Prognostic Value of Polypoid Changes of the Middle Turbinate in Relapsed Nasal Polypi after FESS: A Prospective Cohort Study

Abstract Introduction Despite the high level of patient satisfaction with functional endoscopic sinus surgery (FESS) and the clinical improvement, polyp recurrence is observed in 23% to 87% of patients and requires reoperation. Objective To assess the prognostic value of polypoid changes of the middle turbinate (PCMT) in relapse of paranasal sinus polyps in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) after FESS and the effect of partial middle turbinectomy (PMT) on the outcome of surgery. Methods We conducted a prospective clinical study on 60 patients with CRSwNP with and without PCMT. The patients were allocated into three groups: group I included twenty patients without PCMT; group II, twenty patients with PCMT; and group III included twenty patients with PCMT submitted to PMT. The patients were evaluated endoscopically according to the Lund-Kennedy endoscopic scoring system, radiologically according to the Lund-Mackay scoring system, and symptomatically through the 22-item Sinonasal Outcome Test (SNOT-22). Results The total postoperative Lund-Kennedy score differed significantly among the 3 groups (p < 0.001), with a group II presenting a significantly higher total score compared to groups I and III. The Preoperative SNOT-22 score differed significantly among the three groups (p = 0.013), with group II presenting a significantly higher score compared to group I. There was a significant association involving the 3 groups and relapse at 12 months (p = 0.029); relapse was higher in group II (50.0%) than in groups I (20%) and III (15.0%). Conclusion There was a significant association between PCMT and the relapse of nasal polyps. Also, nasal polyposis recurred at a lower rate in the group submitted to middle turbinate resection compared to the group in whom it was preserved.

SPECIAL ARTICLE COVID-19: Covid-19-Related Acute Invasive Fungal Sinusitis: Clinical Features and Outcomes

Abstract Introduction There is a noticeable increase in the incidence of acute invasive fungal sinusitis which coincides with the ongoing coronavirus pandemic. It is a potentiallylethal fungal infection, with the most common form being the rhino-orbito-cerebral presentation. Objectives The aim of the present study is to discuss the different epidemiological factors, risk factors, clinical presentations and outcomes of acute invasive fungal sinusitis which is noticeably related to the coronavirus disease 2019 (Covid-19) pandemic. Methods The present cross-sectional cohort study included 22 adult patients who presented with Covid-19-related acute invasive fungal sinusitis. The diagnosis of acute invasive fungal sinusitis was confirmed by histopathological biopsy. All data, including demographics, risk factors, clinical findings, different lines of treatment and their outcomes, were recorded and analyzed. Results All patients had diabetes mellitus (100%), and 17 (77.3%) had been submitted to systemic steroids. All patients (100%) had unilateral sinonasal disease. Proptosis was found in 15 patients (68.2%), ophthalmoplegia was observed in 12 patients (54.5%), and intracranial affection occurred in 10 patients (45.5%). A total of 20 patients (90.9%) received liposomal amphotericin B. Surgical debridement was performed in 18 patients (45.5%). Non-septated mycelia was present in 19 biopsies (86.4%), while 3 (13.6%) showed septated mycelia. Total improvement was achieved in 10 patients (45.5%), while the mortality rate was of 27.3% (6 out of 22 participants). Conclusion Diabetes mellitus is the most common preexisting medical condition associated with Covid-19-related acute invasive fungal sinusitis. Systemic corticosteroid therapy is considered a predisposing factor. It is necessary to raise the level of awareness to diagnose this condition, especially in patients with Covid-19 infection or those who have recently recovered from it.

Machine Learning Model for Predicting Postoperative Survival of Patients with Colorectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Machine learning (ML) is a strong candidate for making accurate predictions, as we can use large amount of data with powerful computational algorithms. We developed a ML based model to predict survival of patients with colorectal cancer (CRC) using data from two independent datasets. @*Materials and Methods@#A total of 364,316 and 1,572 CRC patients were included from the Surveillance, Epidemiology, and End Results (SEER) and a Korean dataset, respectively. As SEER combines data from 18 cancer registries, internal validation was done using 18-Fold-Cross-Validation then external validation was performed by testing the trained model on the Korean dataset. Performance was evaluated using area under the receiver operating characteristic curve (AUROC), sensitivity and positive predictive values. @*Results@#Clinicopathological characteristics were significantly different between the two datasets and the SEER showed a significant lower 5-year survival rate compared to the Korean dataset (60.1% vs. 75.3%, p < 0.001). The ML-based model using the Light gradient boosting algorithm achieved a better performance in predicting 5-year-survival compared to American Joint Committee on Cancer stage (AUROC, 0.804 vs. 0.736; p < 0.001). The most important features which influenced model performance were age, number of examined lymph nodes, and tumor size. Sensitivity and positive predictive values of predicting 5-year-survival for classes including dead or alive were reported as 68.14%, 77.51% and 49.88%, 88.1% respectively in the validation set. Survival probability can be checked using the web-based survival predictor (http://colorectalcancer.pythonanywhere.com). @*Conclusion@#ML-based model achieved a much better performance compared to staging in individualized estimation of survival of patients with CRC.

