Prolonged Itraconazole Therapy as Sole Treatment for Patients with Allergic Fungal Rhinosinusitis

BACKGROUND

Currently, the mainstay of treatment for allergic fungal rhinosinusitis (AFRS) is surgical debridement along with topical or systemic steroids. However, prolonged systemic steroid therapy comes with side effects and is also sometimes contraindicated. Systemic antifungals have been used earlier as an adjunct to steroids or in refractory cases, but they have not been used as the sole primary treatment.

OBJECTIVE

To study the effectiveness of sole Itraconazole therapy in patients with AFRS by comparison of clinical, radiological, and biochemical parameters before and after treatment.

METHODS

Thirty-four patients diagnosed with localized sino-nasal AFRS were recruited and started on the tablet Itraconazole 200 mg orally twice daily for 3 months with q2weekly monitoring of liver function tests. The baseline clinical, radiological, and biochemical parameters were then compared with those after completion of 3 months of Itraconazole therapy.

RESULTS

There was significant difference between all the parameters-clinical: SNOT-22 score (p < 0.001) and Meltzer endoscopy score (p < 0.001), radiological: Lund-Mackay score (p = 0.004) and 20-point CT score (p = 0.002), and biochemical: serum total IgE (p < 0.001), Aspergillus-specific IgE (p < 0.001), and absolute eosinophil count (p < 0.001). The clearance of the disease was more in anterior sinuses than the posterior ones.

CONCLUSION

Prolonged Itraconazole can be given as sole therapy in AFRS, especially in patients for whom steroids are contraindicated or in those who are awaiting surgery. It can result in symptomatic and radiological improvement, but surgery still remains the definitive treatment option for AFRS for complete clearance of disease.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:545-551, 2024.

Identification of Novel PROP1 and POU1F1 Mutations in Patients with Combined Pituitary Hormone Deficiency

Growth hormone deficiency (GHD) results from variations affecting the production and release of growth hormone (GH) and is of 2 types: isolated growth hormone deficiency (IGHD) and combined pituitary hormone deficiency (CPHD). IGHD results from mutations in GH1 and GHRHR while CPHD is associated with defects in transcription factor genes PROP1, POU1F1, and HESX1. The present study reports on screening of POU1F1, PROP1, and HESX1 in CPHD patients and the novel variations identified. Fifty-one CPHD patients from 49 unrelated families clinically diagnosed on the basis of biochemical and imaging investigations along with 100 controls were enrolled. Detailed family history was noted from all participants and 5 ml blood samples drawn were processed for DNA isolation followed by direct sequencing of POU1F1, PROP1, and HESX1genes. Of the 51 patients, 8 were females and 43 were males. Mean height standard deviation score (SDS) and weight SDS were -5.50 and -2.76, respectively. Thirty-six of the 51 patients underwent MRI of which 9 (25%) had normal pituitary structure and morphology while 27 (75%) showed abnormalities. Molecular analysis revealed 10 (20%) patients to have POU1F1 and PROP1 mutations/variations of which 5 were novel and 2 previously reported. No mutations were identified in HESX1. The novel variations identified were absent in the 100 healthy individuals screened and the control database Exome Aggregation Consortium (ExAC). Reported POU1F1 and PROP1 mutation hotspots were absent in our patients. Instead, novel POU1F1 changes were identified suggesting existence of a distinct mutation spectrum in our population.

Bilateral parotid swelling: a radiological review

Bilateral parotid swelling is not an uncommon occurrence and may pose a challenge for clinicians and radiologists. Numerous causes of bilateral parotid swellings have been identified. The purpose of this pictorial review is to display this wide array with a focus on multimodality approach.

Vocal cord schwannoma: a rare case report

Schwannomas of the larynx are rare benign tumors, most commonly involving aryepiglottic folds or false vocal folds. When a tumor involves vocal cord, it causes clinical symptoms like hoarseness of voice and foreign body sensation. We report the CT and magnetic resonance imaging findings in a 19-year-old male patient with vocal cord mass histologically diagnosed as a vocal cord schwannoma.

