Ophthalmology

EDITORIAL
	Driving blind - Should tests of visual function be mandatory for driving license?	p. 193
	Santosh G Honavar DOI:10.4103/ijo.IJO_150_19
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ONE MINUTE OPHTHALMOLOGY
	Just another chalazion?	p. 195
	Jonathan McLaughlin, Sara E Lally, Carol L Shields DOI:10.4103/ijo.IJO_18_19
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REVIEW ARTICLE
	Visual function assessment, ocular examination, and intervention in children with developmental delay: A systematic approach. Part 1	p. 196
	Meenakshi Swaminathan, Deiva Jayaraman, Namita Jacob DOI:10.4103/ijo.IJO_524_18   Children with special needs form a unique subset with regards to visual function and examination techniques needed to assess them. With more awareness among the general public, neurologists, and pediatricians, these children are referred for assessment to the ophthalmologist or optometrist and sometimes even to the rehabilitation professional at an early age. This clinical practice guideline and review gives a systematic approach for examining the visual functions of a child with special needs. It outlines the procedures to be followed with equipment needed in clinical practice. Functional vision assessment guidelines are also included. This is the first part in a two-part series, with the first part presenting clinical examination guidelines and the second presenting intervention and vision enhancement techniques.
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ORIGINAL ARTICLES
	Causes of visual impairment in applications for blindness certificates in a tertiary center of Bihar and its role in health planning	p. 204
	Anita Ambastha, Rakhi Kusumesh, Shalini Sinha, Bibhuti P Sinha, Gyan Bhasker DOI:10.4103/ijo.IJO_837_18   Purpose: To analyze applications for blindness certificates to find causes of visual impairment (VI), handicap, and blindness in a tertiary hospital of Bihar. Methods: Applications for blindness certificates were analyzed over a two-year period. The main cause of blindness, visual handicap, and VI in these applications was ascertained by age group and etiology. VI disability percentages and definitions proposed by Governmen of India (category 0–4; 20–100%) were used to categorize and give percentage to all applicants. Results were compared with data from studies on blindness certificates and population based studies. Results: In total, 203 applicants were reviewed. Mean age was 23.5 ± 7.9 years. Overall, most common cause of visual handicap (40–100% impairment) and blindness (75–100% impairment) was macular pathology (P <.05), while most common cause of overall VI (20–100% impairment) was amblyopia. In age group 0–15 years, most common causes of blindness/visual handicap were congenital globe and hereditary retinal or optic nerve disorders (P = 0.016). In age group 16–30 years, macular pathology was the most common cause of visual handicap [P = 0.007], while amblyopia was the most common cause of VI [P = 0.00]. Between 31 and 45 years of age group, corneal scar in one eye was the most common cause of VI, while macular scar in both eyes was the most common cause of visual handicap. Glaucoma and diabetic retinopathy were the most common causes of blindness/visual handicap between 46 and 65 years and above 65 years of age, respectively. Data about causes of VI such as amblyopia, complicated cataract surgery, and one eyed blindness could not be ascertained by analyzing blindness certificate alone. Conclusion: Data from applications for blindness certificates provide valuable information regarding different causes of VI that might otherwise not be eligible for blindness certification and provide an insight into the overall trends in disease profile and service delivery.
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	Iris and knot configuration after Single Pass Four Throw (SFT) pupilloplasty as imaged by the spectral-domain optical coherence tomography	p. 209
	Dhivya Ashok Kumar, Amar Agarwal, Radhika Chandrasekar, Nagaraj Jaganathasamy DOI:10.4103/ijo.IJO_885_18   Purpose: To analyze the morphological changes in the iris-knot complex configuration using spectral-domain optical coherence tomography (SD-OCT) following the single pass four throw (SFT) pupilloplasty. Methods: In this retrospective case series, eyes with SFT pupilloplasty were examined by SD-OCT (Optovue). Iris morphology compared to the normal iris, presence of specific patterns (single hump, double humps, peaks and valleys, tethering), prolene suture, knot complex (length and orientation), and intraocular lens (IOL) vault were evaluated. Results: Overall, 41 knots of 26 patients with a mean time duration of 3.1 ± 2 months from surgery were analyzed. Iris configurations seen were single hump (n = 28, 63.8%), double humps (n = 7, 17%), loop (n = 2, 4.8%), flat (n = 3, 7.3%), and mulberry (n = 1, 2.4%). The mean length and the height of the knot complex was 784.1 ± 433.7 μm and 317.7 ± 110.4 μm, respectively. Knot positions were at 3 clock hours in 9 eyes (21.9%), 9 in 8 eyes (19.5%), and others in 24 eyes (58.5%). Cut end of the prolene suture was detectable in 26 eyes (63.4%) as hyper-reflective line, and the mean cut length was 465.8 ± 321.1 μm. The suture was predominantly vertically oriented (80.6%) to the iris with a mean distance of 3.6 ± 0.3 mm (2.6–4 mm) away from corneal endothelium. The mean distance from the knot complex and the IOL was 289.2 ± 146 μm and the mean anterior chamber depth was 4.1 ± 0.1 mm. Conclusion: A significant change in iris configuration was noted after SFT pupilloplasty, and vertically oriented retained prolene suture was predominant with good endothelial vault.
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	Perceived difficulties and complications in learners of phacoemulsification: A principal component analysis model	p. 213
	Sagnik Sen, Mukesh Patil, Rohit Saxena, Atul Kumar, Sreelakshmi P Amar, Deepsekhar Das, Anand Singh Brar, Pragya Saini DOI:10.4103/ijo.IJO_1133_18   Purpose: To evaluate the difficulty perceived of each step of phacoemulsification and analyze the factors affecting them. Methods:Overall, 12 trainee residents were allotted 10 cases of phacoemulsification of eyes with senile cataract, under a single observer, and the steps of each surgery were rated from very easy to very difficult with a questionnaire. The completion rates of steps and complications of each surgery were noted. Principal component analysis of the responses to the difficulty level questionnaire was conducted to obtain factors resulting in the perceived difficulty. Results: The lowest difficulty scores were for initial step of incision creation (1.63 ± 0.84), followed by intraocular lens insertion (2.51 ± 0.8). The most difficult step was divide/chop of the nucleus (3.74 ± 0.97) followed by phacoemulsification (3.32 ± 0.82). Highest completion rates were seen for the initial steps of the surgery and the lowest for divide/chop. We identified two major patterns of difficulty among the trainees – one for steps involving high amount of binocularity and the other, for steps involving high precision of hand control. The rate of complication of our study was within acceptable range. Conclusion: Although trainees have practiced phacoemulsification steps on simulation, real-life situation may bring in unprecedented level of difficulty and challenges, which may be documented and used for targeted improvement of surgical skills. Stereopsis and hand control training should form a major part of training modules of cataract surgery both on simulation and real-life scenarios.
