A Retrospective Analysis from Western Romania Comparing the Treatment and Survivability of p16-Positive versus p16-Negative Oropharyngeal Cancer

BACKGROUND

Oropharyngeal cancer is a global health concern due to its multifaceted nature. Recent molecular studies have linked p16 overexpression, associated with the human papillomavirus, to oropharyngeal cancer and its prognostic implications.

MATERIALS AND METHODS

This retrospective study in Western Romania examined 60 patients, categorizing them based on p16 biomarker status: 28 were p16 positive, and 32 were p16 negative. Statistical tests, including Fisher's exact and chi2, were used for analysis.

RESULTS

Patients with p16-positive oropharyngeal cancer exhibited a better prognosis (3-year survival, p = 0.0477; midtreatment, p = 0.0349) and reported lower alcohol (p = 0.0046) and tobacco (p < 0.0001) use.

CONCLUSIONS

The study highlights the importance of p16 testing in oropharyngeal carcinoma diagnosis. It suggests modifying treatment approaches based on p16 status and underscores the differing prognoses associated with p16-positive and p16-negative cases.

Clinical features and outcomes of patients with myasthenia gravis admitted to an intensive care unit: A 20-year retrospective study

Background

There are limited data on the clinical characteristics and outcomes of patients with myasthenia gravis (MG) admitted to the intensive care unit (ICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Objectives

The aim was to study the clinical characteristics and outcomes of patients with MG admitted to the CMJAH over two decades.

Methods

A retrospective study was undertaken of patients with MG admitted to the multidisciplinary ICU of CMJAH over a 20-year period, from 1998 to 2017. Demographic data, clinical features, management and outcomes of patients were assessed and reviewed from the case records.

Results

Thirty-four patients with MG were admitted to the ICU during this period: 24 female and 10 male. The mean age ± SD was 37.4 ± 13.0 years, with a range of 16 - 66 years. Four patients were human immunodeficiency virus (HIV)-positive. The mean length of stay (LOS) in ICU was 10.6 ± 20.1 days, ranging from 1 to 115 days. Two patients were diagnosed with MG in the ICU after failure to wean from the ventilator. Overall, 22 patients were intubated and ventilated on admission. Morbidities included self-extubation, aspiration pneumonia and iatrogenic pneumothorax. History of thymectomy was present in 12 patients. The treatments received for MG included pyridostigmine (73.5%), corticosteroids (55.9%), azathioprine (35.3%), plasmapheresis (26.5%) and intravenous immunoglobulin (8.8%). The overall mortality in the ICU was 5.9%.

Conclusion

MG is a serious disorder with considerable morbidity and mortality. It is, however, a potentially manageable disease, provided that appropriate ICU resources are available.

Contributions of the study

This study provides further insight into the characteristics and outcomes of myasthenia gravis patients in ICU, within a South African context.

Efficacy of Bilateral Cochlear Implantation in Pediatric and Adult Patients with Profound Sensorineural Hearing Loss: A Retrospective Analysis in a Developing European Country

This retrospective study aimed to evaluate the outcomes of bilateral cochlear implantation in patients with severe-to-profound sensorineural hearing loss at the Timisoara Municipal Emergency Clinical Hospital ENT Clinic. The study involved 77 participants, divided into four groups based on their hearing loss characteristics and implantation history. Assessments were conducted pre- and post-implantation, focusing on speech perception, speech production, and reading achievement. Standard surgical procedures were performed, and participants were provided with a comprehensive rehabilitation program involving auditory training and communication therapy. The variables considered for analysis included demographic factors, implantation period, and quality of life assessment, with no statistically significant differences pre-implantation between the four study groups. Results revealed significant improvements in speech perception, speech production, and reading achievement after cochlear implantation. In adult patients, speech perception scores increased from 21.3% to 73.4% for WIPI and from 22.7% to 68.4% for HINT after 12 months of rehabilitation. Speech production scores improved from 33.5% to 76.8% and reading achievement scores increased from 76.2 to 106.3. Moreover, there was a significant improvement in patients' quality of life following cochlear implantation, with mean scores increasing from 2.0 to 4.2. Although it is known that bilateral cochlear implantation significantly improves speech perception, speech production, reading achievement, and quality of life in patients with severe-to-profound sensorineural hearing loss, this is the first study of its kind from Romania. Further research is warranted to optimize patient selection and rehabilitation strategies to maximize outcomes and determine better policies towards funding and access of cochlear implants for a wider range of patients in need.

