Objectives:
To determine correlations between symptoms, nasal endoscopy findings, and computed tomography (CT) scan findings in post‐surgical chronic rhinosinusitis (CRS) patients.
Study Design:
...Cross‐sectional.
Material and Methods:
A total of 51 CRS patients who had undergone endoscopic sinus surgery (ESS) completed symptom questionnaires, underwent endoscopy, and received an in‐office sinus CT scan during one clinic visit. For metrics, we used the Sinonasal Outcomes Test‐20 (SNOT‐20) questionnaire, visual analog symptom scale (VAS), Lund‐Kennedy endoscopy scoring scale, and Lund‐MacKay (LM) CT scoring scale. We determined Pearson correlation coefficients, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between scores for symptoms, endoscopy, and CT.
Results:
The SNOT‐20 score and most VAS symptoms had poor correlation coefficients with both endoscopy and CT scores (0.03–0.24). Nasal drainage of pus, nasal congestion, and impaired sense of smell had moderate correlation coefficients with endoscopy and CT (0.24–0.42). Endoscopy had a strong correlation coefficient with CT (0.76). Drainage, edema, and polyps had strong correlation coefficients with CT (0.80, 0.69, and 0.49, respectively). Endoscopy had a PPV of 92.5% and NPV of 45.5% for detecting an abnormal sinus CT (LM score ≥1).
Conclusions:
In post‐ESS CRS patients, most symptoms do not correlate well with either endoscopy or CT findings. Endoscopy and CT scores correlate well. Abnormal endoscopy findings have the ability to confidently rule in the presence of CT opacification, thus validating the importance of endoscopy in clinical decision making. However, a normal endoscopy cannot assure a normal CT. Thus, symptoms, endoscopy, and CT are complementary in the evaluation of the post‐ESS CRS patient. Laryngoscope, 2011
No discurso do direito internacional, emerge o direito à verdade como um novo conceito jurídico a mobilizar uma diversidade de agendas e interesses. O presente estudo procura interpretar o direito à ...verdade como direito à memória a partir da análise da sentença de condenação do Brasil pela Corte Interamericana no caso Gomes Lund e outros ("Guerrilha do Araguaia"). Por ser um caso exemplar de demanda perante a Corte Interamericana de Direitos Humanos, procura-se demonstrar que o persistente desconhecimento da verdade equivale à amnésia institucional forçada e a persistência de delitos do esquecimento, que pretendem apagar os traços das violências passadas contra a dignidade da pessoa humana. Palavras-chave: Direito à verdade. Direito à memória. Corte Interamericana de Direitos Humanos. Guerrilha do Araguaia. In the discourse of international law, the right to truth emerges as a new legal concept to mobilize a diversity of agendas and interests. The present study seeks to interpret the right to the truth as a right to memory from the analysis of the sentence of condemnation of Brazil by the Inter-American Court in the Gomes Lund et al. Case ("Araguaia Guerrilla"). As an exemplary case of a petition before the Inter-American Court of Human Rights, it is sought to demonstrate that the persistent ignorance of the truth amounts to forced institutional amnesia and the persistence of crimes of forgetfulness, which seek to erase the traces of past violence against the dignity of human person. Keywords: Right to truth. Right to memory. Inter-American Court of Human Rights. Araguaia Guerrilla.
Objectives/Hypothesis
Eosinophilic chronic rhinosinusitis (eCRS) has recently been recognized as a CRS subtype characterized by inflammation rather than chronic infection. Consequently, the role of ...antibiotics as a component of maximal medical therapy for eCRS has been called into question. The purpose of this study was to investigate whether the use of antibiotics, which lack any secondary anti‐inflammatory properties, are useful in the treatment of eCRS.
Study Design
Prospective individual cohort study.
