Quail egg homogenate with zinc as adjunctive therapy in seasonal allergic rhinitis: a randomised, controlled trial.

OBJECTIVE: Because most available treatments for managing seasonal allergic rhinitis show some side effects without reducing recurrence, natural anti-allergic products could represent an interesting treatment addition. This study aimed to analyse the efficacy and tolerance of quail egg as adjunctive therapy in seasonal allergic rhinitis. METHOD: In a Consolidated Standards of Reporting Trials compliant framework, patients with seasonal allergic rhinitis were prospectively randomised to receive mometasone nasal spray for four weeks or the same topical corticosteroid therapy plus commercially available oral quail egg and zinc tablets. RESULTS: Forty patients were enrolled. The mometasone + quail egg and zinc tablets group showed a greater reduction in nasal itching, sneezing and total nasal symptom scores than the mometasone nasal spray only group. A higher proportion of participants in the mometasone + quail egg and zinc tablets group had good rhinitis control than in the mometasone nasal spray only group, with no need for rescue medications. CONCLUSION: Despite the need for a further larger study, quail egg preliminarily appears to be an effective adjunct to topical steroid therapy in seasonal allergic rhinitis.

An unusual case of melanoma metastasis in the buccal space: learning by mistakes to distinguish it from salivary neoplasms.

BACKGROUND: The buccal space is an unusual location of malignancies. We report here the case of a woman with a melanoma metastasis in buccal fat pad, to evaluate the imaging features which might lead to the correct, although uncommon, diagnosis. CASE PRESENTATION: A 71-year-old woman presented with a painless visible swelling of the left cheek. MRI revealed the presence of a solid lesion located in the buccal fat pad with features suggestive of malignancy. It showed T1 hyperintensity and T2 hypointensity, and restriction of diffusion. Histological examination showed neoplastic cells compatible with melanoma. DISCUSSION: The lesion features (T1 hyperintensity and T2 hypointensity) initially lead our team to believe that there was a hemorrhagic component, possibly a residue of the biopsy. However, when associated with other malignancy features, such as low apparent diffusion coefficient (ADC) values and contrast enhancement, they should evoke the suspect of melanoma, provided that no biopsy was performed and no trauma occurred in the 3-7 days before.

Olfactory disorders in coronavirus disease 2019 patients: a systematic literature review.

OBJECTIVE: Recent scientific literature has widely described a possible major role of smell dysfunction as a specific symptom of coronavirus disease 2019. This systematic review may provide a more holistic approach to current knowledge of the disease. METHODS: A systematic review was completed using Embase, PubMed and Web of Science databases that considered original articles focused on olfactory evaluation in coronavirus disease 2019 patients, published between March and May 2020, in English language. RESULTS: From the 483 research papers initially identified, 32 original studies were selected, comprising a total of 17 306 subjects with a laboratory confirmed diagnosis of coronavirus disease 2019. Individual study sample sizes ranged from 6 to 6452 patients. This comprehensive analysis confirmed that olfactory disorders represent an important clinical feature in coronavirus disease 2019, with a prevalence of 11-100 per cent in included patients, although there was heterogeneity in terms of assessment tools and population selection criteria. CONCLUSION: The results indicate that an accurate clinical evaluation should be carried out using structured questionnaires and tests with olfactory substances.

The role of narrow-band imaging in parathyroid surgery: a preliminary evaluation in five parathyroid adenoma cases.

BACKGROUND: Narrow-band imaging uses selective haemoglobin light absorption to emphasise vascular visualisation and capillary networks. OBJECTIVE: This study aimed to evaluate the application of this technique to parathyroid surgery. METHOD: This preliminary evaluation was carried out on five consecutive patients with single parathyroid adenoma being considered for minimally invasive video-assisted parathyroidectomy. The adenomas were checked for narrow-band imaging vascular patterns. Minimally invasive video-assisted parathyroidectomy was then carried out in accordance with our standard protocol. RESULTS: In four out of the five cases, narrow-band imaging integrated the white endoscopic light and direct vision, but in one case narrow-band imaging allowed distinction between the hidden neoplastic tissue and the surrounding structures thanks to the different vascular patterns. CONCLUSION: Narrow-band imaging was helpful in properly identifying adenoma. It is suggested that this technique be considered as a means for surgeons to improve their confidence in selected surgical treatments and to improve treatment quality.

Numerical simulation of thermal water delivery in the human nasal cavity.

