Histologic characterization of primary ciliary dyskinesia chronic rhinosinusitis

KEY POINTS

We present the largest cohort of structured histopathology reports on primary ciliary dyskinesia-related chronic rhinosinusitis (PCD-CRS). Despite endoscopic differences, PCD-CRS and cystic fibrosis-related chronic rhinosinusitis (CF-CRS) had similar structured histopathology reports. Compared to healthy patients and those with idiopathic chronic rhinosinusitis without nasal polyps, patients with PCD-CRS had an increased neutrophil count.

The Surprising Effect of Priming on SNOT-22 Results

BACKGROUND

Priming is a psychological phenomenon where subconscious cues in the environment impact our behavioral responses in certain situations. Well studied in the worlds of business, marketing, and even politics, it is unclear how the priming phenomenon impacts patient perception of their own disease state nor how they report that perception using tools like the Sinonasal Outcomes Test (SNOT-22), used to measure that perception in chronic rhinosinusitis.

OBJECTIVE

To determine the impact of positive or negative priming on self-reported patient perception of their chronic rhinosinusitis disease using the SNOT-22 disease-specific quality of life instrument.

METHODS

Single-blind, randomized, prospective cohort pilot study of 206 consecutive adult patients with a clinical diagnosis of chronic rhinosinusitis presenting to a university rhinology clinic. Patients were randomized to receive "positive priming" (103) or "negative priming" (103) by reading a passage about the positive or negative aspects of chronic sinusitis and its treatment respectively. Patients were then asked to fill out the SNOT-22 and results between the two groups were compared.

RESULTS

The negative priming group had a higher median SNOT-22 score of 49 [IQR = 39] compared to the positive priming groups' score of 22 [IQR = 27], p < 0.0001), a difference of nearly three times the minimal clinical impactful difference (MCID). This effect was consistent regardless of age or sex of the patient. Subgroup analysis revealed a greater impact when priming was performed by the senior male attending regardless of patient age or sex (p < 0.001), while priming performed by the younger female research fellow had greater impact on older patients (>59 years, p = 0.001) and female patients (p = 0.003).

CONCLUSIONS

Priming impacts how patient's perceive their chronic rhinosinusitis as determined by the SNOT-22. It is imperative that the rhinologist understand this when using this instrument in research applications and in clinical decision-making for patients.

"Left on their own": Left-handedness among rhinologists and otolaryngology trainees

KEY POINTS

Left-hand-dominant (LHD) respondents reported higher rates of training difficulties because of handedness differences. LHD respondents cited particular difficulty with functional endoscopic sinus surgery. Both LHD and right-hand-dominant respondents perceived a need for laterality-specific training during residency.

Characterizing Adverse Events of Biologic Treatment of T2 Disease: A Disproportionality Analysis of the FDA Adverse Event Reporting System

INTRODUCTION

Over the last 3 years, the FDA has approved dupilumab, omalizumab, and mepolizumab for the treatment of CRSwNP; however, adverse events of these biologics have not been described in post-marketing surveillance trials. By utilizing the FDA Adverse Event Reporting System (FAERS), this study describes and compares biologic-associated adverse events in T2 disease.

METHODS

This case-non-case study assessed disproportionate reporting rates using reporting odds ratios (RORs). RORs and p values for biologic-associated AEs were categorized and compared among dupilumab, omalizumab, and mepolizumab. This analysis included AEs associated with all treatment indications. Relative AE rates and outcomes were calculated.

RESULTS

There were a total of 112,560, 24,428, and 18,741 unique AE reports associated with dupilumab, omalizumab, and mepolizumab, respectively. Omalizumab had the strongest association with anaphylaxis (ROR = 20.80, 95% confidence interval [CI]: 18.58, 23.29). Dupilumab had large relative proportions and positive signals in the ophthalmologic category (7.76%, ROR = 6.20, 95% CI: 6.06, 6.35), such as with blurry vision (ROR = 3.80, CI: 3.52, 4.12) and visual impairment (ROR = 1.98, CI: 1.80, 2.19). Dupilumab was the only biologic associated with injection-site reactions (7.98%, ROR = 8.17, 95% CI: 7.98, 8.37).

DISCUSSION/CONCLUSION

This is the first large-scale comparative analysis of the AE profiles of dupilumab, omalizumab, and mepolizumab. Our data suggest possible relations between dupilumab and ophthalmologic and injection-site AEs. Omalizumab was the only biologic with a positive anaphylaxis signal. This FAERS investigation suggests important AE differences among these biologics.

Sinonasal quality of life in primary ciliary dyskinesia

KEY POINTS

Our findings suggest that primary ciliary dyskinesia (PCD)-related chronic rhinosinusitis (CRS) has a more significant impact on quality of life than CRS without nasal polyps and cystic fibrosis (CF). PCD and CF have similar mucociliary clearance defects, yet sinonasal symptom severity varies between the two.