Otosclerosis under the magnifying glass

Otosclerosis is a bone condition affecting the stapes bone within the otic capsule, and its exact cause is still unknown. It is characterized by a lack of proper remodeling of newly formed vascular and woven bone, leading to the development of abnormal osteons and the formation of sclerotic bone. Bilateral otosclerosis is seen in 80% of patients and 60% of otosclerosis patients have a family history of the condition. The etiology of this disease is still unknown, there are lots of theories to explain it. The histopathological (HP) studies of otosclerosis showed that osteoblasts, osteoclasts, vascular proliferation, fibroblasts, and histiocytes were observed in the stapes footplate. The onset of the symptoms occurs by the early third decade of life, usually it doesn't start later. In otosclerosis, the energy exerted by sound at the level of the tympanic membrane is reduced in the inner ear due to the fixation and rigidity of the ossicular chain, leading to hearing loss, especially for low frequencies. The primary clinical symptom of otosclerosis is conductive hearing loss but it is important to note that sensorineural hearing loss and mixed hearing loss can also occur as secondary symptoms of the condition. Another symptom present in patients with otosclerosis is tinnitus. The paper carried out a retrospective study of 70 patients diagnosed with otosclerosis in the Department of Otorhinolaryngology of Emergency City Hospital, Timişoara, Romania, between January 2021 to December 2022. Tissue fragments were processed at Service of Pathology by standard Hematoxylin-Eosin staining. The HP diagnosis was completed using Masson's trichrome staining, Giemsa histochemical staining, and immunohistochemical (IHC) reactions with anti-cluster of differentiation (CD)20, anti-CD3, anti-CD4, anti-CD8, anti-CD34, and anti-CD31 antibodies. The microscopic examination showed a chronic diffuse inflammatory infiltrate that consisted predominantly of mature T-lymphocytes, immunohistochemically positive for CD3, CD4 and CD8. There were also present rare CD20-positive B-lymphocytes. Among the lymphocytes, relatively numerous mast cells were identified, highlighted histochemically by the Giemsa staining. They had numerous purple-violet intracytoplasmic granules. In the connective tissue support, a relatively rich vascular network was identified, consisting of hyperemic capillaries, highlighted immunohistochemically with anti-CD31 and anti-CD34 antibodies. Bone tissues trabeculae showed extensive areas of fibrosis. The collagen fibers were highlighted by Masson's trichrome staining, being stained in green, blue, or bluish green.

A Review Regarding the Connections between Allergic Rhinitis and Asthma - Epidemiology, Diagnosis and Treatment

Allergic rhinitis is characterized by an acute or chronic inflammation of the nasal mucosa, being frequently associated with other airway conditions such as sinusitis, serous otitis media, nasal polyposis, sleep disorders and asthma in particular. Among the comorbidities of allergic rhinitis it counts asthma, being a risk factor for this disorder, in which, more than 75% of patients develop asthma (either allergic or nonallergic), whereas the patients with allergic rhinitis can be affected up to 40% by asthma. The classic symptoms for allergic rhinitis involves sneezing, nasal mucosal swelling and watery rhinorrhea; whereas the main symptoms which occurred in patients with asthma are wheezing, breathlessness, chest tightness, coughing, fast heartbeat, confusion, exhaustion or dizziness. Avoiding allergens is the first line of treatment for allergic rhinitis, followed by medication and allergen immunotherapy. Due to the strong connection between allergic rhinitis and asthma, one can affirm that the treatment for allergic rhinitis lead to the improvement of asthma symptoms. One can diagnose asthma by recognizing a certain pattern of respiratory symptoms and expiratory airflow restriction, which varies for each patient. In conclusion, accurate identification of the differences between allergic rhinitis and asthma depends on a thorough history, physical examination, and therapeutic treatments. This article provides an overview of the connection between these disorders, as well as of the diagnosis of these conditions and their current management options.