This work describes an extensive numerical investigation of thermal water delivery for the treatment of inflammatory disorders in the human nasal cavity. The numerical simulation of the multiphase air-droplets flow is based upon the Large Eddy Simulation (LES) technique, with droplets of thermal water described via a Lagrangian approach. Droplet deposition is studied for different sizes of water droplets, corresponding to two different thermal treatments, i.e. aerosol and inhalation. Numerical simulations are conducted on a patient-specific anatomy, employing two different grid sizes, under steady inspiration at two breathing intensities. The results are compared with published in vivo and in vitro data. The effectiveness of the various thermal treatments is then assessed qualitatively and quantitatively, by a detailed analysis of the deposition patterns of the droplets. Discretization effects on the deposition dynamics are addressed. The level of detail of the present work, together with the accuracy afforded by the LES approach, leads to an improved understanding of how the mixture of air-water droplets is distributed within the nose and the paranasal sinuses.

Nasal cytology in children: scraping or swabbing?

Nasal cytology has become a valuable tool in the assessment of a multitude of nasal pathologies in children. Collection methods differ significantly and even though the use of the nasal curette is regarded as the most reliable in adults, most practitioners use the nasal swab in children. However, no studies have validated the reliability and supposed better tolerability of the latter. We have compared these two sampling methods regarding their tolerability and analysed the diagnostic accuracy of the cotton nasal swab (NSW) to identify nasal cytotypes and rhinitis phenotypes, using nasal scraping (NSC) for comparison. In a multicentric prospective study we recruited 208 children and performed nasal cytology by means of NSW and NSC. Microscopic evaluating of the nasal cytotypes was performed and tolerability of NSW and NSC was tested. Our data revealed a significantly inferior diagnostic accuracy of NSW compared to NSC regarding reliability and cell counts. Our study is the first to shed light on the role of the sampling tools for pediatric nasal cytology. We documented a poor diagnostic accuracy of NSW, thus suggesting using only the nasal curette in clinical practice. Furthermore, tolerability did not differ between the two, refuting the common thesis that swabs are to be preferred when doing nasal cytology in children.

Bariatric Surgery to Target Obesity in the Renal Transplant Population: Preliminary Experience in a Single Center.

During the last century, obesity has become a global epidemic. The effect of obesity on renal transplantation may occur in perioperative complications and impairment of organ function. Obese patients have metabolic derangements that can be exacerbated after transplantation and obesity directly impacts most transplantation outcomes. These recipients are more likely to develop adverse graft events, such as delayed graft function and early graft loss. Furthermore, obesity is synergic to some immunosuppressive agents in triggering diabetes and hypertension. As behavioral weight loss programs show disappointing results in these patients, bariatric surgery has been considered as a means to achieve rapid and long-term weight loss. Up-to-date literature shows laparoscopic bariatric surgery is feasible and safe in transplantation candidates and increases the rate of transplantation eligibility in obese patients with end-stage organ disease. There is no evidence that restrictive procedures modify the absorption of immunosuppressive medications. From 2013 to 2016 we performed six bariatric procedures (sleeve gastrectomy) on obese patients with renal transplantation; mean preoperative body mass index (BMI) was 39.8 kg/m2. No postoperative complication was observed and no change in the immunosuppressive medications regimen was needed. Mean observed estimated weight loss was 27.6%, 44.1%, 74.2%, and 75.9% at 1, 3, 6, and 12 months follow-up, respectively. Our recommendation is to consider patients with BMI >30 kg/m2 as temporarily ineligible for transplantation and as candidates to bariatric surgery if BMI >35 kg/m2. We consider laparoscopic sleeve gastrectomy as a feasible, first-choice procedure in this specific population.

Transnasal endoscopic microfractured fat injection in glottic insufficiency.

OBJECTIVE: We evaluated a novel treatment for glottic insufficiency involving the injection of autologous material with direct glottic visualisation in an outpatient setting. METHODS: Three patients with vocal cord palsy underwent laryngoplasty under local anaesthesia using only a flexible endoscope with a working canal for Microfractured Fat Fibre-endoscopic Injection (MFFI). Adipose tissue was processed using the Lipogems device, which allows optimal purity, fluidity, and mesenchymal stem cell content in the resultant emulsion. RESULTS: According to the preliminary data, MFFI was well tolerated and no complications were observed. During the 12-month follow-up period, voice improvement was constant in all three patients, hinting at the stem cell-related regenerative potential of the procedure. CONCLUSIONS: MFFI was proven to be a useful and straightforward tool, combining all of the relevant advantages of other known treatments for glottic insufficiency, and is an efficacious and innovative treatment that can be performed on an outpatient basis using only autologous material.

[Auriculo temporal nerve. Neuroanatomic bases of the Frey's syndrome]. / El nervio auriculotemporal. Bases neuroanatómicas del síndrome de Frey.

