the decision-making process.

PMID:37970624 | PMC:PMC10642399 | DOI:10.5312/wjo.v14.i10.755