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	Retrospective study on outcomes of terminal chop technique of nuclear fragmentation in phacoemulsification and combined surgery: An observational study	p. 217
	Arvind K Morya, Sahil Bhandari, Anushree Naidu DOI:10.4103/ijo.IJO_711_18   Purpose: Terminal chop, a new technique of nuclear segmentation, has been recently described in literature. The technique is considered to be a safe and effective option. Methods: We did a retrospective study to evaluate the outcome of terminal chop. Patients operated for terminal chop (phacoemulsification with or without trabeculectomy) from October 2016 to July 2018 were included in the study. Results: In all, 933 patients were included in the study. The grade of nuclear sclerosis ranged from 2 to 5. All the patients had a significant visual improvement at 1 month postop. Around 3.4% had pseudoexfoliation and 8.89% of the eyes underwent combined surgery. Cumulative dissipated energy showed a proportionate relation with the grade of nucleus. Intraoperative complication rate was 0.08%. Postoperative complication rate was 3.50%. Conclusion: Terminal chop proved to be a safe, reproducible, and effective technique of nuclear segmentation in different grades of cataract.
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	Frequency and surgical difficulties associated with pseudoexfoliation syndrome among Indian rural population scheduled for cataract surgery: Hospital-based data	p. 221
	Rajesh S Joshi, Sonali V Singanwad DOI:10.4103/ijo.IJO_931_18   Purpose: To study the frequency and intraoperative difficulties associated with pseudoexfoliation (PXF) syndrome at a tertiary eye care center in a rural central India. Methods: This study included patients scheduled for cataract surgery who were diagnosed with PXF syndrome. All patients underwent a complete ophthalmologic evaluation, including slit-lamp examination, tonometry, gonioscopy, and ophthalmoscopy before the surgery. Cataract surgeries were performed by a single surgeon who reported the intraoperative difficulties. Results: In total, 1022 phakic eyes of 1823 patients were evaluated, 226 of whom (22.1%) were diagnosed with PXF syndrome. Most eyes (n = 81, 35.8%) with PXF syndrome were ≥81 years old. Eighty-six eyes (38.1%) had bilateral involvement, whereas 70 (30.9%) had right or left eye involvement. Further, PXF material was distributed on the iris, pupil, and lens in 70 eyes (30.9%) and on the pupillary margin in 36 eyes (15.9%). The mean pupillary dilation was 5.1 (±1.4) mm in patients with PXF syndrome compared with 7.2 (±1.6) mm in those without it (P = 0.03). Grade VI cataract was observed in 93 eyes (41.2%) and hypermature cataract was the most commonly observed cataract stage. Twenty-one eyes (9.3%) had increased intraocular pressure. Intraoperative difficulties were encountered in 62 eyes (27.4%) with poor pupillary dilation being the most common problem (32 eyes, 14.2%), followed by zonular dehiscence (18 eyes, 8%). Conclusion: This hospital-based study showed that PXF syndrome is common in Indian rural population and that the intraoperative complication rate in these patients is high.
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	Quantification of RAPD by an automated pupillometer in asymmetric glaucoma and its correlation with manual pupillary assessment	p. 227
	Manju R Pillai, Sapna Sinha, Pradeep Aggarwal, Ravilla D Ravindran, Claudio M Privitera DOI:10.4103/ijo.IJO_648_18   Purpose: The relative afferent pupillary defect (RAPD) is an important sign of asymmetrical retinal ganglion cell damage. The purpose of this study was to quantify RAPD by a pupillometer (RAPiDo, Neuroptics) and assess its correlation with asymmetric glaucoma and manual pupillary assessment. Methods: A total of 173 subjects were enrolled in the study and categorized into glaucoma, n = 130, and control, n = 43. Subjects were all recruited in the Glaucoma Clinic of the Aravind Eye Hospital in Madurai during their follow-up. They were 18 years and older, with best corrected visual acuity of 6/36 or better. Exclusion criteria included all retinal pathologies, optic atrophies, ocular injuries, severe uveitis, cloudy corneas, dense cataracts, or use of mydriatics or miotic drugs. RAPD was assessed in all subjects using an automated pupillometer and the results were compared with the swinging flash light test conducted on the same subjects by an experienced ophthalmologist. We looked at the correlation between RAPD and the intereye difference in cup-to-disc ratio (CDR), mean deviation (MD) of visual field testing, and retinal nerve fiber layer (RNFL) thickness. Sensitivity and specificity were assessed by area under the receiver operator characteristic (AUROC) analysis. Results: Glaucoma patients had significant RAPD (0.55 ± 0.05 log units) when compared with the controls (0.25 ± 0.05 log units), P < 0.001. Significant intereye differences in CDR, MD, and RNFL between glaucoma and control (P < 0.001) were seen. There was a good correlation between the magnitude and sign of RAPD and these intereye differences in CDR (r = 0.52, P < 0.001), MD (r = 0.44, P < 0.001) and RNFL thickness (r = 0.59, P < 0.001). When compared with the experienced ophthalmologist, AUROC was 0.94, with 89% sensitivity and 91.7% specificity. Conclusion: The good correlation between the magnitude of RAPD, as measured by the automated pupillometer, and intereye differences in MD, CDR, and RNFL thickness in glaucomatous, and the good sensitivity and specificity when compared with the experienced ophthalmologist, suggest that pupillometry may be useful as a screening tool to assess asymmetric glaucoma.
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	Intermediate-term outcome of Aurolab aqueous drainage implant	p. 233
	Reji Philip, Premanand Chandran, Nabeed Aboobacker, Mrunali Dhavalikar, Ganesh V Raman DOI:10.4103/ijo.IJO_675_18   Purpose: To report the intermediate-term safety and efficacy of Aurolab aqueous drainage implant (AADI) in patients with glaucoma. Methods: Retrospective review of patients who underwent AADI between January 2013 and December 2016. Patients aged >16 years and with a minimum follow-up of 6 months were included. Success was defined as complete when the intraocular pressure was ≥6 and ≤21 mmHg without antiglaucoma medication and as qualified if those requiring additional antiglaucoma medications were included. Results: The study included 55 patients (55 eyes) with a mean age ± standard deviation (SD) of 47.3 ± 18.1 years with a mean follow-up of 16.7 ± 11.4 months. Mean intraocular pressure reduced from 30.8 ± 11.1 mmHg to 13.1 ± 4.7, 14.1 ± 4.8, 15.7 ± 2.5 (P < 0.001) mmHg at 6 months, 1 year, and 2 years, respectively. The mean number of antiglaucoma medications reduced from 3.4 ± 1 to 0.8 ± 1.2, 0.7 ± 1.1, 0.8 ± 1 (P < 0.001) at 6 months, 1 year, and 2 years, respectively. The cumulative probability of complete and qualified success was 62% and 100% at 6 months, 54% and 92% at 1 year, and 43% and 88% at 2 years, respectively. Four patients failed during the follow-up period. Postoperative complication occurred in 28 eyes (51%), of which 17 eyes (31%) required intervention. Conclusion: AADI is a safe and effective treatment for the control of intraocular pressure in patients with glaucoma.
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COMMENTARY
	Commentary on: Glaucoma drainage devices: Boon or bane	p. 238
	Sushmita Kaushik DOI:10.4103/ijo.IJO_1234_18
