Validation of modular endoscopic medial maxillectomies for inverted papilloma of the maxillary sinus

BACKGROUND

Treatment of inverted papilloma of the maxillary sinus (IPMS) has a lower success rate compared to other IPs. As such, its correct management generally needs trans-nasal endoscopic medial maxillectomy (EMMs) for adequate resection. The aim of this manuscript is to describe outcomes and major prognostic factors of a cohort of patients with IPMS who were treated with EMM.

METHODOLOGY

In this multicentric study, patients affected with IPMS and treated with EMMs were included. The site of origin of the IPMS were studied as well as the type of EMM performed. The histological features (IP vs dysplasia), type of mucosal resection (total vs. pedicle oriented), and post-operative complications were analyzed.

RESULTS

310 patients were included (212 primary and 98 recurrent cases). After a mean follow-up of 45.4 months, 15 patients experienced recurrence (4.8%) due to the application of EMMs tailored to the surgical insertion point. Dysplasia was significantly associated with a higher risk of recurrence. The rates of early and late complications were 11.6% and 11.9%, respectively.

CONCLUSIONS

IPMS resection via tailored EMM is associated with excellent disease control, thus excluding the systematic use of extended EMMs, which can however be justified in case of dysplastic IPMS given its significant impact on recurrence.

Early predictors of dysphagia in ischemic stroke patients

INTRODUCTION

Post-stroke dysphagia affects outcome. In acute stroke patients, we aimed to evaluate clinical, cognitive, and neuroimaging features associated with dysphagia and develop a predictive score for dysphagia.

METHODS

Ischemic stroke patients underwent clinical, cognitive, and pre-morbid function evaluations. We retrospectively scored dysphagia on admission and discharge with the Functional Oral Intake Scale (FOIS).

RESULTS

We included 228 patients (mean age 75.8; 52% males). On admission, 126 (55%) were dysphagic (FOIS≤6). Age (OR 1.03, 95%CI 1.00-1.05), pre-event modified Rankin scale (mRS) (OR 1.41, 95%CI 1.09-1.84), National Institute of Health Stroke Scale (NIHSS) (OR 1.79, 95%CI 1.49-2.14), frontal operculum lesion (OR 8.53, 95% CI 3.82-19.06), and Oxfordshire total anterior circulation infarct (TACI) (OR 1.47, 95%CI 1.05-2.04) were independently associated with dysphagia at admission. Education (OR 0.91, 95%CI 0.85-0.98) had protective role. At discharge, 82 patients (36%) were dysphagic. Pre-event mRS (OR 1.28, 95%CI 1.04-1.56), admission NIHSS (OR 1.88, 95%CI 1.56-2.26), frontal operculum involvement (OR 15.53, 95%CI 7.44-32.43), and Oxfordshire classification TACI (OR 3.82, 95%CI 1.95-7.50) were independently associated with dysphagia at discharge. Education (OR 0.89, 95%CI 0.83-0.96) and thrombolysis (OR 0.77, 95%CI 0.23-0.95) had protective role. The 6-point "NOTTEM" (NIHSS, Opercular lesion, TACI, Thrombolysis, Education, MRS) score predicted dysphagia at discharge with good accuracy. Cognitive scores had no role in dysphagia risk.

CONCLUSIONS

We defined dysphagia predictors and developed a score to evaluate dysphagia risk during stroke unit stay. In this setting, cognitive impairment is not a predictor of dysphagia. Early dysphagia assessment may help planning future rehabilitative and nutrition strategies.

Case Report: A Fatal Case of West Nile Virus Meningoencephalomyelitis in a Woman with Systemic Lupus Erythematosus Initially Misdiagnosed as SARS-CoV-2 Infection

We present a fatal case of West Nile virus meningoencephalomyelitis initially misdiagnosed as COVID-19 in a 63-year-old Egyptian woman with a previous diagnosis of systemic lupus erythematosus. The patient's medical history and immunosuppressive therapy, as well as the COVID-19 pandemic, substantially broadened the differential diagnosis of her encephalitis.

Living Alone and Dementia Incidence: A Clinical-Based Study in People With Mild Cognitive Impairment

INTRODUCTION

Social isolation and living alone have been associated with negative outcomes, especially in the older population. We aim to investigate the effect of living alone on the development of dementia in people with mild cognitive impairment (MCI).

MATERIALS AND METHODS

In this longitudinal study, we enrolled 345 outpatients with MCI evaluated at baseline through a clinical and neuropsychological protocol. Data on living situation (living alone vs. living with someone) were also collected. The development of dementia at follow-up was the outcome of the study. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression analyses. Laplace regression was used to model the time-to-dementia diagnosis as a function of living situation.

RESULTS

During the follow-up time (mean [SD]: 2.8 [2.2] years), 172 (50%) participants developed dementia. After controlling for age, sex, years of education, MCI subtype, presence of comorbidities, and antidepressant therapy, people with MCI living alone were more likely to develop dementia (HR: 1.5; 95% CI: 1.1-2.1), when compared to those living with someone. In addition, participants with MCI living alone were diagnosed with dementia 1 year earlier than those living with someone ( P = .012).

CONCLUSION

Living alone increases by 50% the risk of developing dementia and anticipates by 1 year the diagnosis in people with MCI. These results, in line with findings of previous population-based studies, emphasize the pivotal role of the living situation in identifying a frailer share of the population at higher risk of dementia to which devote ad hoc assessment and care.

Diagnostic role of (18)F-FDG-PET or PET/CT in salivary gland tumors: A systematic review

Salivary gland tumors are rare neoplasms that have not been extensively studied with (18)F-FDG-PET- or PET/CT up to now. This review aims to evaluate the diagnostic performance of PET in this particular setting, analyzing the available literature. A comprehensive literature search in the PubMed/MEDLINE, Embase and Scopus databases was performed including articles up to November 2014, resulting in the selection of 22 articles. The studies selected suggest that: (1) PET is not useful in discriminating benign from malignant SGTs because of the overlap of uptake in both conditions; (2) PET not only is complementary to conventional imaging techniques for the staging and restaging but in some cases could also be superior to them; (3) PET may often have a highly positive impact on clinical decision making. Despite many limitations affecting the analysis, PET seems to be useful in SGTs. However, more extensive studies and cost-effectiveness analyses are desirable to determine its correct position in the diagnostic flow chart.