Methods
Institutional review board–approved, prospective study of 39 patients presenting with chronic rhinosinusitis (CRS). In all patients, Lund‐Kennedy endoscopy scores, Lund‐Mackay computed tomography scores, and Sino‐Nasal Outcome Test‐22(SNOT‐22) scores were obtained before and after treatment with amoxicillin–clavulanic acid twice a day (625 mg) for 4 weeks. Patients were subsequently stratified into eCRS and non‐eCRS groups based on having over 10 eosinophils per high‐power field by histopathological examination. The efficacy of antibiotic therapy was compared between groups using the nonparametric Mann–Whitney U test.
Results
Within the non‐eCRS group (n = 14), there was a significant improvement in both the Lund‐Mackay score (P = .002) and SNOT‐22 score (P < .001) but not the endoscopy score. Among the eCRS patients (n = 25), the Lund‐Mackay score was similarly improved (P = .007); however, there was no significant improvement in the endoscopy or SNOT‐22 scores.
Conclusions
The use of antibiotics without independent anti‐inflammatory properties have limited efficacy in patients with eCRS. The concept of maximal medical therapy using antibiotics must continue to evolve in the setting of new evidence for inflammatory subtypes of CRS.
Level of Evidence
2b. Laryngoscope, 127:794–796, 2017
Protest and reconciliation rituals play a contested but important role in social change. This essay analyzes how rituals of reconciliation effectively negotiate between competing factions and norms ...by using ritual techniques as embodied symbols. Against the horizon of theory from Victor and Edith Turner and Cas Wepener, participant observation of the Lutheran and Catholic Joint Commemoration of the Reformation “Common Prayer” in Lund, Sweden on October 31, 2016 reveals five stages: crisis/diagnosis, redress, forgiveness and acceptance, binding, and reparative mission. Each is marked by its own characteristic techniques, whereas some symbolic elements manifest the different stages throughout the liturgy. This liturgy demonstrates how one liturgy can speak to various factions and stages in the process of accommodating a new norm (Christian unity) within a contested set of identities (“Lutheran” and “Catholic”). It is in the stages of forgiveness and binding that the relationship between the ritual-symbolic realm and the real work of social reconciliation is most directly visualized.
To perform a systematic review of proposed sinus computed tomography (CT) scoring systems and determine their association with patient-reported outcome measures (PROMs).
PubMed, CINAHL, Scopus, and ...Cochrane Library.
A systematic search was conducted following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing CT scores and PROMs in patients with chronic rhinosinusitis.
A total of 144 studies were included. Out of 20,741 patients, 53.6% were male and 55.5% had nasal polyposis. A meta-analysis of correlations revealed a moderate correlation between Lund-McKay (LM) and the 22-item Sinonasal Outcome Test (SNOT-22; r = 0.434, P < .001) and a weaker correlation between LM and the 20-item Sinonasal Outcome Test (SNOT-20; r = 0.257, P = .039). Meta-regression also revealed a weak association between LM and SNOT-20 (n = 25 studies) but no significant associations between Zinreich score and SNOT-22 or LM scores and PROMs, including SNOT-22 (n = 94 studies), Rhinosinusitis Disability Index (n = 25), nasal obstruction visual analog scale (n = 15), Chronic Sinusitis Survey (n = 12), Total Nasal Symptom Score (n = 4), Total Symptom Score (n = 3), and 12-Item Short Form Health Survey (n = 3).
There is essentially little association between radiologic grade and PROMs. CT grading systems with improved clinical utility are needed.
Abstract Parkinson's disease (PD) is a complex illness characterized by progressive dopaminergic neuronal loss. Several mechanisms associated with the iron-induced death of dopaminergic cells have ...been described. Ferroptosis is an iron-dependent, regulated cell death process that was recently described in cancer. Our present work show that ferroptosis is an important cell death pathway for dopaminergic neurons. Ferroptosis was characterized in Lund human mesencephalic cells and then confirmed ex vivo (in organotypic slice cultures) and in vivo (in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine mouse model). Some of the observed characteristics of ferroptosis differed from those reported previously. For example, ferroptosis may be initiated by PKCα activation, which then activates MEK in a RAS-independent manner. The present study is the first to emphasize the importance of ferroptosis dysregulation in PD. In neurodegenerative diseases like PD, iron chelators, Fer-1 derivatives and PKC inhibitors may be strong drug candidates to pharmacologically modulate the ferroptotic signaling cascade.
