Cumulative comorbidity burden does not worsen outcomes in management of chronic rhinosinusitis

BACKGROUND

The impact of multiple coexisting medical comorbidities on treatment outcomes in chronic rhinosinusitis (CRS) is unknown. In this study we sought to evaluate the effect of comorbidities on sinonasal quality of life (QOL) and general health utility values by utilizing the Functional Comorbidity Index (FCI) in CRS patients.

METHODS

Patients with CRS were prospectively enrolled in a cross-sectional study of medical and surgical therapies. The 22-item Sino-Nasal Outcome Test (SNOT-22) and Medical Outcomes Study Short-Form 6D (SF-6D) scores were recorded at enrollment and 6-month follow-up; Lund-Kennedy endoscopy and Lund-Mackay computed tomography scores were recorded at enrollment. The FCI was calculated using the electronic medical record. The impact of cumulative comorbidity burden on baseline and posttreatment outcomes was assessed using univariate and bivariate correlations.

RESULTS

A total of 428 participants with CRS were included. The average (mean standard ± deviation) FCI score was 3.03 ± 2.28 (range, 0-12). Significant linear correlations were identified between increasing FCI score and baseline SNOT-22 and SF-6D scores (R = 0.166, p = 0.001 and R = -0.245, p < 0.001, respectively). There was no correlation between FCI and change in SNOT-22 or SF-6D scores after CRS treatment (R = 0.066, p = 0.17 and R = -0.087, p = 0.074, respectively). Achievement of a minimally clinically important difference was also independent of FCI.

CONCLUSION

Although cumulative comorbidity burden, as measured by FCI, is associated with worse baseline SNOT-22 and SF-6D scores, it does not appear to limit posttreatment improvement in either outcome measure. On average, patients with high comorbidity burden report substantial improvement in both QOL and health utility after CRS treatment, similar to those with fewer comorbidities.

Measurement of day and night neutrino energy spectra at SNO and constraints on neutrino mixing parameters

The Sudbury Neutrino Observatory (SNO) has measured day and night solar neutrino energy spectra and rates. For charged current events, assuming an undistorted 8B spectrum, the night minus day rate is 14.0%+/-6.3%(+1.5%)(-1.4%) of the average rate. If the total flux of active neutrinos is additionally constrained to have no asymmetry, the nu(e) asymmetry is found to be 7.0%+/-4.9%(+1.3%)(-1.2%). A global solar neutrino analysis in terms of matter-enhanced oscillations of two active flavors strongly favors the large mixing angle solution.

Direct evidence for neutrino flavor transformation from neutral-current interactions in the Sudbury Neutrino Observatory

Observations of neutral-current nu interactions on deuterium in the Sudbury Neutrino Observatory are reported. Using the neutral current (NC), elastic scattering, and charged current reactions and assuming the standard 8B shape, the nu(e) component of the 8B solar flux is phis(e) = 1.76(+0.05)(-0.05)(stat)(+0.09)(-0.09)(syst) x 10(6) cm(-2) s(-1) for a kinetic energy threshold of 5 MeV. The non-nu(e) component is phi(mu)(tau) = 3.41(+0.45)(-0.45)(stat)(+0.48)(-0.45)(syst) x 10(6) cm(-2) s(-1), 5.3sigma greater than zero, providing strong evidence for solar nu(e) flavor transformation. The total flux measured with the NC reaction is phi(NC) = 5.09(+0.44)(-0.43)(stat)(+0.46)(-0.43)(syst) x 10(6) cm(-2) s(-1), consistent with solar models.

Resolution of the pathways of poliovirus type 1 transmission during an outbreak

An outbreak of poliomyelitis with 20 cases occurred in Israel, Gaza, and the West Bank from October 1987 to October 1988. The wild type 1 poliovirus associated with the outbreak was most closely related to viruses found in the Nile Delta. The epidemiologic links among patients involved in the outbreak and patients with community-acquired infections during the outbreak were inferred from the evolutionary relationships among isolates of the outbreak virus. Complete VP1 sequences (906 nucleotides) were determined for 12 clinical and 4 sewage isolates. A total of 58 nucleotide differences were found among the 16 isolates; 74% of all substitutions were synonymous third-position transitions. An evolutionary tree, representing both the pathways of VP1 sequence evolution and the inferred chains of virus transmission during the outbreak, was constructed under the assumption that each substitution had occurred only once. The combined epidemiologic and molecular data suggest that a single founder strain was introduced into Israel from the vicinity of Gaza in the fall of 1987. Poliovirus circulation was apparently localized to southern communities during the winter and spread north by the following summer into the Hadera subdistrict of Israel, where it radiated via multiple chains of transmission into other communities in northern Israel and the West Bank. The close sequence matches (>99%) between clinical and sewage isolates from the same communities confirm the utility of environmental sampling as a tool for monitoring wild poliovirus circulation.