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ORIGINAL ARTICLES
	Renewal of driving license in India and glaucoma: A study of prevalent practice and its lacunae	p. 240
	Gowri J Murthy, Ajinkya V Deshmukh, Ayyappa R Mallidi, Praveen R Murthy, Jyoti S Kattige, Vinay R Murthy DOI:10.4103/ijo.IJO_776_18   Purpose: Glaucoma affects different aspects of vision including visual field. This prospective observational study aims to collect details of driving license (DL) renewal procedure (in an urban metro in India) among patients with diagnosed glaucoma and the method of reporting of vision-related requirements during renewal. Methods: One-hundred patients with diagnosed glaucoma above 40 years, having valid DL (with at least one renewal cycle), were included. Patients with other ocular comorbidities were excluded. Driving Habits Questionnaire and a questionnaire about license renewal were administered. Driving eligibility was compared to international guidelines. Results: Study population included patients with 69% early, 29% moderate, and 2% advanced glaucoma. Sixteen percent of patients had stopped driving. Legal license renewal procedure was bypassed by 45%. Form-1 was not submitted by 43% and 49% did not submit Form-1A at the time of renewal. Only 7.01% mentioned about glaucoma in the self-declaration form. None were asked about their visual field during renewal. Among 61 patients who submitted a medical certificate, the undersigning doctor was an ophthalmologist in only six patients. Thirty percent patients with valid Indian DL would not have satisfied International College of Ophthalmologists guidelines. Driving difficulties were experienced by 44%, more so in advanced glaucoma (F (1, 82) = 22.12, P < 0.001). Conclusion: Vision-related testing at the time of renewal of DL is inadequate in India. Chronic eye diseases such as glaucoma are commonly not self-declared or detected at pre-renewal testing. Clear-cut guidelines about visual requirements and implementation are required to prevent road traffic events because of vision-related errors.
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	Clinical profile of uveitis patients developing central serous chorioretinopathy: An experience at a tertiary eye care center in India	p. 247
	Parthopratim Dutta Majumder, Nitin Menia, Sridharan Sudharshan, Chetan Rao, Sudha K Ganesh, Jyotirmay Biswas DOI:10.4103/ijo.IJO_831_18   Purpose: To evaluate clinical profile of patients with uveitis who developed central serous chorioretinopathy (CSC). Methods:Retrospective case series of consecutive patients of uveitis with CSC managed at a tertiary eye care center in India between 1994 and 2014. The data about clinical features, investigations, treatment, and outcomes were obtained from their medical records. Results: A total of 31 eyes of 26 patients with uveitis with a diagnosis of CSC between June 1994 and May 2014 were included in the study. The mean age of presentation was 42.8 ± 9.2 years, and 88.4% of the patients were male. CSC was bilateral in 19.2% of the patients, and in 38.4% patients uveitis was because of infectious etiology. CSC developed in 23 (88.5%) patients when they were on oral corticosteroid. The most common cause of uveitis in our study was choroiditis (48.4%), followed by retinal vasculitis (12.9%). The mean time for resolution of CSC was relatively less in patients with uveitis because of infectious etiology. In 10% eyes vision remained the same and deterioration of vision was noted in 19% eyes. Best corrected visual acuity of the patients at the time of presentation with CSC was 0.56 ± 0.34 and after the resolution of CSC was 0.48 ± 0.5 (P < 0.0005). Conclusion: Patients with choroidal inflammations are more prone to develop CSC compared with other subtypes of uveitis. Management of CSC in uveitis can be challenging.
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	Choroidal thickness in normal Indian eyes using swept-source optical coherence tomography	p. 252
	Amber A Bhayana, Vinod Kumar, Akshay Tayade, Mahesh Chandra, Parijat Chandra, Atul Kumar DOI:10.4103/ijo.IJO_668_18   Purpose: The purpose of this study is to provide normative database for subfoveal choroidal thickness in Indian eyes using swept-source optical coherence tomography. Methods: This is a cross-sectional study based at a tertiary eye care center in Northern India. Two hundred and thirty eight eyes of 119 healthy subjects were examined in terms of axial length, spherical equivalent, and choroidal thickness. Inclusion criteria included age 19–60 years, no retinal or choroidal disorder, and patients with clear media and good fixation. Patients with high hypermetropia (>4 D) or myopia (>6 D) or any systemic disease likely to affect choroidal thickness were excluded. Twelve radial line scans were obtained centered on the fovea that were used to calculate choroidal and retinal thickness in 9 early treatment diabetic retinopathy study (ETDRS) zones. Results: The mean age of all the subjects was 28.70 ± 11.28 years; mean axial length was 23.63 ± 1.96 mm, and mean spherical equivalent was − 0.92 ± 3.08 D. The mean subfoveal choroidal thickness was 299.10 ± 131.2 μ and mean foveal thickness was 239.92 ± 48.16 μ. A negative correlation was found between subfoveal choroidal thickness and age (r = −0.0961, P = 0.1392) and axial length (r = −0.3166, P < 0.001). A statistically significant positive correlation was found between subfoveal choroidal thickness and refractive error (r = 0.2393, P = 0.0002). Conclusion: This study provides normative database for subfoveal choroidal thickness and foveal thickness using swept-source optical coherence tomography. The choroidal thickness measured with swept-source platform is slightly higher than that reported with spectral domain platforms.
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COMMENTARY
	Commentary: Choroidal thickness in the era of swept-source optical coherence tomography	p. 256
	Aniruddha Agarwal DOI:10.4103/ijo.IJO_1893_18
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ORIGINAL ARTICLE
	Outcome of delayed adjustable strabismus surgery in children using a bow-tie optional adjustable technique	p. 258
	R Muralidhar, Lal Churawan, M Sekar, AP Chidambaram, P Mugdha, D Ramamurthy DOI:10.4103/ijo.IJO_398_18   Purpose: The aim of this article is to study the feasibility of a delayed adjustable technique of strabismus surgery in children using an optional adjustable suture technique. Methods: The retrospective study included patients <12 years of age. Recessions were done using an optional adjustable bow-tie technique and resections were done by the conventional technique. Patients were evaluated on the third postoperative day and adjustments done when needed. Statistical analysis was done using Microsoft Excel 2010®. Results: The study included 11 patients with exotropia and 16 patients with esotropia. The mean age of the patients was 5.2 years (range 1–11 years). The mean preoperative distance deviation was 46.7 ± 10.4 prism diopters (PD) for exotropic patients and 47.1 ± 16.9 PD for esotropic patients. The mean preoperative near deviation was 46.6 ± 11 PD for exotropic patients and 52.4 ± 17.1 PD for esotropia. Two patients with exotropia (18.2%) and four patients with esotropia (25%) were adjusted under intravenous ketamine in the operating room under anesthetist supervision. No difficulty was encountered in advancing/recessing the muscles. The success rate at 1 month was 100% for exotropia and 87.5% for esotropia. The success rate at the final follow-up was 81.8% for patients with exotropia and 68.7% for patients with esotropia. Conclusions: This delayed optional adjustable strabismus surgery technique provides good short-term results and lower adjustment rates.