Development and Preliminary Characterization of Polyester-Urethane Microparticles Used in Curcumin Drug Delivery System for Oropharyngeal Cancer

Background and Objectives: Curcumin (Cc) as an active substance is known for its anti-inflammatory, anticoagulant, antioxidant, and anti-carcinogenic effects, together with its role in cholesterol regulation, and its use in different gastrointestinal derangements. On the other hand, curcumin can be used for its properties as an inactive substance, with Cc particles being more often tested in pharmaceutical formulations for drug delivery, with promising safety records and kinetics. The aim of this research was to obtain and characterize polyurethane microparticles that can be used as a carrier with a controlled Cc release. Materials and Methods: The in vitro samples were characterized by the Zetasizer procedure, and UV-Vis spectroscopy, while the in-vivo measurements on human subjects were performed by non-invasive skin assays (trans-epidermal water loss, erythema, and skin hydration). A total of 16 patients with oropharyngeal cancer stages II and III in equal proportions were recruited for participation. Results: The experimental values of sample characteristics using the Zetasizer identified a mean structural size of 215 nm in the polyester-urethane preparate (PU), compared to 271 nm in the curcumin-based PU. Although the size was statistically significantly different, the IPDI and Zeta potential did not differ significantly (22.91 mV vs. 23.74 mV). The average age during the study period was 57.6 years for patients in the PU group, respectively, and 55.1 years in those who received the curcumin preparations. The majority of oropharyngeal cancers were of HPV-related etiology. There were no significant side effects; 75.0% of patients in the PU group reporting no side effects, compared to 87.5% in the Cc group. The 48 h TEWL measurement at the end of the experiment found a statistically significant difference between the PU and the Cc group (2.2 g/h/m² vs. 2.6 g/h/m²). The erythema assessment showed a starting measurement point for both research groups with a 5.1-unit difference. After 48 h, the difference between PU and PU_Cc was just 1.7 units (p-value = 0.576). The overall difference compared to the reference group with sodium lauryl sulfate (SLS) was statistically significant at a 95% significance level. Conclusions: Our findings indicate the obtaining of almost homogeneous particles with a medium tendency to form agglomerations, with a good capacity of encapsulation (around 60%), a medium release rate, and a non-irritative potential. Therefore, this polyester-urethane with Cc microparticles can be tested in other clinical evaluations.

Allergic rhinitis associated with nasal polyps and rhinosinusitis - histopathological and immunohistochemical study

Currently, allergic rhinitis (AR) is the most common allergic disease worldwide. AR is defined as immunoglobulin E (IgE)-mediated chronic inflammatory disease of the upper airways. It characterizes by symptoms like nasal obstruction, rhinorrhea, nasal itching, and sneezing. The immune system and genetic susceptibility in the interaction with the environment lead to the development of AR. Many cytokines, chemokines and cells maintain allergic inflammation. Studies show that 10% to 30% of the adult population are affected, and that prevalence rates are increasing world widely. AR, nasal polyps (NP), as well as chronic rhinosinusitis (CRS) are all associated with eosinophilic infiltration and large quantities of mast cells (MCs) within the mucosa. The diagnosis and management of chronic sinonasal diseases involves the analysis of eosinophilic infiltration, MCs, and their markers eosinophilic cationic protein (ECP) and tryptase. Regarding nasal cancer, nasal allergies were found to exhibit a dual function: immune surveillance may help in the defense against malignant cells, but an opposite effect is observed in tissues with chronic stimulation and inflammation. In the present paper, we studied a group of 70 patients diagnosed with AR and NP, rhinosinusitis or nasal cancer, admitted to the Ear, Nose & Throat (ENT) Clinic of the Emergency City Hospital, Timişoara, Romania, between January 2016 and December 2020, and we identified 37 (53%) patients diagnosed with AR and NP, 25 (36%) patients diagnosed with AR and rhinosinusitis, and eight (11%) patients diagnosed with AR and nasal cancer. The average age of the patients was 53 years old. Every patient included in the study was histopathologically and immunohistochemically diagnosed.