Multiple specificities of the staphylococcal and streptococcal fibronectin-binding microbial surface components recognizing adhesive matrix molecules

Many pathogenic gram-positive bacteria express fibronectin (Fn)-binding microbial surface components recognizing adhesive matrix molecules (MSCRAMMs), most of which have a similar structural organization with a primary ligand-binding domain consisting of 3-6 repeats of 40-50 amino-acid-residue motifs. The MSCRAMMs appear to preferentially bind to the N-terminal region of Fn, which is composed of five type-I modules. Here we report that the Fn-binding MSCRAMM FnbpA of Staphylococcus aureus contains a second ligand-binding domain located outside the repeat units. In addition, several sites in the Fn N-terminus presented as recombinant type-I module pairs bind to the repeat domain of the MSCRAMM. All of the MSCRAMMs analyzed, which include FnbpA of Staphylococcus aureus, Sfb of Streptococcus pyogenes, and FnbA and FnbB of Streptococcus dysgalactiae, were shown to bind to multiple sites in the N-terminal domain of Fn. By dissecting the repeat domain of FnbpA using synthetic peptides and recombinant fragments, we show that discrete, different motifs are responsible for the binding to individual sites in Fn, rather than a common motif being able to bind to several pairs of type-I Fn modules. The C-terminal half of many of the MSCRAMM repeat units contain a common motif, which is shown here to bind to the type-I module pair 4 and 5. In addition, some of the repeat units of FnbpA contain N-terminal motifs which bound to the type-I module pairs 1-2 and 2-3, respectively. These latter binding motifs appear to be partly overlapping and dependent on flanking sequences. Fluorescence polarization experiments using fluorescein-labeled MSCRAMM peptides and recombinant type-I Fn module pairs revealed dissociation constants of 1-13 microM. It was also shown that the fluorescein-labeled peptides differed in their primary binding sites on Fn.

Photodynamic inactivation of herpes viruses with phthalocyanine derivatives

The antiviral photosensitization capacity of 11 different phthalocyanine (Pc) derivatives was examined using herpes simplex virus-1, herpes simplex virus-2 and varicella zoster virus in the search for the most potent sensitizers for viral decontamination of blood. The kinetics of viral photoinactivation were resolved during the stages of viral adsorption and penetration into the host cells. The capacity of Pc in the photodynamic inactivation of viruses was compared with that of merocyanine 540 (MC540), another widely studied photosensitizer. Sensitivity to photoinactivation decreased progressively with time after addition of viruses to their host cells. The viruses were most sensitive to photodynamic inactivation up to 30 min from the initiation of adsorption. Cell-associated viruses, 45-60 min after the onset of adsorption, are highly resistant to photodynamic treatment by most photosensitizers, with the exception of amphiphilic Pc derivatives. Thus the mixed sulfonated Pc-naphthalocyanine derivatives AlNSB3P and AlN2SB2P demonstrated a remarkable decontamination activity even 60 min after the onset of adsorption. Ultrastructural examination of these photosensitized viruses demonstrated damage to the viral envelope which prevented viral adsorption and/or penetration. The non-enveloped adenovirus was found to be resistant to all the dyes tested.

Legionella longbeachae pneumonia in a patient splenectomized for hairy-cell leukemia

A 63-year-old man was admitted to the respiratory intensive care unit for pneumonia. Fifteen years earlier, hairy cell leukemia had been diagnosed and the patient underwent splenectomy. A clinical suspicion of legionellosis, later confirmed by both serology and isolation of the microorganism, prompted initiation of high dose erythromycin intravenously. The patient steadily deteriorated and passed away eight days later. This is the first reported case of hairy cell leukemia in which the diagnosis of Legionella longbeachae sero-group 1 infection was based on both serology and isolation.

Nodular malignant lymphoma presenting as bilateral adnexal masses

A case of nodular malignant lymphoma, small cleaved cell in both ovaries, tubes and peritubal tissue is reported in a 55-year-old nulliparous woman with primary clinical symptoms of dyspnea and chest pain. The disease was first diagnosed at laparotomy. The patient was treated by bilateral adnexectomy and chemotherapy. This is the third case of adnexal small cleaved cell nodular lymphoma reported in the literature. Clinical and pathological aspects of this relatively rare pathological entity are reviewed.

Detection of hepatitis A virus in sewage

Hepatitis A virus was found in the sewage of a town during an outbreak of hepatitis. The test for the presence of the virus in 50 ml sewage samples was carried out by affinity chromatography on an immunoadsorbent column followed by immune electron microscopy. The sewage samples were collected from several locations in the town. Hepatitis A virus was found only in a sample which was taken directly from the affected neighbourhood.

Evaluation of bone marrow granulocyte reserves in neutropenic and nonneutropenic Yemenite Jews

The bone marrow granulocyte reserves of 10 Yemenite Jews with hereditary neutropenia were estimated by measuring the maximum peripheral blood granulocyte increment after the administration of 40 mg prednisone. The control group consisted of 11 nonneutropenic Yemenites and 15 non-Yemenite Jews with normal peripheral blood neutrophil counts. The mean peripheral blood granulocyte increment in the neutropenic and nonneutropenic Yemenites was significantly less than in the non-Yemenite Jews. There was no significant difference in the response of the two Yemenite groups.

Acute lymphoblastic crisis in a patient with chronic lymphatic leukemia

A case of chronic lymphatic leukemia terminating in a lymphoblastic crisis is described. The small lymphocytes were demonstrated to be B cells, they carried immunoglobulins on their surface and formed EAC rosettes. The lymphoblasts had no immunoglobulins on their surface and only 18% of them formed EAC rosettes, none formed E rosettes. The lymphoblasts could be either immature B cells or Null cells.