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COMMENTARY
	Commentary: Adjustable strabismus surgery	p. 263
	Rohit Saxena, Rebika Dhiman DOI:10.4103/ijo.IJO_1000_18
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SURGICAL TECHNIQUE
	Modified Faden operation –A new surgical technique	p. 264
	Manjula Jayakumar, Suganya Vel, Amar Agarwal DOI:10.4103/ijo.IJO_952_18   Faden operation was first described in 1912. It weakens the muscle in its field of action without much slackening and alteration in the primary position. When combined with recession the weakening effect is more. It is a useful surgery in esotropia with high accommodative convergence, nystagmus blockage syndrome, dissociated vertical deviation, Duane's retraction syndrome with up or downshoots, and in sixth nerve paresis, where it is performed on the contralateral normal yoke muscle to increase the field of binocular vision. The conventional procedure is cumbersome due to small working space, entanglement of sutures, and posterior location of Faden site which is not easily accessible. We have modified the Faden operation by using a single 5-0 double-armed polyester suture, which is much easier and simpler to perform, and have done it in a series of small angle esotropias combined with recession. This paper demonstrates the surgical technique so that this surgery can be performed with ease by more surgeons.
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PHOTO ESSAY
	Ocular argyrosis: A case with silver deposits in cornea and lens	p. 267
	Lakshey Dudeja, Ishani Dudeja, Anuja Janakiraman, Manohar Babu DOI:10.4103/ijo.IJO_730_18
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	Anterior chamber migration of intravitreal dexamethasone implant in glued intraocular lens	p. 268
	Dhivya Ashok Kumar, Atul Dhawan, Soumya Narayanan, Amar Agarwal DOI:10.4103/ijo.IJO_841_18
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	Hyperpigmented torpedo maculopathy	p. 270
	PC Ranjith, Anantharaman Giridhar DOI:10.4103/ijo.IJO_886_18
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	Pigmented paravenous retinochoroidal atrophy	p. 271
	Saurabh Deshmukh, Dipankar Das, Hemalata Deka, Harsha Bhattacharjee, Awaneesh Upadhyay, Krati Gupta DOI:10.4103/ijo.IJO_1202_18
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	A rare case having hemi-retinal artery occlusion in one eye and hemi-retinal vein occlusion in the other: Diverse manifestations of retinal vascular occlusion	p. 273
	Pulak Agarwal, Vinod Agarwal, Shorya Azad DOI:10.4103/ijo.IJO_987_18
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OPHTHALMIC IMAGES
	Bilateral vitritis as an initial presentation of primary central nervous system lymphoma	p. 275
	Nitin K Menia, Ranjan Behera, Reema Bansal, Nalini Gupta, Astha Takkar, Vivek Lal DOI:10.4103/ijo.IJO_773_18
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	A complication of ischemic branch retinal vein occlusion	p. 276
	PC Ranjith, Anantharaman Giridhar DOI:10.4103/ijo.IJO_882_18
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	Congenital tortuous retinal vessels	p. 277
	Mohit Dogra, Mangat R Dogra DOI:10.4103/ijo.IJO_1281_18
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	Autofluorescence of optic disc drusens	p. 278
	Nitin K Menia, Swati Kiran, Reema Bansal DOI:10.4103/ijo.IJO_888_18
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	Endoscopic view of mascara laden lacrimal sac with canalicular involvement	p. 279
	Nishi Gupta, Smriti Bansal, Arpan Gandhi DOI:10.4103/ijo.IJO_1348_18
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CASE REPORTS
	Consecutive cyclic esotropia – A case report	p. 280
	Niranjan K Pehere, Usha B Kommineni, Ramesh Kekunnaya DOI:10.4103/ijo.IJO_1018_18   Cyclic esotropia, a rare condition of obscure etiology characterized by regularly alternating periods of esotropia and orthophoria. We present a case of a 7-year-old boy who underwent surgical correction for intermittent exotropia elsewhere and developed esotropia with cyclic pattern post-operatively. Initially the cycle was of half-day orthophoria and half-day esotropia, which later became one full day of esotropia and one day of orthophoria. During re-surgery, right lateral rectus was found to have a stretched scar which was resected and then advanced and medial rectus was recessed. Post-surgery the child was orthophoric without cyclic pattern.
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	Human ocular thelaziasis caused by gravid Thelazia callipaeda – A unique and rare case report	p. 282
	Meenakshi Sharma, Dipankar Das, Harsha Bhattacharjee, Saidul Islam, Nilutparna Deori, Gayatri Bharali, Sumegha Tomar, Priyank Bhola, Apurba Deka DOI:10.4103/ijo.IJO_1110_18   An 80-year-old male reported to the clinic with complaints of diminished vision, foreign body sensation, and occasionally some black object moving in front of the right eye. Detailed ocular examination revealed three slender creamy white live worms in the conjunctival sac of the right eye. Total three worms were retrieved and sent to the pathology department for detailed examination. The worm was identified as gravid Thelazia callipaeda. As per the search results in PubMed and Cochrane search engine, this is the first report of human case of gravid Thelazia infestation with simultaneous existence of embryonated or ensheathed eggs and primary-stage larvae in the same worm.
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	Uncontrolled neovascular glaucoma – an alarming manifestation of chronic myeloid leukemia on imatinib therapy – a case report and review of literature	p. 285
	Prakhyat Roop, Dewang Angmo, Neha Kamble, Ankit S Tomar DOI:10.4103/ijo.IJO_1288_18   A 45-year-old diabetic male, with diabetic retinopathy and medically uncontrolled neovascular glaucoma (NVG) underwent intracameral bevacizumab followed by trabeculectomy, with controlled intraocular pressures (IOP) post-operatively, OD: 12 mmHg; OS: 14 mmHg. Patient was referred to hematology, where he was diagnosed as chronic myeloid leukemia (CML) and started on imatinib mesylate. Thereafter, he presented with recurrence of neovascularization and vascularization of the bleb along with OS vitreous hemorrhage at 6 weeks follow-up. While he was planned for OS vitreo-retinal surgery, he presented with OD spontaneous hyphema with raised IOP (OD: 38 mmHg, OS: 16 mmHg). He had maintained a tight glycemic control. Following imatinib therapy, there was a rapid progression and recurrence of neovascularization, eventually leading to failure of trabeculectomy OD and bilateral severe loss of vision. Imatinib may be implicated in the worsening of NVG in CML patients, especially with co-existing diabetes and thus, such patients should receive regular thorough ophthalmic evaluation as long as imatinib continues.
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	Suprachoroidal hemorrhage after removal of releasable suture with globe massage post-trabeculectomy	p. 287
