Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS).This fungal sinusitis v...Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS).This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion,but lacks angioinvasion microscopically,representing what clinically behaves as a ‘pre-invasive’ subtype of fungal sinusitis.Unlike non-IFS disease,patients with preinvasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus.While sharing some clinical features of IFS,these ‘intermediate’ patients were successfully spared extended and repeated surgical debridements given the microscopic findings,and have been successfully treated with shorter courses of antifungal therapy.These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner,in an undefined zone between the treatments for routine fungal ball and aggressive IFS.展开更多
Objective:Olfactory dysfunction is known to have significant social,psychological,and safety implications.Despite increasingly recognized prevalence,potential risk factors for olfactory loss have been arbitrarily docu...Objective:Olfactory dysfunction is known to have significant social,psychological,and safety implications.Despite increasingly recognized prevalence,potential risk factors for olfactory loss have been arbitrarily documented and knowledge is limited in scale.The aim of this study is to identify potential demographic and exposure variables correlating with olfactory dysfunction.Methods:Cross-sectional analysis of the 2011-2012 and 2013-2014 editions of the National Health Examination and Nutrition Survey was performed.The utilized survey reports from a nationally representative sample of about 5000 persons each year located in counties across the United States.There is an interview and physical examination component which includes demographic,socioeconomic,dietary,and health-related questions as well as medical,dental,physiologic measurements,and laboratory tests.3594 adult respondents from 2011 to 2012 and 3708 respondents from 2013 to 2014 were identified from the above population-based database.The frequency of self-reported disorders as well as performance on odor identification testing was determined in relation to demographic factors,occupational or environmental exposures,and urinary levels of environmental and industrial compounds.Results:In both subjective and objective analysis,smell disorders were significantly more common with increasing age.While the non-Hispanic Black and non-Hispanic Asian populations were less likely to report subjective olfactory loss,they,along with Hispanics,performed more poorly on odor identification than Caucasians.Those with limited education had a decreased prevalence of hyposmia.Women outperformed men on smell testing.Those reporting exposure to vapors were more likely to experience olfactory dysfunction,and urinary levels of manganese,2-Thioxothiazolidine-4-carboxylic acid,and 2-Aminothiazoline-4-carboxylic acid were lower among respondents with subjective smell disturbance.In odor detection,elevated serum levels of lead and urinary levels of 2,4 dichlorophenol were associated with anosmia and hyposmia,respectively.Conclusions:This study provides current,population-based data identifying demographic and exposure elements related to smell disturbances in U.S.adults.Age,race,gender,education,exposure to vapors,urinary levels of manganese,2-Thioxothiazolidine-4-carboxylic acid,2-Aminothiazoline-4-carboxylic acid,2,4 dichlorophenol,and serum lead levels were all implicated in smell disturbance.Care should be taken in interpretation due to lack of consistency between subjective and objective measures of olfaction as well as limitations related to population-based data.Prospective trials are indicated to further elucidate these relationships.展开更多
Background:Inflammatory bowel disease(IBD)is characterized by chronic inflammation of the gastrointestinal tract.Extra-intestinal manifestations such as pulmonary diseases have been reported.Chronic rhinosinusitis(CRS...Background:Inflammatory bowel disease(IBD)is characterized by chronic inflammation of the gastrointestinal tract.Extra-intestinal manifestations such as pulmonary diseases have been reported.Chronic rhinosinusitis(CRS),an inflammatory condition of the sinonasal mucosa,has been associated with several lung diseases.Given the relationship between lung and intestinal pathologies,and lung and sinus pathologies,we aimed to determine the prevalence of IBD among CRS patients.Methods:Pilot prevalence study.Ninety-two CRS patients were screened for IBD symptoms from October 2018 to January 2020.Patient-reported disease symptoms and overall quality of life were evaluated using the Sino-Nasal Outcome Test 22(SNOT-22),Short Inflammatory Bowel Disease Questionnaire(SIBDQ),and EuroQol 5 Dimension 5 Level(EQ-5D-5L)questionnaires.The Modified Lund-Kennedy(MLK)endoscopic and Lund-Mackay(LM)grading systems were used to confirm CRS diagnoses.Individuals who reported subjective symptoms of IBD were referred to a gastroenterologist clinic for further diagnostics.Results:Twenty of the 92(20.2%,95%CI:12.6%-29.8%)CRS patients reported symptoms of IBD and four individuals(4.26%,95%CI:1.17%-10.50%)were sub-sequently diagnosed with IBD.Compared to patients without IBD symptoms(n=72),those with symptoms(n=20)reported significantly worse SNOT-22(P=0.002),SIBDQ(P<0.05),and EQ-5D-3L(P=0.0063)scores.However,these patients did not exhibit significantly different MLK(P=0.81)or LM(P=0.04)scores.Conclusion:The prevalence of IBD may be elevated among individuals with CRS relative to the general Canadian population.This pilot study suggests that CRS with IBD is associated with lower quality of life.Further cross-sectional studies with larger sample sizes are required.展开更多
