Clinical Outcomes of Severe Rhinosinusitis Complicated with Cavernous Sinus Syndrome.

Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms.

[Effect of Plasma Lipids on GDM in the First Trimester of Pregnant Women: a Prospective Cohort Study].

OBJECTIVE: To determine the effect of plasma lipids on gestational diabetes mellitus (GDM) of pregnant women in their first trimester. METHODS: 354 healthy singleton primiparas were followed up in three hospitals in Chengdu until delivery. Basic information about pregnancy was collected using a questionnaire. Dietary intake was assessed using 24 h dietary recall at (12 ± 1) weeks of gestation. Their total energy intake in the first trimester was calculated with a nutrition calculator. Blood samples of the participants were also taken at the (12 ± 1) weeks of gestation to determine plasma triglyceride (TG), total cholesterol (TC), high-density lipoproteincholesterol (HDL-C), low-density lipoproteincholesterol (LDL-C), fasting blood-glucose (FBG). 75 g oral glucose tolerance test (OGTT) was conducted at 24-28 weeks of gestation for the diagnosis of GDM. Multiple logistic regression analyses were performed to estimate odds ratio (OR) of risk factors. Receiver operating characteristic (ROC) curves were drawn to determine the optimal operating point (OOP) of TG level for predicting GDM. Results Women with GDM had significantly higher levels of plasma TG, TC and LDL-C than those without GDM (P < 0.05). After adjustment for maternal pre-pregnant BMI and other confounding factors, women with TG ≥ 1.59 mmol/L and 1.26-1.59 mmol/L showed a higher risk of GDM: 3.86-fold [95% confidence interval (CI): 1.35-11.08] and 2.46-fold (95% CI: 1.05-6.51) as compared with those with TG < 0.94 mmol/L, respectively. The OOP was determined at 1.27 mmol/L with high sensitivity and specificity, and area under the curve 0.634 (95% CI: 0.574-0.711). CONCLUSION: TG level in the first trimester is associated with GDM. It is important to monitor plasma lipids in pregnant women.

[Effect of Sleep in Early Pregnancy on Gestational Diabetes: a Prospective Study.]

OBJECTIVES: To investigate the influence of sleep status in early pregnant women on the occurrence of gestational diabetes mellitus (GDM). METHODS: In this prospective study,542 pregnant women in early pregnancy were selected as subjects.The sleep time,insomnia,pre-gestational body mass and basic information of the subjects were collected by the trained investigators through questionnaire.At the 24th to 28th pregnant week,the body mass of each subject was measured and oral glucose tolerance test (OGTT) was conducted.The diagnosis of GDM was followed the guidelines of diagnose and treatment of gestational diabetes mellitus in China (2014).A non-conditional logistic regression method was adopted to analyze the correlation between sleep status of early pregnant women and the occurrence of GDM. RESULTS: The numbers of subjects in sleep deficiency group,sleep sufficiency group and sleep excessive group were 16 (2.95%),268 (49.45%) and 258 (47.60%),respectively.The incidences of GDM for sleep deficiency group,sleep sufficient group,and sleep excessive group were 62.50%(10/16),25.75%(69/268) and 22.09% (57/258),respectively,the difference was statistically significant (χ2=11.280,P<0.05).Compared with either sleep sufficiency or sleep excessive group,sleep deficiency group had higher GDM occurrence rate with statistically significant (χ2=8.410,11.218,P<0.017).Insomnia subjects in early pregnancy were 137 (25.28%).The incidences of GDM in insomnia group and normal group were 32.12% and 22.72% respectively,the difference was statistically significant (χ2=4.813, P<0.05).After adjusting the confounding factors [age,education,pre-pregnant body mass index (BMI),gained body mass in early and medium pregnancy,family history of type-2 diabetes,gravidity,parity,smoke,drink,exercise and occupation],non-conditional logistic regression results show that sleep deficiency for early pregnant women was an independent risk factor for the occurrence of GDM [odds ratio (OR)=7.38,95% confidence interval (CI): 2.25-24.17].However,the association between insomnia and the occurrence of GDM was not found. CONCLUSIONS: Sleep deficiency in early pregnancy may be a risk factor for the occurrence of GDM.