	Jyoti Shakrawal, Shreyas Temkar, Ramanjit Sihota, Pradeep Venkatesh DOI:10.4103/ijo.IJO_452_18   A 19-year-old female, having aniridia with secondary glaucoma, presented with uncontrolled intraocular pressure (IOP) in the right eye (RE) on maximal topical and systemic medications. On examination, RE had a subluxated cataractous lens with advanced cupping. She underwent trabeculectomy with mitomycin C. On postoperative day 1, as the IOP was 32 mmHg, one releasable suture was removed followed by gentle bleb massage. On postoperative day 2, suprachoroidal hemorrhage was noted, for which the patient underwent two drainage procedures. Hemorrhagic choroidals resolved completely 4 weeks after drainage.
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	Macular toxicity after short-term hydroxychloroquine therapy	p. 289
	Isil Pasaoglu, Funda E Onmez DOI:10.4103/ijo.IJO_732_18   We report an unusual case of hydroxychloroquine (HCQ) toxicity after only 2 months of starting the treatment. A 42-year-old woman presented with visual impairment. Her visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic examination revealed a bull's eye pattern in both eyes which was more prominent in the left eye. She had received HCQ therapy (400 mg/day) for 1 month, and had been taking 200 mg/day for 1 month for the treatment of rheumatoid arthritis. HCQ macular toxicity is rarely seen in short-term use, before 5 years, and to our knowledge, there is only one other case reported in the literature.
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	Quetiapine associated Central Serous Chorioretinopathy: Implicit role of serotonin and dopamine pathways	p. 292
	Manish Jain DOI:10.4103/ijo.IJO_929_18   A 30-year-old insomniac, an off-label user of quetiapine, presented with blurring of central vision, eventually diagnosed as central serous chorioretinopathy. A potential association was suspected based on the drug's actions on the autonomic nervous system. He showed improvement on drug withdrawal; then he unwittingly resumed quetiapine and had a recurrence. Possible underlying mechanisms that include alteration in choroidal perfusion through serotonin and dopamine receptors are discussed. Although retinal vein occlusions and pigment epithelial detachment have been described with quetiapine, to the author's knowledge, this is the first case report of quetiapine-associated central serous chorioretinopathy.
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	Multicolor imaging findings in torpedo maculopathy	p. 295
	Ramesh Venkatesh, Bharathi Bavaharan, Naresh K Yadav DOI:10.4103/ijo.IJO_1317_18   We describe the multicolor imaging findings in two cases of Torpedo maculopathy (TM). Multicolor imaging can be a useful tool in identifying the level of retinal and choroidal layer involvement in TM. This imaging modality further confirms the hypothesis that TM is a localized congenital abnormality of retinal pigment epithelium pigmentation which leads to outer retinal and inner choroidal degeneration.
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	Optical coherence tomography angiography features of retinitis post-rickettsial fever	p. 297
	Mahesh Shanmugam, Vinaya Kumar Konana, Rajesh Ramanjulu, KC Divyansh Mishra, Pradeep Sagar, Dilip Kumar DOI:10.4103/ijo.IJO_799_18   The intraocular manifestations of rickettisial retinitis include retinal vasculitis, maculopathy, optic neuritis, and neurosensory detachment. Extensive leakage of dye on the fundus fluorescein angiography may obscure visualization in eyes with retinitis. We report the vascular changes in eyes with rickettsial retinitis and its response to treatment using optical coherence tomography angiography. The microvascular abnormalities we noted were, capillary drop out areas corresponding to retinitis patches, vascular loops, and pruning of vessels. The choriocapillary slabs showed signal void areas. Post-treatment there was vascular remodeling with decrease in non-perfused area, appearance of new vascular lateral branching, and appearance of collaterals.
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	In vivo diagnosis of intraocular osseous metaplasia in neovascular age-related macular degeneration	p. 300
	Hibba Quhill, Stephen Stewart, Ian G Rennie DOI:10.4103/ijo.IJO_1076_18   A 75-year-old man presented with deterioration of right eye vision for 6 months. He had no relevant medical history. Fundus examination revealed subretinal fluid, fibrosis, and subretinal hemorrhages. Ocular coherence tomography of the right macula illustrated an underlying subretinal lesion with internal lamellae, resembling trabecular bone elsewhere in the body. Bruch's membrane was clearly intact beneath the lesion, indicating an extrachoroidal location. The lesion appeared highly reflective on B-scan ultrasonography, consistent with ossification. Although initially misdiagnosed as choroidal osteoma, this lesion represents in-vivo intraocular osseous metaplasia at the site of neovascular age-related macular degeneration. The authors believe that similar lesions may have been misdiagnosed as "atypical" osteoma caused by failure to identify their extrachoroidal location.
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	Do oblate eyeballs exist? A rare case of rhegmatogenous retinal detachment in an elliptical globe	p. 302
	M Dheepak Sundar, Prakhyat Roop, Atul Kumar, Rohan Chawla, Nasiq Hasan DOI:10.4103/ijo.IJO_1150_18   A patient, being a moderate myope with an axial length of 24.71 mm, presented to us with a fresh rhegmatogenous retinal detachment and marked peripheral chorioretinal degeneration. Difficulty in maneuvering with the standard 23 gauge vitrectomy cutter, inability to identify the break due to poor peripheral contrast, inadequate laser uptake, and an unusual large silicon oil fill (7.3 ml) were a few findings raising suspicion. Postoperative ocular ultrasonography showed an oblate eyeball with a relatively longer oblique axis (26.1 mm) as compared to the axial length confirming our suspicion. Oblateness should be suspected when the chorioretinal degenerations are more marked in the periphery as compared to the posterior pole. Intraoperative difficulties should be kept in mind while operating such cases.
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LETTERS TO THE EDITOR
	Mr. Jack J. Kanski (1939-2019): A tribute	p. 306
	Suresh K Pandey, Vidushi Sharma DOI:10.4103/ijo.IJO_37_19
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	Commentary: Pseudopestalotiopsis theae keratitis	p. 307
	Prashant Garg DOI:10.4103/ijo.IJO_1490_18
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	Vitamin D supplementation in patients with xeroderma pigmentosum	p. 308
	Ashik Mohamed, Archana Bhargava, Sunita Chaurasia DOI:10.4103/ijo.IJO_1319_18
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	Changes in pattern electroretinogram after application of 0.01% atropine eye drops	p. 309
	Mihir Kothari, Deepak Bhat, Nitu Khadse, Rishika Jain, Vivek Rathod, Pallavi Aru DOI:10.4103/ijo.IJO_989_18
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	Comment on: Validating the pachychoroid disease spectrum using multimodal imaging	p. 310
	Jay U Sheth, Anantharaman Giridhar DOI:10.4103/ijo.IJO_1460_18
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	Response to comment on: Validating the pachychoroid disease spectrum using multimodal imaging	p. 312
	Guruprasad Ayachit, Apoorva Ayachit, Harsha Nadgir, Shrinivas Joshi DOI:10.4103/ijo.IJO_1870_18
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	Comment on: Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome	p. 312
	Anamika Dwivedi, Sujata Lakhtakia DOI:10.4103/ijo.IJO_1633_18
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Metabolic tumor volume and total lesion glycolysis predict tumor progression and survival after salvage surgery for recurrent oral cavity squamous cell carcinoma