Objective: Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide a...Objective: Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide an evidence-based systemic review of the diagnostic value of different modalities in detecting local, regional, and distal recurrent NPC, as well as the associated costs with these modalities.Methods: MEDLINE, EMBASE, and the Cochrane review database were queried. Two hundred and twenty-three abstracts were generated using the inclusion criteria: patients >18 years of age;histopathological reference standard;and modalities pertaining to imaging or microbiology.Results: Twenty-four manuscripts fulfilled the inclusion criteria and 5 surveillance tools identified: endoscopy, MR, FDG-PET, Tc-99m MIBI and201TI SPECT, and EBV DNA.Conclusions: For local surveillance, endoscopy is the gold standard recommendation, with increased efficacy if Narrow Band Imaging or contact endoscopy are utilized. MRI and FDG-PET is also recommended to help with local to distal spread;however, Tc-99m MIBI and201TI SPECT are options as well. EBV DNA is recommended as a cheap and accessible adjunct surveillance tool if an available as an option.展开更多
Objective:Leptospermum Honey (Manuka honey) has proven to be effective in improving acute and chronic wound healing presumably due to its antibacterial and anti-inflammatory properties. The aim is to determine if Manu...Objective:Leptospermum Honey (Manuka honey) has proven to be effective in improving acute and chronic wound healing presumably due to its antibacterial and anti-inflammatory properties. The aim is to determine if Manuka honey decreases scar formation and results in a cosmetically appealing scar. Methods:A prospective single-blinded randomized control trial was performed. All patients received an 8 cm incision. Patients randomized to honey treatment were instructed to apply Manuka honey paste topically to the incision site once per day post surgery for 4 weeks. The patients’ scar was then analyzed objectively by a blinded observer and subjectively at 4 and 8 weeks postoperatively. The primary outcome measure used was the Patient and Observer Scar Assessment Scale (POSAS). Results:A total of 21 patients completed the entire scar analysis (honey treatment Z 9, stan-dard treatment Z 12). There was no statistically significant difference between patient scar assessment scale and observer scar assessment scale at 4 and 8 weeks postoperatively.Conclusion: Despite Leptospermum Honey’s reported anti-inflammatory and antibacterial properties, this study did not show a difference in scar appearance when applied.展开更多
Objective:To identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice-daily for twelve weeks...Objective:To identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice-daily for twelve weeks following sinus surgery (FESS).Methods:Forty-six CRS patients were recruited.Sinus tissue biopsies were collected during FESS and then at 5 and 12 weeks postoperatively during the course of treatment.A multiplex cytokine assay quantified the abundance of 17 cytokines in biopsied tissue.Cytokine expression fold-change was analyzed between each time point using a robust linear regression model and compared between the two treatment groups.Results:Compared to the saline irrigation group,five cytokines were differently expressed (CI =95%) in sinonasal tissue obtained from subjects in the LH irrigation group during the 12-week treatment period.Cytokines IL-6 (P =0.0400),IL-8 (P =0.0398),MCP-1 (P =0.0284),and MIP-1β (P =0.016) were significantly increased in the LH irrigation group compared to the saline irrigation group.IL-13 was significantly increased in the saline irrigation group compared to the LH group (P =0.0086).Conclusion:LH may potentially act to modulate the expression of IL-6,IL-8,IL-13,MCP-1 and MIP-1β in sinonasal tissue.展开更多
文摘Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS).This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion,but lacks angioinvasion microscopically,representing what clinically behaves as a ‘pre-invasive’ subtype of fungal sinusitis.Unlike non-IFS disease,patients with preinvasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus.While sharing some clinical features of IFS,these ‘intermediate’ patients were successfully spared extended and repeated surgical debridements given the microscopic findings,and have been successfully treated with shorter courses of antifungal therapy.These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner,in an undefined zone between the treatments for routine fungal ball and aggressive IFS.