Effect of Viscum schimperi on advanced glycation endproducts formation

Diabetes is a disease characterized by elevated uncontrolled glucose level. Hyperglycemia results in diabetic complication due to a reaction between sugar and amino acid of proteins to form advanced glycation endproducts [AGEs] in different tissues. Medicinal plants are considered as a great source of bioactive compounds that affect many ailments. In this regard; AGEs formation could be inhibited by many bioactive compounds isolated from medicinal plants. Viscum schimperi Engl. is a plant belongs to Loranthaceae and known for its antidiabetic activity. In this study; total methanol extract of V. schimperi [VT] was prepared, suspended in water and subjected to fractionation with chloroform followed by n-butanol to give [VC] and [VB] fractions respectively. The aqueous mother liquor was evaporated to form [VA] fraction. The inhibitory effect of all prepared fraction on the formation of advanced glycation endproducts [AGEs] was studied. The results revealed that V. schimperi extract and its different fractions inhibited protein glycation and oxidation of BSA induced by ribose together with decrease of protein aggregation. In conclusion; V. schimperi will be useful in management of diabetic complications based on its inhibition of advanced glycation endproduct formation

Luteal phase endometrial echo-pattern in predicting pregnancy outcome during in-vitro fertilization and embryo transfer

The objective of this study was to evaluate the relationship between the sonographic assessment of the endometrium in the luteal phase and the in vitro fertilization embryo transfer outcome. Sixty-six women undergoing in vitro fertilization ET [IVF-ET] and another 66 women undergoing frozen embryo transfer [FET] were included in this study. All women underwent transvaginal ultrasound evaluation of the endometrial thickness and echogenic pattern three days after their embryo transfer. The 132 evaluated cycles were classified into two groups: Those with homogeneous hyperechogenic [HH] endometrial pattern and those with non-homogeneous hyperechogenic pattern [non- HH]. The clinical pregnancy rates were 31% versus 14%, the live birth rates were 24% versus 9%, the implantation rates were 14% versus 4% and the miscarriage rates were 21% versus 33% in HH and non-HH cycles in the IVF-ET group. There were no statistical differences between the pregnancy outcomes and echo-pattern in the FET group of women. There were no significant differences in age, number of oocytes retrieved, fertilization rate or the number of embryos transferred between conception and non-conception cycles in IVF-ET

One-stop clinic for peri-, postmenpausal bleeding; does it have a role?

The aim of the study was to evaluate the impact of one stop PMB clinic on reaching a diagnosis and initiate treatment. Since the service started, 107 women were referred to PMB clinic. The prospective finding of eighty patients who met the criteria of direct general practitioner referral to PMB clinic was analyzed. The mean time from GP referral to consultation at PMB clinic was 14.8 days [range 2-24 days]. TVS was done for 97.5% of women and abnormal findings were reported in 67.5%. Pipette endometrial sampling was performed in 31 patients and a sample was obtained successfully in 21 women. Ten women referred directly for diagnostic hysteroscopy and another ten had hysteroscopy following failed pipette sampling. After reassurance by consultation and normal TVS, 24 women discharged back to their GPs. Seventy women considered a single PMB clinic visit was satisfactory. This study demonstrated the effective role of one-step PMB clinic to provide quick reassurance, arrive at a diagnosis and initiate plan of management during single outpatient visit

Incidence of astigmatism in Alexandria population

Astigmatism was studied in 1000 patients [500 Males and 500 females] using Nidek [AR 1100] Autorefractometer. The total incidence off astigmatism was found to be 95.4%. The incidence of significant astigmatism [above 0.5 diopters] was 56.5%. There was no statistically significant difference between males and females. The most common type of astigmatism was found to be compound myopic astigmatism was found to be compound myopic astigmatism [55.07%]