Fortuitous discovery of melanomas in the ENT Department - a histopathological and immunohistochemical study

The melanoma, having its origin in the melanocyte cells, is one of the most aggressive forms of skin cancer in the world with one of the highest rates of brain metastasis. The incidence of cutaneous melanoma in the Mediterranean countries varies from three to five cases/100 000 people/year. Its prognosis is based on an early diagnosis. Sinonasal mucosal melanoma (SNMM) is an extremely rare tumor, accounting for 0.3–2% of all melanomas. The non-specific symptomatology is often delaying the presentation of the patient at the hospital and therefore the diagnosis. The SNMM is a highly aggressive tumor, and the presence of metastasis at the diagnosis usually implies a poor prognosis. The management of the melanomas requires a precise pre-therapeutic assessment and a multidisciplinary approach for the diagnosis, with surgical treatment or radiotherapy required in order to ensure a better a quality of life. In this paper, we retrospectively analyzed two cases of mucosal melanoma and one case of cutaneous melanoma of the nose.

Head and neck metachronous tumors - clinical, histopathological and immunohistochemical study

Multiple primary tumors (MPT) represent an important factor affecting the survival of some patients. They present an incidence of about 0.7-11% of all carcinomas developing in any region of the human body, being either synchronous or metachronous. These tumors raise problems of differential diagnosis, with tumoral relapses and distance metastases; also, they involve problems related to chemotherapy, radiotherapy and surgical treatment. In the present paper, we studied a group of 902 patients diagnosed with head and neck tumors admitted to the Ear, Nose & Throat (ENT) Clinic of the Emergency County Hospital of Timişoara, Romania, and we identified 12 patients with metachronous tumors, representing 1.33% of the hospitalized cases. Of the 12 patients with metachronous tumors, a single case was a woman, the other 11 cases being diagnosed in men. Regarding the age of the patients with metachronous tumors, only a single patient was aged less than 60 years old; most of them (nine patients) were aged between 60 and 69 years old, while two patients were aged over 70 years old. Nine patients were alcohol consumers, while 10 (83.33%) patients were smokers of about 20 cigarettes∕day. All the metachronous tumors localized in the head and neck were squamous cell carcinomas. The second primary tumor was identified in the prostate, kidneys, ureter, lungs, salivary gland, thyroid gland, meninges, colon, rectum or skin.

Effect of a dietary supplement containing blueberry and sea buckthorn concentrate on antioxidant capacity in type 1 diabetic children

Many studies have shown that oxidative stress plays an important role in the etiology of diabetes and its complications. New methods of treatment for prevention and control of this disease is a priority for the international scientific community.

METHODS

We investigated the relationship between the glycated hemoglobin, C peptide and two antioxidant enzymes. Thirty type 1 diabetic children were treated with a blueberry and sea buckthorn concentrate for two months.

RESULTS

After two months of administering the product to diabetic children, the erythrocyte superoxide dismutase activity was significantly higher (p < 0.05). Levels of glycated hemoglobin were significantly lower (p < 0.05). The activity of whole blood glutathione peroxidase was moderately increased but the difference was not statistically significant. C peptide concentration was significantly higher after treatment with this dietary supplement (p < 0.05).

CONCLUSION

These results suggest that treatment with this dietary supplement has a beneficial effect in the treatment of type 1 diabetic children and it should be considered as a phytotherapeutic product in the fight against diabetes mellitus.

Pulmonary echinococcosis

Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. Four species are recognised and the vast majority of infestations in humans are caused by E. granulosus. E. granulosus causes cystic echinococcosis, which has a worldwide distribution. Humans are exposed less frequently to E. multilocularis, which causes alveolar echinococcosis. E. vogeli and E. oligarthrus are rare species and cause polycystic echinococcosis. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cyst or develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material and secondary immunological reactions that develop from cyst rupture. The cysts are characteristically seen as solitary or multiple circumscribed or oval masses on imaging. Detection of antibody directed against specific echinococcal antigens is found in only approximately half of patients with pulmonary cysts. Surgical excision of the cyst is the treatment of choice whenever feasible.