MR sialography of iatrogenic sialocele: comparison with conventional sialography

OBJECTIVE

The objective of this study was to compare the conventional sialography with MR sialography in a series of patients with iatrogenic sialocele (sialocyst).

METHODS

50 salivary glands in 39 patients with suspected inflammatory disease of the salivary gland underwent conventional sialography and MR sialography. Out of these 39 patients, 6 patients (age range: 16-35 years; 4 males and 2 females; mean age: 23.8 years) had sialoceles and formed our study group. MR sialography findings were compared with conventional sialography findings regarding demonstration of ductal anatomy, the cyst and its communication with the ductal system.

RESULTS

MR sialography demonstrated the site of communication of the sialocyst with the ductal system in all six patients. MR provided additional information over conventional sialography in five cases. In four cases, the ductal system proximal to the cyst was not opacified on digital sialography but was well visualized in all cases by MR sialography. Constructive interference in steady-state (CISS) sequence demonstrated the intraglandular ducts and communication of cysts with ducts better than half-fourier acquisition single-shot turbo-spin echo (HASTE) images.

CONCLUSION

Our preliminary results suggest that MR sialography is a robust, non-invasive method for demonstrating the ductal system up to second-order branches, the site of ductal injury and the focal cystic lesion. MR provided at least the same information as conventional sialography in the evaluation of site of communication but provided additional information about the sialocyst and upstream ductal system in five cases. Being a non-invasive modality, we recommend MR sialography as the investigation of choice in the evaluation of an iatrogenic sialocyst.

Temperature dependence of optical constants of MoS(2) for pyrooptical devices

The temperature sensitivity of the reflectance of MoS(2) under small temperature modulations has been investigated.It is feasible to detect temperature changes of 10(-2) degrees C by monitoring the reflectance, and thus MoS(2) is a potential candidate material for the pyrooptical sensors.

Dielectric and pyroelectric properties of triglycerol-gelatin films

The dielectric and pyroelectric properties of triglycerol-gelatin thick films were studied as a function of temperature and frequency. The films exhibited a strong dispersion in the dielectric permittivity accompanied by a high dielectric loss near room temperature. The pyroelectric current measured by the static Byer-Roundy method is heavily dominated by the thermally stimulated currents. Measurements performed on prepoled samples using the dynamic technique of A.G. Chynoweth (1956) clearly proved the presence of a true, reversible pyroelectric response in the examined films. The value of the pyroelectric coefficient of the films was found to be comparable to that of polyvinylidene fluoride (PVDF).

Electric field-induced orthogonal polarization switching in morphotropic phase boundary Pb(0.57)Ba(0.43)Nb(2)O(6) (PBN57) single crystals

Tungsten bronze crystals of Pb(0.57)Ba(0.43)Nb(2)O(6) composition near the morphotropic phase boundary were examined for possible switching of the polarization vector. It is demonstrated that for the single crystal lead barium niobate of tetragonal symmetry, the polarization vector can be switched orthogonally to an orthorhombic phase simply by the application of an electric field.

Relationship of crystallographic polarity to piezoelectric, pyroelectric and chemical etching in Li2GeO3 and LiGaO2 single crystals

Absolute assignment of the atomic planes of Li2GeO3 and LiGaO2 is made by ion surface scattering (ISS) and the crystallographic polarity is defined. Pyroelectric coefficients p 3 and the piezoelectric constants d 33 of lithium metagermanate and lithium gallate are determined. Pyroelectric and piezoelectric coefficient signs when defined on the crystallographic sign convention of the axes are negative and positive, respectively. The results are correlated with chemical etching studies.

Clinical patterns and complications of diabetes mellitus in India

The records of 274 diabetics attending an outpatient clinic in New Delhi have been reviewed and the patients classified into four main types.

The relationship of the disease to nutritional, socio-economic and environmental factors has been discussed.

The incidence of complications in the various types is reported and the differences between them analysed.