Background
We evaluated the accuracy of nasal endoscopy in diagnosing chronic rhinosinusitis (CRS) compared with paranasal sinus computed tomography (CT).
Methods
Two authors independently searched ...the 5 databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) up to March 2019. For all included studies, we calculated correlation coefficients between the endoscopic and CT scores. We extracted data on true-positive and false-positive and true-negative and false-negative results. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (version 2).
Results
We included 16 observational or retrospective studies. A high correlation (r = .8543; 95% confidence interval CI 0.7685–0.9401, P < .0001, I2 = 76.58%) between endoscopy and CT in terms of the diagnostic accuracy for CRS was apparent. The odds ratio (Lund–Kennedy endoscopic score ≥1) was 7.915 (95% CI 4.435–14.124; I2 = 28.361%). The area under the summary receiver operating characteristic curve was 0.765. The sensitivity and specificity were 0.726 (95% CI 0.584–0.834) and 0.767 (95% CI 0.685–0.849), respectively. However, high interstudy heterogeneity was evident given the different endoscopic score thresholds used (Lund–Kennedy endoscopic score ≥1 vs 2). In a subgroup analysis of studies using a Lund–Kennedy endoscopic score threshold ≥2, the area under the summary curve was 0.881, and the sensitivity and specificity were 0.874 (95% CI 0.783–0.930) and 0.793 (95% CI 0.366–0.962), respectively.
Conclusion
Nasal endoscopy is a useful diagnostic tool; the Lund–Kennedy score was comparable with that of CT.
Background
Chronic rhinosinusitis (CRS) is one of the most common health disorders in humans and has a major impact on health-related quality of life (HRQoL). Of the many factors contributing to the ...etiology of CRS, less is known about the correlation between CRS and bacterial biofilms and their impact on HRQoL.
Objective
The aim of this prospective study was to investigate the relationship between biofilm-producing bacteria and patients' objective findings and HRQoL.
Methods
Forty-eight patients with CRSwNP were enrolled in a 12-month prospective study. The Lund-Mackay (LM) CT and endoscopic Lund-Kennedy (LK) scores were obtained before endoscopic sinus surgery (ESS), and patients completed the HRQoL instruments: the 22-item Sinonasal Outcome Test (SNOT−22), the 36-item Short Questionnaire (SF−36), and the visual analog scale (VAS). A sinus culture was obtained at ESS, bacteria were isolated, and in vitro quantification of the biofilm was performed. The LK score and HRQoL were determined postoperatively at months 1, 3, 6, and 12.
Results
The most common bacterial isolates in patients with CRSwNP were Staphylococcus aureus (28%), coagulase-negative staphylococci (52%), and Pseudomonas aeruginosa (8%). Preoperatively, the highest LM and LK scores were found in patients with strong biofilm producers. Postoperative LK scores were significantly reduced in all patients. Postoperative VAS scores were significantly reduced from month 1 to month 12 postoperatively. Patients with strong biofilm producers had significantly worse nasal blockage, secretion, headache, facial pressure and pain, and loss of smell preoperatively, compared to patients with low biofilm producers. The most significant reduction in preoperative scores SNOT−22 and SF−36 (excluding physical functioning) was seen in patients with S. aureus and P. aeruginosa.
Conclusions
Patients with strong biofilm producers had higher LK and LM scores preoperatively, and greater improvement in LK and HRQoL scores postoperatively. Microbiologic surveillance of all CRS patients is recommended.