Abstract

Background

This study evaluated the prognostic role of Fluorine 18‐fluorodeoxyglucose positron emission tomography/CT (¹⁸F‐FDG PET/CT) parameters quantitatively measured in patients with recurrent oral cavity cancer.

Methods

Cox proportional hazards regression analyses were used to assess the associations between quantitative ¹⁸F‐FDG PET/CT parameters and other clinicopathological factors and progression‐free survival (PFS) and overall survival (OS).

Results

All of the ¹⁸F‐FDG PET parameters (SUV_max, SUV_mean, SUV_peak, metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were significantly associated with poor PFS and OS outcomes after salvage treatment (P < .01). In multivariate analyses, Karnofsky performance score, recurrence site, MTV, and TLG were independent variables predictive of both PFS and OS (P < .05). High MTV (>8.8 mL) or TLG (>29.4 g) values at recurrent lesions were associated with >5‐fold increased risk for tumor progression and mortality after salvage surgery.

Conclusions

The PET parameters of MTV and TLG measured at recurrent lesions may predict tumor progression and survival after salvage treatment.

Condensed Abstract

This study examined the role of ¹⁸F‐FDG PET/CT at recurrent staging for predicting tumor progression and survival in 71 consecutive patients with recurrent oral cavity squamous cell carcinomas. Of ¹⁸F‐FDG parameters, metabolic tumor volume and total lesion glycolysis were independent factors predictive of tumor progression and survival after salvage treatment.

http://bit.ly/2Wbrfde

Radioiodine Uptake and Thyroglobulin-Guided Radioiodine Remnant Ablation in Patients with Differentiated Thyroid Cancer: A Prospective, Randomized, Open-Label, Controlled Trial

Thyroid, Volume 29, Issue 1, Page 101-110, January 2019.


http://bit.ly/2RZQHmV

Leslie J. De Groot (September 20, 1928–October 3, 2018)

Thyroid, Volume 29, Issue 1, Page 1-6, January 2019.


http://bit.ly/2HwHy10

Future Meetings

Thyroid, Volume 29, Issue 1, Page 157-158, January 2019.


http://bit.ly/2RZxEsQ

Correction to: Diagnostic Performance of Ultrasound-Based Risk-Stratification Systems for Thyroid Nodules: Comparison of the 2015 American Thyroid Association Guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American College of Radiology Guidelines Ha EJ, Na DG, Moon W-J, Lee YH, and Choi N Thyroid 2018;28:1532–1537. DOI: 10.1089/thy.2018.0094

Thyroid, Volume 29, Issue 1, Page 159-159, January 2019.


http://bit.ly/2HwHrCC

Unfavorable Socioeconomic Factors Underlie High Rates of Hospitalization for Complicated Thyrotoxicosis in Some Regions of the United States

Thyroid, Volume 29, Issue 1, Page 27-35, January 2019.


http://bit.ly/2S6F91c

Association Between Diethylhexyl Phthalate Exposure and Thyroid Function: A Meta-Analysis

Thyroid, Ahead of Print.


http://bit.ly/2HwHnmm

Neural Switch Asymmetry in Feature-Based Auditory Attention Tasks

Abstract

Active listening involves dynamically switching attention between competing talkers and is essential to following conversations in everyday environments. Previous investigations in human listeners have examined the neural mechanisms that support switching auditory attention within the acoustic featural cues of pitch and auditory space. Here, we explored the cortical circuitry underlying endogenous switching of auditory attention between pitch and spatial cues necessary to discern target from masker words. Because these tasks are of unequal difficulty, we expected an asymmetry in behavioral switch costs for hard-to-easy versus easy-to-hard switches, mirroring prior evidence from vision-based cognitive task-switching paradigms. We investigated the neural correlates of this behavioral switch asymmetry and associated cognitive control operations in the present auditory paradigm. Behaviorally, we observed no switch-cost asymmetry, i.e., no performance difference for switching from the more difficult attend-pitch to the easier attend-space condition (P→S) versus switching from easy-to-hard (S→P). However, left lateral prefrontal cortex activity, correlated with improved performance, was observed during a silent gap period when listeners switched attention from P→S, relative to switching within pitch cues. No such differential activity was seen for the analogous easy-to-hard switch. We hypothesize that this neural switch asymmetry reflects proactive cognitive control mechanisms that successfully reconfigured neurally-specified task parameters and resolved competition from other such "task sets," thereby obviating the expected behavioral switch-cost asymmetry. The neural switch activity observed was generally consistent with that seen in cognitive paradigms, suggesting that established cognitive models of attention switching may be productively applied to better understand similar processes in audition.

http://bit.ly/2R90hiL

To Be Cautious or Not: Tension Pneumothorax After First Tracheostomy Tube Exchange

Abstract

Tracheostomy tube change is a relatively common procedure once a tracheo-cutaneous tract matures. Regular tracheostomy tube changes prevent the formation of granulation tissue and reduce bacterial colonization (Yaremchuk and Yaremchuk in Laryngoscope 113(1):1–10, 2003). However, serious complications such as subcutaneous emphysema, loss of airway and mediastinitis, can occur if the tube exchange is performed inappropriately. We present a rare association of tension pneumothorax following a tracheostomy tube exchange in a 50-year-old patient who underwent tracheotomy 3 days back. The patient was successfully managed conservatively with chest tube and supportive care.

http://bit.ly/2RWz3R1

Expression, Localization, and Regulation of the Sodium Bicarbonate Cotransporter NBCe1 in the Thyroid

Thyroid, Ahead of Print.


http://bit.ly/2B0N7Pu

Kimura’s Disease: A Diagnostic and Therapeutic Challenge

Abstract

Kimura's disease, also known as Eosinophilic Granuloma, is a rare chronic condition seen mainly in Oriental population. It presents with subcutaneous nodules, lymphadenopathy, salivary gland hypertrophy with peripheral eosinophilia and raised serum IgE levels; rarely renal involvement may also be present. Its etiology mainly remains unknown. We present a case series of two patients. Our first case is a middle aged female which presented with a parotid swelling, mimicking a parotid neoplasm. Further investigations revealed associated intra-parotid and cervical lymphadenopathy. An excisional biopsy in the form of Superficial Parotidectomy with lymph node excision was done. Histopathological examination of the excised specimen revealed it to be a case of Kimura's disease. Our second case, a young adult, presented with a gradually increasing post-auricular swelling. Preliminary investigations in this case pointed towards Kimura's disease. Excision biopsy of the lesion was done. Histopathological studies confirmed the diagnosis for the same. Both the patients are under our regular follow up and remain disease-free at a follow up of 1 year and 8 months respectively.

http://bit.ly/2HqWP3e

An Immunohistochemical Study of HIF-1 Alpha in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma

Abstract

To evaluate and compare the expression of HIF-1 Alpha (HIF-1α) in oral epithelial dysplasia (OED) and various grades of Oral squamous cell carcinoma (OSCC). 30 cases each of OEDand OSCC were stained with HIF-1α antibody. Quantification of HIF-1α positive cellswas carried out and the data was statistically analysed. The mean % HIF-1α labeling index (HIF-1α LI) increased significantly from mild OED (32.11%), moderate OED (55.07%), to severe OED (64.58%). There was a statistically significant increase in the expression of HIF-1α as grades of OED increased. The mean HIF-1α LI % in well differentiated OSCC was 46.3%, Moderately differentiated OSCC—76.31% and Poorly differentiated OSCC—89.9%. The mean HIF-1α LI was found to increase with increasing grades of OSCC which was statistically significant (P < 0.05). Further a comparison of mean HIF-1α LI in OED with different histologic grades of OSCC by Independent samples t test was performed. We found statistically significant difference between OED and moderately differentiated OSCC and OED and poorly differentiated OSCC (P = 0.000). Progressive increase in expression of HIF-1α was noted from OED to OSCC. It can be postulated that epithelial dysplastic lesions with increased HIF-1α expression are at greater risk of malignant transformation, suggesting that the expression of HIF-1α is an early event in oral carcinogenesis.

http://bit.ly/2S4Uq2r

Our experience of shorter stay and lower cost for local versus general anaesthetic placement of tracheoesphageal fistulae in 27 patients

Abstract

Secondary trache‐oesophageal puncture and fistula formation is often undertaken after laryngectomy to restore voice.

The procedure was historically carried out under general anaesthesia (GA).

This has been largely supplanted by local anaesthetic (LA) techniques as GA puts patients at a greater risk and the procedure is a more technically difficult undertaking.

LA techniques have, however, never been validated against GA techniques in terms of length of stay, cost and complication rates.