Prognostic factors in severe community-acquired pneumonia in patients without co-morbid illness

OBJECTIVES

We wished to determine the prognostic factors and the impact of initial empirical antibiotic therapy on the outcome of severe community-acquired pneumonia in patients without underlying co-morbid illness.

METHODOLOGY

This is a retrospective record review of consecutive patients with severe community-acquired pneumonia who were divided into those with and without underlying co-morbid illness.

RESULTS

There were 182 patients including 112 primary (no co-morbid illness) and 70 secondary (underlying co-morbid illness) pneumonias. The overall mortality was 41.8% and there were no differences in APACHE II score or mortality when comparing cases with primary (37.5%) and secondary infections (48.6%). The mortality was significantly higher in patients with negative microbiology. Univariate analysis identified a number of parameters and various antibiotic regimens, which appeared to be associated with a significantly poorer outcome. On multivariate analysis multilobar pulmonary consolidation, need for mechanical ventilation, inotropes and dialysis were documented to be independent predictors of mortality. Only in their absence could different antibiotic regimens be shown to have an apparent impact on outcome and further analysis suggested that the reason for these differences related predominantly to differences in the severity of the infection.

CONCLUSIONS

Markers of disease severity appear to be the most important predictors of outcome in patients with severe community-acquired pneumonia.

Bacteremic pneumococcal pneumonia in HIV-seropositive and HIV-seronegative adults

STUDY OBJECTIVES

To compare the demographic, clinical, laboratory, and microbiological data, and the hospital course and outcome of HIV-seropositive and HIV-seronegative adults with bacteremic pneumococcal pneumonia.

DESIGN

Retrospective observation study conducted over a 2-year period.

SETTING

Academic teaching hospital attached to the University of the Witwatersrand, Johannesburg, South Africa.

PATIENTS

Consecutive patients with bacteremic pneumococcal pneumonia were identified on the basis of positive blood culture results.

INTERVENTIONS

All available demographic, clinical, routine laboratory, radiographic, and microbiological data were recorded retrospectively for each of the patients, and the combined data for the HIV-seropositive patients were compared with those of the HIV-seronegative patients.

MEASUREMENT AND RESULTS

A total of 112 patients (31 HIV-seropositive and 81 HIV-seronegative patients) were entered into the study. The HIV-seropositive patients were significantly younger than the HIV-seronegative patients (32.8 vs 39.6 years old) and had lower admission hemoglobin (11.8 vs 13.4 g/dL), WBC count (10.3 vs 14.3 x 10(9)/L), serum albumin (31 vs 36 g/L), sodium (129 vs 132 mmol/L), and potassium (3.0 vs 3.5 mmol/L), respectively. Although the HIV-seropositive patients appeared to have more multilobar pulmonary consolidation on the chest radiograph than the HIV-seronegative patients (60% vs 34%), this did not quite reach statistical significance. In addition, the HIV-seropositive patients had significantly more infections (48.4% vs 20.8%) with pneumococcal serogroups/serotypes (serogroups 6, 19, 23, and serotype 14) that are found more commonly in children, and they also had more penicillin-resistant isolates (13% vs 2.5%) than the HIV-seronegative patients, respectively. Similarly, it was noted that when these data were analyzed according to gender (irrespective of HIV status), women had significantly more infections than men (47% vs 21%) with serogroups/serotypes that are usually found in children, more penicillin-resistant isolates (15% vs 1%), and more co-trimoxazole-resistant isolates (21% vs 5%), respectively. There were no differences noted in any of the other parameters, including initial APACHE (acute physiology and chronic health evaluation) II score, PaO2/fraction of inspired oxygen ratio, duration of temperature, duration of IV therapy, duration of hospitalization, complications, and outcome, when comparing HIV-seropositive and HIV-seronegative patients. Two patients in each group died.