Characteristics of olfactory dysfunction in patients with long-haul covid-19

Background

A subset of individuals suffering from Coronavirus Disease 2019 (COVID-19) will experience ongoing symptoms that last longer than three months (i.e., long-haul COVID). This includes olfactory dysfunction (OD), which is currently estimated to occur in 1-63.5% of patients at one-year post-infection. However, OD in individuals with long-haul COVID-19 is poorly understood, and there is little information regarding how initial SARS-CoV-2 variants correlate with long-haul symptoms. In this study, we investigated the prevalence and severity of OD in patients with long-haul COVID-19 and investigated how OD severity varied with SARS-CoV-2 variants.

Methods

Patients were recruited from the University of North Carolina-Chapel Hill COVID Recovery Clinic. Each patient completed the University of Pennsylvania Smell Identification Test (UPSIT). The dominant strain at the time of infection was determined using the date of COVID-19 diagnosis, and Centers for Disease Control and Prevention, World Health Organization, and North Carolina Department of Health and Human Services databases.

Results

Nearly 85% of patients with long-haul COVID-19 reported some degree of OD, which persisted in some patients for two or more years from the date of the initial infection. There was no association between the time since COVID-19 infection and severity of OD. No difference was detected between OD in patients with long-haul COVID-19 based on the dominant variant at the time of infection (p=0.0959).

Conclusion

A vast majority of patients with long-haul COVID-19 had some degree of ongoing olfactory complications, although the severity of symptoms was not dependent on the dominant SARS-CoV-2 variant at the time of infection.

Granulomatosis With Polyangiitis Presenting as an Infratemporal Fossa Mass

Granulomatosis with polyangiitis is a rare autoimmune disease that affects small to medium-sized blood vessels throughout the body. Here, we present a case of an infratemporal mass that was the result of granulomatosis with polyangiitis. A 51-year-old male presented to the emergency department due to right cheek and facial pain that he had been experiencing for 2 to 3 months. An MRI revealed a mass within the right infratemporal and pterygopalatine fossae extending into the inferior right orbital fissure along the maxillary division of the trigeminal nerve (V2) and the vidian nerve causing concern for malignancy. Histology from an endoscopic biopsy demonstrated multiple arteries with luminal obliteration with non-necrotizing granulomas. The patient was started on steroids and immunosuppressive therapy, which improved his symptoms and decreased the size of the residual mass. This case illustrates the need for laboratory testing, imaging, and biopsy of the involved tissue in cases where GPA is suspected to prevent treatment delays that could lead to the destruction of vital organs.

Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study

Introduction:

The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID-19.

Material and method:

This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan.

Result:

A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01).

Conclusion:

Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.

Management and outcome of gastric carcinoma in Zaria, Nigeria

INTRODUCTION

Gastric cancer is the second leading cause of cancer death in the world. The objective of this study was to present the clinical evaluation, treatment and outcome of 179 patients with gastric carcinoma in Zaria, Nigeria.

METHODS

Patients managed for histologically diagnosed gastric carcinoma were reviewed. The extent of surgical intervention was based on pre-operative and intra-operative staging balanced against the age and overall fitness of the patient. Mortality, morbidity and patient's survival were monitored.

RESULTS

There were 179 patients, with a male to female ratio of 1.4:1. Their mean age was 51 ± 6.3. Ten (5.6%) patients presented with early gastric cancer. Overall, 155(86.6%) patients had surgical intervention including gastric resection in 87 (56.1%). Of the gastrectomies , 28.7% were curative (R0). Postoperative complications were seen in 43(27.7%) patients. Postoperative mortality in 25(16.1%) patients was significantly associated with peritoneal metastasis (p<0.001), preoperative comorbidity (p<0.01) and age more than 60 years (p<0.03). The overall median survival was 13.6 months while 70.1% and 21.8% of patients that underwent gastrectomy survived for 1 and 5 years respectively.

CONCLUSION

Treatment of gastric cancer should be based on a reasonable choice of operation that must consider not only the survival benefits but also the surgical risks and postoperative quality of life.

Avoiding painful blood sampling in neonates by transcutaneous bilirubinometry

BACKGROUND

Transcutaneous bilirubinometry, Bilicheck (kindly provided by Oxygen Care Company, Dublin) is a non-invasive, screening method for determining bilirubin levels in neonates. It has not previously been validated in Irish babies.

AIMS

To determine the clinical accuracy and precision of Bilicheck measurements in comparison to total serum bilirubin (TSB) measurements in Irish neonates, and to determine whether Bilicheck is a useful non-invasive screening method of avoiding blood tests in neonates.

METHODS

Correlation data were obtained from 53 neonates between simultaneous TSB and Bilicheck readings. Bilicheck was used to screen 100 neonates who were assessed as requiring serum bilirubin measurement. TSB was only performed on neonates whose Bilicheck was above the phototherapy line of a recognised serum bilirubin chart.

RESULTS

Bilicheck and TSB were significantly correlated (r=0.890). Bland and Altman analysis showed that on average, Bilicheck read 30 micromol/l lower than TSB. Of 100 jaundiced neonates screened by Bilicheck, blood sampling was avoided in 70 because Bilicheck did not meet phototherapy guidelines.

CONCLUSIONS

There is a good correlation between TSB and Bilicheck, although the latter tends to under-read by 30 micromol/l. Bilicheck may be a useful screening device to decrease the risks and discomfort associated with blood sampling in neonates.