The aim of this study was to precise the relationships of the auriculotemporal nerve in the infratemporal and parotid regions. We realized micro-dissections of thirty-two infratemporal and parotid regions of human cadaver's formol-fixed. The pattern of origin was: one root: 15.4%, two roots: 73.1%, three roots: 11.5%. In all cases, the lateral root present the major diameter (2-2.5 mm). In those cases with two roots, these formed a neural loop round the middle meningeal artery in the 89.4% of the cases. The origin of the medial root was the posterior border of the inferior alveolar nerve. The median distance between the lateral root and the temporomandibular joint capsule was 1.5 mm, with asymmetric pattern: right: 2 mm (rank: 0-7 mm; ED: 1.90 mm); left: 1.25 mm (rank: 0-3 mm; ED: 0.88 mm). In 10 cases (31.3%) the lateral root was in direct contact with the articular capsule, with asymmetric pattern: left: 46.1%; right: 21%. The median distance between the superior aspect of the articular disk and the trunk of the auriculotemporal nerve in the posterior aspect of the temporomandibular joint was 10,5 mm (ED: 4.06 mm), with asymmetric pattern: right: 9 mm (rank: 5-18.0 mm; ED: 3.70 mm); left: 11.0 mm (rank: 3.0-20 mm; ED: 4.41 mm). We discussed the rol of this findings in the etiology of the Frey's syndrome.

El nervio auriculotemporal. Bases neuroanatómicas del Síndrome de Frey / Auriculo temporal nerve. Neuroanatomic bases of the Frey´ Syndrome

El propósito de este estudio fue precisar las relaciones del nervio auriculo temporal en las regiones infratemporal y parotídea. Se realizó la microdisección de 32 regiones infratemporales y parotídeas de cadáveres humanos formolados. Los patrones de origen fueron: raíz única: 15.4%, dos raíces: 73.1% y tres raíces: 11.5%. En todos los casos la raíz lateral era la de mayor diámetro (2-2,5 mm). En los casos con dos raíces estas constituían un ojal nervioso a la arteria meníngea media en el 89.4% de los casos. La raíz medial se originaba en todos los casos del borde posterior del segmento inicial del nervio alveolar inferior. La distancia media entre la raíz lateral del nervio auriculotemporal y la cápsula dela articulación temporo mandibular fue de 1.5 mm, con patrón asimétrico, derecha: 2 mm (rango: 0-7 mm; DE1.90 mm); izquierda: 1.25 mm (rango: 0-3 mm; DE 0.88mm). En 10 casos (31.3%) la raíz lateral se encontraba en contacto directo con la cápsula articular, izquierda (46.1%) y a derecha (21.1%). La distancia media en la cara posterior de la articulación temporomandibular, desde la cara superior del disco articular al tronco del nervio auriculo temporal fue de 10,5 mm (DE: 4.06 mm),con patrón asimétrico, derecha: 9 mm (rango: 5,0-18,0mm; DE 3,70 mm), izquierda: 11.0 mm (rango: 3.0-20.0mm; DE 4.41 mm). Se discute el rol de estos hallazgos en la etiología del síndrome de Frey

The aim of this study was to precise the relationships of the auriculo temporal nerve in the infratemporal and parotid regions. We realized micro-dissections of thirty–two infratemporal and parotid regions of human cadaver’s form ol-fixed. The pattern of origin was: one root: 15.4%, two roots: 73.1%, three roots: 11.5%. In all cases, the lateral root present the major diameter(2-2,5 mm). In those cases with two roots, these formed a neural loop round the middle meningeal artery in the 89.4% of the cases. The origin of the medial root was the posterior border of the inferior alveolar nerve. The median distance between the lateral root and the temporo mandibular joint capsule was 1.5 mm, with a symmetric pattern: right: 2 mm (rank: 0-7 mm; ED:1.90mm); left: 1.25 mm (rank: 0-3 mm; ED: 0.88 mm).In 10 cases (31.3%) the lateral root was in direct contact with the articular capsule, with asymmetric pattern: left: 46.1%; right: 21%. The median distance between the superior aspect of the articular disk and the trunk of the auriculo temporal nerve in the posterior aspect of the temporo mandibular joint was 10,5 mm (ED: 4.06 mm), with asymmetric pattern: right: 9 mm (rank: 5-18.0 mm; ED: 3.70 mm); left: 11.0 mm (rank: 3.0-20mm; ED: 4.41 mm). We discussed the rol of this findings in the etiology of the Frey’s syndrome

Left ventricular hypertrophy and QT interval in obesity and in hypertension: effects of weight loss and of normalisation of blood pressure.