We compare a GA and an LA technique and found a shorter length of stay, reduced cost and similar complication profile.

This article is protected by copyright. All rights reserved.

http://bit.ly/2FFXnRa

Recurrent Bell's palsy

Abstract

Objective

Although recurrent facial palsy was first reported in 1871, the etiology, definitions, classifications, pathogenesis, treatment options, and prognosis have not been clearly determined. There have been no systematic reviews and meta‐analyses of recurrent Bell's palsy. The purpose of this study was to evaluate the clinical manifestations of recurrent Bell's palsy through a systematic review and meta‐analysis.

Design

The SCOPUS, PubMed, Cochrane Library, and EBSCO databases were searched through May 1, 2018, using the search terms 'recurrent Bell's palsy' and 'recurrent facial palsy', for studies involving patients with recurrent Bell's palsy. Reference lists of eligible studies were also reviewed.

Results

A search of titles and abstracts in these four databases identified 222 studies; of these, 27 studies, involving 1,041 patients from 13 countries, were analyzed. The mean percentage of patients who experienced recurrence of Bell's palsy ranged from 0.8% to 19.4%. Five studies that included 191 patients were included in the meta‐analysis.

Conclusions

Among patients previously affected by Bell's palsy, the mean incidence of recurrent Bell's palsy was 6.5%. Sidedness of recurrent disease, relative to the side of the original disease, had no effect on patient prognosis. Of all patients with Bell's palsy, 66.0% recovered completely, with the recovery rate lower in patients with recurrent than with primary Bell's palsy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2FV2UTu

Validation of french versions of the facial disability index (fdi) and the facial clinimetric evaluation (face) scale, specific quality of life scales for peripheral facial palsy patients

Abstract

Objectives

To translate and validate French versions of two health‐related quality of life questionnaires for patients with peripheral facial palsy: Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale.

Design

Prospective cohort study.

Setting

University tertiary referral center.

Participants

A pilot test was performed on 10 subjects (5 patients with facial palsy of more than 1‐month duration and 5 normal subjects), then 67 adult patients with facial palsy were enrolled in the validation study.

Main outcome measures

Translation of the original questionnaires has followed international guidelines using a forward‐backward translation method. A pilot test and a validation study based on the translated questionnaires were performed. Internal consistency, test–retest reliability, validity and responsiveness were assessed. Validity was assessed by comparing to SF‐36 and Sunnybrook/House‐Brackmann grading systems. Subjects answered scales twice within a one‐week interval.

Results

67 patients were enrolled, among which 63 completed scales one week later (retest). For physical and social functions of FDI and FaCE scores, Cronbach's α representing internal consistency were 0.88, 0.70 and 0.89, and test–retest reliability by intra‐class correlation coefficients were 0.81, 0.86 and 0.89 respectively. The correlation of facial movement score of FaCE scale was good with Sunnybrook/House‐Brackmann grading systems (0.73 and ‐0.75, p<0.01). The correlation of social function of FaCE scale was excellent with social function of SF‐36 (0.8, p<0.01).

Conclusions

French versions of FDI and FaCE scale are psychometrically valid. Both questionnaires can be used for clinical studies to assess the quality of life of patients with peripheral facial palsy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2FLL6dW

Hypereosinophilic syndrome presenting with bilateral ear fullness

Publication date: Available online 23 January 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): H.J. Jung, G.H. Yu, J.H. Park

Abstract

Introduction

Hypereosinophilic syndrome is a rare disease with hypereosinophilia resulting in end-organ dysfunction. Patients present with organ-associated symptoms, and the targets frequently affected are heart, lung, skin, or the nervous system, and the middle ear involvement is rare.

Case report

A 30-year-old female with left ear fullness and hearing loss, which persisted for 6 months, was finally diagnosed with hypereosinophilic syndrome (HES). After high dose systemic steroids treatment, all symptoms improved.

Conclusion

Eosinophilic otitis media and HES involving the middle ear share many clinical manifestations. Prompt and accurate differential diagnosis is required for these diseases to ameliorate symptoms and promote recovery.

http://bit.ly/2HrVRUz

Cost‐effectiveness analysis of screen‐and‐treat strategy in asymptomatic Chinese for preventing Helicobacter pylori‐associated diseases

Abstract

Background

The high prevalence of Helicobacter pylori (H pylori) infection in China results in a substantial public health burden. Medical experts have not agreed on the best solution of population intervention for this problem. We presented a health economic evaluation of a population‐based H pylori screen‐and‐treat strategy for preventing gastric cancer, peptic ulcer disease (PUD), and nonulcer dyspepsia (NUD).

Materials and Methods

Decision trees and Markov models were developed to evaluate the cost‐effectiveness of H pylori screening followed by eradication treatment in asymptomatic Chinese. The modeled screen‐and‐treat strategy reduced the risk of gastric cancer, PUD, and NUD. The main outcomes were the costs, effectiveness, and the incremental cost‐effectiveness ratio. Uncertainty was explored by one‐way and probabilistic sensitivity analyses.

Results

For preventing gastric cancer, PUD, and NUD together in a cohort of 10 million asymptomatic Chinese at the age of 20 years, the H pylori screen‐and‐treat strategy saved 288.1 million dollars, 28 989 life years, and 111 663 quality‐adjusted life years, and prevented 11 611 gastric cancers, 5422 deaths from gastric cancer, and 1854 deaths from PUD during life expectancy. Uncertainty of screening age from 20 to 60 did not affect the superiority of the screen‐and‐treat strategy over the no‐screen strategy. The one‐way and probabilistic sensitivity analyses confirmed the robustness of our study's results.

Conclusions

Compared with the no‐screen strategy, population‐based screen‐and‐treat strategy for H pylori infection proved cheaper and more effective for preventing gastric cancer, PUD, and NUD in Chinese asymptomatic general population.

http://bit.ly/2WepGuX

The risk of Helicobacter pylori infection for adverse pregnancy outcomes: A systematic review and meta‐analysis

Abstract

Objective

To estimate the current evidence regarding the association between Helicobacter pylori infection during pregnancy and adverse pregnancy outcomes.

Materials and Methods

A systematic literature search for relevant publications was conducted using PubMed, EMBASE, Cochrane Library, and Web of science databases through November 17th, 2018. The pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were selected as the effect size. Subgroup analysis and sensitivity analysis were performed.

Results

Thirty‐one studies with a total of 22 845 participants were identified. There was significant association of H pylori infection with preeclampsia (OR: 2.51; 95% CI: 1.88‐3.34; P < 0.001), fetal growth restriction (OR: 2.28; 95% CI: 1.21‐4.32; P = 0.01), gestational diabetes mellitus (OR: 2.03; 95% CI: 1.56‐2.64; P < 0.001), spontaneous abortion (OR: 1.50; 95% CI: 1.05‐2.14; P = 0.024), and birth defect (OR: 1.63; 95% CI: 1.05‐2.54; P = 0.03). Sensitivity analysis showed the significant association between H pylori infection and low birthweight (OR: 1.59; 95% CI: 1.05‐2.40; P = 0.03).