CONCLUSIONS

The clinical features of bacteremic pneumococcal pneumonia are similar in HIV-seropositive and HIV-seronegative patients. Although differences are noted in various laboratory and microbiological parameters, they do not appear to have an impact on outcome.

The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation

Endotracheal tube colonization in patients undergoing mechanical ventilation was investigated. In the first part of this prospective study, the airway access tube was examined for the presence of secretions, airway obstruction and bacterial colonization, in cases undergoing extubation or tube change. In the second part of the study, the sequence of oropharyngeal, gastric, respiratory tract and endotracheal tube colonization was investigated by sequential swabbing at each site twice daily for 5 days in consecutive noninfected patients. In the first part, it was noted that all airway access tubes of cases undergoing extubation had secretions lining the interior of the distal third of the tube which were shown on scanning electron microscopy to be a biofilm. Gram-negative micro-organisms were isolated from these secretions in all but three cases. In the second part, it was noted that the sequence of colonization in patients undergoing mechanical ventilation was the oropharynx (36 h), the stomach (3660 h), the lower respiratory tract (60-84 h), and thereafter the endotracheal tube (60-96 h). Nosocomial pneumonia occurred in 13 patients and in eight cases identical organisms were noted in lower respiratory tract secretions and in secretions lining the interior of the endotracheal tube. The endotracheal tube of patients undergoing mechanical ventilation becomes colonized rapidly with micro-organisms commonly associated with nosocomial pneumonia, and which may represent a persistent source of organisms causing such infections.

IgG subclasses in previously healthy adult patients with acute community-acquired pneumonia

OBJECTIVE

To measure IgG antibody subclasses in previously healthy adult patients with acute community-acquired pneumonia, and to assess any association between differences of subtype levels and severity of illness or prognosis.

DESIGN

Prospective study.

SETTING

The intensive care unit (ICU) and general medical wards of Hillbrow Hospital, Johannesburg, an urban general hospital.

PATIENTS

Sixty-six previously healthy adult patients with acute community-acquired pneumonia, of whom 47 were considered less severely ill, while 19 were admitted to an ICU.

OUTCOME MEASURES

Measurement of IgG subclass levels and determination of any association between differences in subtype levels and various poor prognostic factors in pneumonia, need for ICU admission, complications of illness, and APACHE II score of ICU cases or outcome of patients.

RESULTS

A number of statistically significant differences (P < 0.05) were noted between the two groups of patients (critically ill v. others) representing well-known negative prognostic factors in pneumonia. A greater degree of tachycardia and tachypnoea and extremes of white cell count, a higher serum urea concentration and multilobar pulmonary consolidation characterised the patients in the ICU. In addition, the mortality rate in the ICU patients was significantly greater (P < 0.0001). Similar findings were noted when survivors and non-survivors were compared. Few abnormalities of IgG subclass levels were noted in the various patient groups, which did not allow adequate analysis of their clinical significance.

CONCLUSION

This study demonstrated a small number of abnormalities in IgG subclass levels in previously healthy adult patients with acute community-acquired pneumonia.

Cryptococcosis: an unusual cause of endobronchial obstruction

We report the case of a 43 year old male patient, with normal immune function, who presented with right middle and lower lobe collapse. At bronchoscopy, a white lobulated lesion was seen, completely obstructing the origin of bronchus intermedius. Bronchial washings and biopsy of the lesion demonstrated cryptococcal organisms. The patient responded clinically and radiologically to amphotericin B and flucytosine; however, repeat bronchoscopy revealed only partial resolution of the endobronchial lesion.

[Postoperative arterial oxygen saturation in children]

In 46 pediatric patients (ASA-group I + II) the arterial saturation of oxygen was monitored perioperatively by the Nellcor N-100 and N-200, respectively. During postoperative transportation a statistically significant desaturation could be detected. But the saturation remained within a clinically acceptable range after a trial period of breathing various fractions of oxygen spontaneously before transfer. Motion artifacts occurred to a far lesser extent using the ECG-triggered Nellcor N-200 as compared to the N-100. As there was no significant difference between the lateral and supine position as far as arterial saturation is concerned, the lateral position is still highly recommended for postoperative transportation.