Is sino-nasal outcome test-22 reliable for guiding chronic rhinosinusitis patients for endoscopic sinus surgery?

Chronic rhino-sinusitis (CRS) is a significant health problem whose incidence and prevalence is rising. An emphasis has been placed on diseasespecific quality of life (QoL as the predominant measure for most current outcome studies. Therefore a validated measure of health-related QoL in sinonasal disease is needed. The present prospective and observational study was conducted on 50 patients in the Department of ENT at Govt. Medical College and Rajindra Hospital Patiala, Punjab, India. The primary outcomes were the following: (1) the chance of attaining minimal clinically important difference (MCID) improvements of nine points at the 22-item Sino-Nasal Outcome Test (SNOT-22) after endoscopic sinus surgery (ESS) for different preoperative QoL levels, and (2) the percentage of relative improvement in SNOT-22 after ESS for different preoperative QoL levels. METHODS: Patients with CRS who were elected for ESS were prospectively enrolled into an observational cohort study. They were categorized into 10 preoperative SNOT-22 groups based on 10-point increments beginning with a score of 10 and ending at 110. Standard protocol for all patients presenting for evaluation included completion of the SNOT-22 prior to and following surgical intervention. The scores were calculated and the data collected were compiled and analyzed. RESULTS: A total of 50 patients were included in this study. Patients with a SNOT-22 score between 10 and 19 had the lowest chance of achieving an MCID. Patients with a SNOT-22 score greater than 30 had a greater than 90% chance of achieving an MCID, and there was a relative improvement of 43.3% on their preoperative SNOT-22 scores. CRS patients with polyp had better outcomes (47.1% improvement) after ESS than those without polyp (33.2% improvement). CONCLUSION: There is an increased probability of achieving an MCID at SNOT-22 score >30 and in general the percentage of relative improvement increased with an increase in preoperative SNOT score.

Overactivity, impulsivity and repetitive behaviour in males with fragile X syndrome: contrasting developmental trajectories in those with and without elevated autism symptoms.

BACKGROUND: Hyperactivity and repetitive behaviour are characteristic features of fragile X syndrome (FXS). However, little is known about the influence of autism symptomatology on how these characteristics develop over time. We investigate the profiles and developmental trajectories of overactivity, impulsivity and repetitive behaviour, in males with FXS over three time points spanning 8 years. METHOD: Participants formed two subgroups, those who displayed elevated symptoms of autism at Time 1 (n = 37; Mage  = 16.32; age range = 6.61-43.51) and those who did not (n = 32; Mage  = 8.43; age range = 8.94-47.49). RESULTS: Participants without elevated symptoms of autism showed a reduction in impulsivity and repetitive questioning over time, whereas those with elevated symptoms of autism did not. Differences between the two subgroups in several topographies of repetitive behaviour emerged at Time 3 only. CONCLUSIONS: These results further understanding of the relationship between autistic phenomenology and behavioural characteristics in FXS.