文摘Objective:Olfactory dysfunction is known to have significant social,psychological,and safety implications.Despite increasingly recognized prevalence,potential risk factors for olfactory loss have been arbitrarily documented and knowledge is limited in scale.The aim of this study is to identify potential demographic and exposure variables correlating with olfactory dysfunction.Methods:Cross-sectional analysis of the 2011-2012 and 2013-2014 editions of the National Health Examination and Nutrition Survey was performed.The utilized survey reports from a nationally representative sample of about 5000 persons each year located in counties across the United States.There is an interview and physical examination component which includes demographic,socioeconomic,dietary,and health-related questions as well as medical,dental,physiologic measurements,and laboratory tests.3594 adult respondents from 2011 to 2012 and 3708 respondents from 2013 to 2014 were identified from the above population-based database.The frequency of self-reported disorders as well as performance on odor identification testing was determined in relation to demographic factors,occupational or environmental exposures,and urinary levels of environmental and industrial compounds.Results:In both subjective and objective analysis,smell disorders were significantly more common with increasing age.While the non-Hispanic Black and non-Hispanic Asian populations were less likely to report subjective olfactory loss,they,along with Hispanics,performed more poorly on odor identification than Caucasians.Those with limited education had a decreased prevalence of hyposmia.Women outperformed men on smell testing.Those reporting exposure to vapors were more likely to experience olfactory dysfunction,and urinary levels of manganese,2-Thioxothiazolidine-4-carboxylic acid,and 2-Aminothiazoline-4-carboxylic acid were lower among respondents with subjective smell disturbance.In odor detection,elevated serum levels of lead and urinary levels of 2,4 dichlorophenol were associated with anosmia and hyposmia,respectively.Conclusions:This study provides current,population-based data identifying demographic and exposure elements related to smell disturbances in U.S.adults.Age,race,gender,education,exposure to vapors,urinary levels of manganese,2-Thioxothiazolidine-4-carboxylic acid,2-Aminothiazoline-4-carboxylic acid,2,4 dichlorophenol,and serum lead levels were all implicated in smell disturbance.Care should be taken in interpretation due to lack of consistency between subjective and objective measures of olfaction as well as limitations related to population-based data.Prospective trials are indicated to further elucidate these relationships.
文摘Background:Inflammatory bowel disease(IBD)is characterized by chronic inflammation of the gastrointestinal tract.Extra-intestinal manifestations such as pulmonary diseases have been reported.Chronic rhinosinusitis(CRS),an inflammatory condition of the sinonasal mucosa,has been associated with several lung diseases.Given the relationship between lung and intestinal pathologies,and lung and sinus pathologies,we aimed to determine the prevalence of IBD among CRS patients.Methods:Pilot prevalence study.Ninety-two CRS patients were screened for IBD symptoms from October 2018 to January 2020.Patient-reported disease symptoms and overall quality of life were evaluated using the Sino-Nasal Outcome Test 22(SNOT-22),Short Inflammatory Bowel Disease Questionnaire(SIBDQ),and EuroQol 5 Dimension 5 Level(EQ-5D-5L)questionnaires.The Modified Lund-Kennedy(MLK)endoscopic and Lund-Mackay(LM)grading systems were used to confirm CRS diagnoses.Individuals who reported subjective symptoms of IBD were referred to a gastroenterologist clinic for further diagnostics.Results:Twenty of the 92(20.2%,95%CI:12.6%-29.8%)CRS patients reported symptoms of IBD and four individuals(4.26%,95%CI:1.17%-10.50%)were sub-sequently diagnosed with IBD.Compared to patients without IBD symptoms(n=72),those with symptoms(n=20)reported significantly worse SNOT-22(P=0.002),SIBDQ(P<0.05),and EQ-5D-3L(P=0.0063)scores.However,these patients did not exhibit significantly different MLK(P=0.81)or LM(P=0.04)scores.Conclusion:The prevalence of IBD may be elevated among individuals with CRS relative to the general Canadian population.This pilot study suggests that CRS with IBD is associated with lower quality of life.Further cross-sectional studies with larger sample sizes are required.