BACKGROUND: Left ventricular hypertrophy (LVH) and prolonged QT interval at ECG (QTc) are common in both obesity and arterial hypertension (AH), and are risk factors for cardiovascular disease and sudden death. METHODS: We compared the frequencies of LVH (ECG criteria) and QTc in obese-AH (n=41), in normotensive obese (n=75), in lean-AH (n=30), and in lean controls (n=68) comparable for age and sex; in obese patients, LVH and QTc were evaluated under basal conditions and 1 y later, that is, after a significant weight loss induced by bariatric surgery. RESULTS: LVH was more frequent, and QTc was longer, in obese-AH, in normotensive obese, and in lean-AH than in lean controls; after weight loss, frequency of LVH decreased in obese subjects becoming normotensive (n=87), not in obese subjects remaining hypertensive (n=29), while QTc decreased in all obese subjects. CONCLUSION: Weight loss can effectively reduce QTc; when concomitant AH disappears, weight loss can also reduce the prevalence of LVH. In obese patients remaining hypertensive, aggressive pharmacological treatment is therefore indicated to correct LVH.

Autoantibodies to amphiphysin I and amphiphysin II in a patient with sensory-motor neuropathy.

A proportion of patients with peripheral neuropathies has circulating autoantibodies directed against neural antigens. In some cases, autoantibodies may play a pathogenic role. We studied a patient with a progressive sensory-motor axonal neuropathy of unknown etiology, looking for circulating autoantibodies against neural antigens and we showed that the patient's serum contained anti-amphiphysin I (AMP I) and amphiphysin II (AMP II) autoantibodies. A sural nerve biopsy revealed an axonal neuropathy. Indirect immunofluorescence experiments with the patient's serum showed a staining of rat axons due to alpha-AMP I autoantibodies and a specific labelling of cytoplasm and Schmidt-Lanterman incisures of Schwann cells due to alpha-AMP II autoantibodies. In conclusion we identified a patient affected by a sensory-motor neuropathy with autoantibodies against both AMP I and AMP II.

Nicotinamide improves insulin secretion and metabolic control in lean type 2 diabetic patients with secondary failure to sulphonylureas.

Eighteen patients with non-insulin-dependent (type 2) diabetes mellitus of normal body weight [body mass index (BMI) <25 kg/m2] without signs of autoimmunity [negative for islet cell antibodies (ICA)], with secondary failure of sulphonylureas, defined as persistent hyperglycaemia in spite of maximal doses of sulphonylureas, were evaluated for C-peptide release under basal conditions and 6 min after i.v. glucagon, for glycosylated haemoglobin (HbA1C), and for fasting and mean daily blood glucose levels. They entered a 6-month, single-blind study in which they were randomly assigned to one of three treatments: (1) insulin plus nicotinamide (group 1, 0.5 g, three tablets/day); (2) insulin plus placebo (group 2, 3 tablets/day); (3) current sulphonylureas plus nicotinamide (group 3, 0.5 g, three tablets/day). They were re-evaluated for C-peptide, HbA1C, and fasting and mean daily blood glucose levels after 6 months. Compared with group 2, C-peptide release increased in both groups 1 and 3, while HbA1C, fasting and mean daily blood glucose levels improved in the three groups to the same extent. With multiple regression analysis, nicotinamide administration was the only significant factor for the improvement of C-peptide release. These data indicate that nicotinamide improves C-peptide release in type 2 diabetic patients with secondary failure of sulphonylureas, leading to a metabolic control similar to patients treated with insulin.

Insulin sensitivity and lipid levels in obese subjects after slimming diets with different complex and simple carbohydrate content.

The ideal hypocaloric diet should reduce body weight, decrease fat more than muscle tissue, and ameliorate insulin sensitivity and lipid levels. The aim of this study was to investigate the effect of three hypocaloric diets with different carbohydrate (CHO) and fat contents on body weight reduction, insulin release and sensitivity, and lipid levels in patients with simple obesity. Twenty-five obese subjects with normal glucose tolerance were randomly allocated to three hypocaloric (800 kcal) diets containing: 60% high complex/high starch and fibre (HC/HSF-CHO) and 20% fat (group 1;11 subjects); 60% high simple/high natural fibre (HS/HNF-CHO) and 20% fat (group 2; 7 subjects); or 20% CHO (L-CHO) and 60% fat (group 3; 7 subjects). The remaining 20% of the diet was protein. In all cases the duration of the diet was 21 days. Before and after the diet, seven subjects from each group underwent a hyperglycemic clamp, and the other four subjects of group 1 underwent a euglycemic-hyperinsulinemic clamp, combined with a glucose turnover study. A similar decrease in body weight, fat-free mass, fat mass, total cholesterol, LDL cholesterol and apo B levels was observed in the three groups. The M/I ratio during hyperglycemic and euglycemic-hyperinsulinemic clamp and the glucose turnover rate during euglycemic-hyperinsulinemic clamp significantly decreased, and FFA levels significantly increased only after the HC/HSF-CHO diet. HDL cholesterol and apo A1 significantly increased only during the HS/HNF-CHO diet.(ABSTRACT TRUNCATED AT 250 WORDS)