ABSTRACT
Abstract Introduction The three-dimensional (3D) endoscope is considered a new surgical tool used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of 3D over two-dimensional (2D) endoscopy that have been demonstrated in clinical applications, surgical training, and different experimental studies. Objective To show the difference between using the 3D and 2D endoscopes during endonasal and anterior skull base surgery and its importance. Methods Our study is divided into two phases (clinical and cadaveric phases). In the clinical study we, have performed 52 endonasal and anterior skull base surgical procedures (26 study cases and 26 control cases). We recorded accuracy, duration, and intraoperative complication for each case. The cadaveric study was performed on three cadavers. Differences in accuracy and dissection time were recorded using 3D and 2D endoscopy for each side chosen by randomization. Results In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared with cases done using 2D endoscope. In cadaveric dissection, while using 3D endoscope, there was better depth of perception regarding the anatomical landmarks compared with 2D endoscope. Conclusion Three-dimensional endoscopy is an advanced instrument that allows better training for the coming generation of ear, nose, and throat surgeons. Both clinical and cadaveric studies offer a promising outcome in both endonasal and anterior skull base surgery.
ABSTRACT
Abstract Introduction Allergic rhinitis (AR) is estimated to affect up to 30% of the world population. With the rise in cases, newer treatment modalities have been explored. Probiotics have shown to reduce symptoms of AR and improve quality of life. A few systematic reviews have been published aiming to assess the role of probiotics in AR. Objectives To consolidate the recent evidence with an overview of systematic reviews by extracting data regarding subjective outcomes (from quality of life questionnaires, the Total Nasal Symptom Score, the Total Ocular Symptom Score, the Daily Total Symptom Score, the incidence of AR, and the Rhinitis Total Symptom Score) and objective outcomes (levels of antigen-specific immunoglobulin E [IgE], total IgE, interleukin 10 [IL-10], interferon gamma [IFNG], eosinophil, and the T helper 1/T helper 2 [Th1/Th2] ratio). Data Synthesis We conducted a literature search on the PubMed, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library up to April 14, 2020. The qualitative assessment was performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool. A total of 419 titles were screened, and 3 systematic reviews met our eligibility criteria. Probiotics in the treatment of AR have been shown to improve quality of life, the total nasal and ocular symptom scores, the daily total symptom scores and Th1/Th2 ratio. No difference was ascertained for rhinitis total symptom score, and the rates of antigen-specific IgE, total IgE, IL-10, INFG and eosinophil. Conclusion The present review showed that there is considerable evidence that probiotics are useful in the treatment of AR. Further randomized trials targeting the limitations of the currently-available evidence can help ascertain the usefulness of probiotics in cases of AR.
ABSTRACT
Skull base surgery has experienced dramatic advances in the last decade. Recently, various surgical disciplines have conducted reviews of quality of randomised controlled trials (RCTs). This is the first review to our knowledge regarding RCT quality within skull base surgery. Systematic review of skull base surgery RCTs published between 2000 and 2014 were conducted. Literature search provided 96 papers. Duplicates and trials which did not meet our inclusion criteria were excluded. This left 28 papers for analysis. A total of 1785 patients participated across trials. Consolidated Standards of Reporting Trials statement (CONSORT) and Jadad scale were used assess to the quality of reporting. These were our main outcome measures. The mean CONSORT score prior to 2011 was 16.9 (n = 17, range; 13 – 22), and post 2011 was 17.5 (n = 11, range; 12 – 22). The mean Jadad score was 3.1 (n = 28, range 2 – 5). CONSORT were found to increase significantly with both increasing sample size (rho=0.467, p=0.012) and Jadad scores (rho=0.540, p=0.003). Linear regression showed CONSORT increase by 0.36 (95% CI: 0.02 – 0.70, p=0.041) for each additional 10 patients included, and by 1.50 (95% CI: 0.58 – 0.24, p=0.002) for each increase of one in the JADAD score. There are common omissions related to randomization, sample size calculations and availability of protocols. RCTs in skull base surgery are comparable to other surgical disciplines. We recommend utilisation of the CONSORT statement during protocol formation of RCTs to improve reporting of trials.