文摘Objective: Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide an evidence-based systemic review of the diagnostic value of different modalities in detecting local, regional, and distal recurrent NPC, as well as the associated costs with these modalities.Methods: MEDLINE, EMBASE, and the Cochrane review database were queried. Two hundred and twenty-three abstracts were generated using the inclusion criteria: patients >18 years of age;histopathological reference standard;and modalities pertaining to imaging or microbiology.Results: Twenty-four manuscripts fulfilled the inclusion criteria and 5 surveillance tools identified: endoscopy, MR, FDG-PET, Tc-99m MIBI and201TI SPECT, and EBV DNA.Conclusions: For local surveillance, endoscopy is the gold standard recommendation, with increased efficacy if Narrow Band Imaging or contact endoscopy are utilized. MRI and FDG-PET is also recommended to help with local to distal spread;however, Tc-99m MIBI and201TI SPECT are options as well. EBV DNA is recommended as a cheap and accessible adjunct surveillance tool if an available as an option.
文摘Objective:Leptospermum Honey (Manuka honey) has proven to be effective in improving acute and chronic wound healing presumably due to its antibacterial and anti-inflammatory properties. The aim is to determine if Manuka honey decreases scar formation and results in a cosmetically appealing scar. Methods:A prospective single-blinded randomized control trial was performed. All patients received an 8 cm incision. Patients randomized to honey treatment were instructed to apply Manuka honey paste topically to the incision site once per day post surgery for 4 weeks. The patients’ scar was then analyzed objectively by a blinded observer and subjectively at 4 and 8 weeks postoperatively. The primary outcome measure used was the Patient and Observer Scar Assessment Scale (POSAS). Results:A total of 21 patients completed the entire scar analysis (honey treatment Z 9, stan-dard treatment Z 12). There was no statistically significant difference between patient scar assessment scale and observer scar assessment scale at 4 and 8 weeks postoperatively.Conclusion: Despite Leptospermum Honey’s reported anti-inflammatory and antibacterial properties, this study did not show a difference in scar appearance when applied.
文摘Objective:To identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice-daily for twelve weeks following sinus surgery (FESS).Methods:Forty-six CRS patients were recruited.Sinus tissue biopsies were collected during FESS and then at 5 and 12 weeks postoperatively during the course of treatment.A multiplex cytokine assay quantified the abundance of 17 cytokines in biopsied tissue.Cytokine expression fold-change was analyzed between each time point using a robust linear regression model and compared between the two treatment groups.Results:Compared to the saline irrigation group,five cytokines were differently expressed (CI =95%) in sinonasal tissue obtained from subjects in the LH irrigation group during the 12-week treatment period.Cytokines IL-6 (P =0.0400),IL-8 (P =0.0398),MCP-1 (P =0.0284),and MIP-1β (P =0.016) were significantly increased in the LH irrigation group compared to the saline irrigation group.IL-13 was significantly increased in the saline irrigation group compared to the LH group (P =0.0086).Conclusion:LH may potentially act to modulate the expression of IL-6,IL-8,IL-13,MCP-1 and MIP-1β in sinonasal tissue.