Conclusion

The present meta‐analysis offers proof to support that H pylori infection during pregnancy can increase the risk on adverse pregnancy outcomes. Screening and treating for H pylori infection before pregnancy should be taken into account.

http://bit.ly/2R6rHFW

Decreased Treg-derived miR-181a and miR-155 correlated with reduced number and function of Treg cells in allergic rhinitis children

Abstract

Background

Regulatory cells (Tregs) have been proved to be deeply involved in allergic airway inflammation. This study aims to evaluate the expression of miRNA in children with AR and their association with Tregs as well as the severity of AR.

Methods

Twenty-five AR children and 20 healthy children were enrolled in this study. The Treg-cell percentage and expression of IL-10 and TGF-β were detected by flow cytometry and enzyme-linked immunosorbent assay. The microRNA microarray analysis in purified Tregs was performed and differentially expressed microRNAs were confirmed by quantitative polymerase chain reaction (qPCR).

Results

Children with AR had lower percentage of Tregs and expression of IL-10 and TGF-beta compared with control children. We found that significantly lower levels of miR-155 and miR-181a in Tregs from AR than healthy controls. Furthermore, intracellular miR-155 and miR-181a level were positively correlated with percentage of Tregs and expression of IL-10 and TGF-beta. Similarly, total nasal severity scores (TNSS) were found to be negatively correlated with miR-155 and miR-181a levels.

Conclusion

Decreased Treg-derived miR-181a and miR-155 were correlated with reduced number and function of Tregs in AR children. The intracellular miR-155 and miR-181a levels may serve as predictors of disease severity in childhood AR.

http://bit.ly/2RFVPwW

A cross-sectional evaluation of outcomes of pediatric branchial cleft cyst excision

Publication date: Available online 23 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jillian Mattioni, Sarah Azari, Travis Hoover, Daniel Weaver, Sri Kiran Chennupati

Abstract

Objective

To examine complications following pediatric branchial cleft cyst excision by surgical specialty, demographics, and comorbid conditions.

Methods

A retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2015 through May 1, 2017 with a current procedural terminology code of 42810 (excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues) or 42815 (excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities.

Results

Of the 895 cases that met inclusion criteria, the median age was two years and there was an approximately equal number of males (46.8%) and females (53.2%). Forty-five patients (5.0%) experienced at least one 30-day complication, the most predominant of which was superficial surgical site infection. There was no statistically significant difference between complications and surgical specialty, complications and patient demographics, or complications and depth of excision. There was a statistically significant difference (p = 0.05) in the percentage of patients with a past medical history of developmental delay between those with at least one complication (11.1%) compared to those without any complications (4.2%).

Conclusion and relevance

Branchial cleft excision is a generally safe procedure across surgical specialties and patient demographics. There is an association between a history of developmental delay and 30-day postoperative complications.

http://bit.ly/2CFRDTs

Acute otitis media in infants younger than two months of age: Epidemiologic and microbiologic characteristics in the era of pneumococcal conjugate vaccines

Publication date: Available online 23 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Oren Ziv, Mordechai Kraus, Racheli Holcberg, Anat Bahat Dinur, Sofia Kordeluk, Dan Kaplan, Hadar Naidorf Rosenblatt, Shalom Ben-Shimol, David Greenberg, Eugene Leibovitz

Abstract

Objectives

To evaluate the epidemiology, microbiology, Streptococcus pneumoniae serotypes distribution and serious bacterial infections (SBIs) occurrence in infants <2 months of age with tympanocentesis-documented acute otitis media (AOM), before and after the introduction of pneumococcal conjugate vaccines (PCVs).

Methods

The medical records of all hospitalized infants with AOM who underwent tympanocentesis during 2005–2014 were reviewed.

Results

Of the 303 infants with AOM who were diagnosed by an ENT specialist, 182 underwent tympanocentesis, 92 during 2005–2009 (prevaccine period) and 90 during 2010–2014 (postvaccine period). Streptococcus pneumoniae and nontypeable Hemophilus influenzae were isolated in 46/92 (50%) and 37/92 (40.2%) patients during 2005–2009 and decreased to 27/90 (30%) and 21/90 (23.3%). Respectively, during 2010–2014 (P = 0.006 and P = 0.001). The proportion of culture-negative patients increased from 18/92 (19.6%) during 2005–2009 to 32/90 (35.6%) during 2010–2014 (P = 0.02). There were only 6 (3.3%) patients <2 weeks of age. The most common S. pneumoniae vaccine serotypes isolated during 2005–2009 were 5, 3, 1, 19F and 14 (15.2%, 13.0%, 10.9%, 6.5%, and 4.3%, respectively) and 3, 5, 1, 14 and 19A (22.2%, 11.1%, 7.4%, 7.4%, and 7.4%, respectively) during 2010–2014. The proportion of culture-positive patients decreased during 2013–2014 compared with 2011–2012 (7/18, 38.9% vs. 40/54, 74.1%, P = 0.007). Serotypes 1 and 5 were not isolated during 2013–2014 and serotype 19A was not isolated during 2011–2014. . SBIs were recorded in 23/182 (12.64%) patients and urinary tract infections represented 19/23 (82.61%) of them (Escherichia coli isolated in 12, 63.2%).

Conclusions

The overall number of AOM cases needing tympanocentesis seen at the PER and the proportion of S. pneumoniae and nontypeable H. influenzae-AOM decreased while the proportion of culture-negative AOM increased following the introduction of PCVs. SBIs associated with AOM were frequent and were represented mostly by urinary tract infections caused by pathogens unrelated to the etiologic agents of AOM.

http://bit.ly/2RLaeIa

Metastatic Cellular Neurothekeoma in Childhood

Publication date: Available online 22 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kaitlyn Zenner, John Dahl, Gail Deutsch, Erin Rudzinski, Randall Bly, Jonathan A. Perkins

http://bit.ly/2CFRCPo

Endoscopic Arytenoid Abduction Lateropexy for the treatment of Neonatal Bilateral Vocal Cord Paralysis – long-term results

Publication date: Available online 22 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Balázs Sztanó, Ádám Bach, Vera Matievics, Eszter Erdélyi, Ilona Szegesdi, Christopher T. Wootten, László Rovó

ABSTRACT

OBJECTIVES

Bilateral vocal cord paralysis often causes severe dyspnea requiring an early airway intervention in neonates. Endoscopic arytenoid abduction lateropexy (EAAL) with suture is a quick, reversible, minimally-invasive vocal cord lateralizing technique to enlarge the glottis. The arytenoid cartilage is directly lateralized to a normal abducted position. It can be performed even in early childhood with the recently-introduced pediatric endoscopic thread guide instrument. The long-term results and the stability of the lateralization were evaluated.

METHODS

Three newborns had inspiratory stridor immediately after birth. Laryngo-tracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation. The follow-up period was >3 years.

RESULTS

After extubation on the 4-7^th postoperative day no dyspnea or swallowing disorder occurred. Laryngo-tracheoscopy, clinical growth charts and voice analysis showed satisfactory functional results.

CONCLUSIONS

The endoscopic arytenoid abduction lateropexy might be a favorable solution for neonatal bilateral vocal cord paralysis. In one step, airway patency can be achieved without irreversible damage to the glottic structures. Normal swallowing function was preserved. The results are durable, and neither medialization nor dyspnea re-appeared during observation.

http://bit.ly/2RJRQQ7

Prospective analysis of mid-facial fractures in a single-center pediatric-adolescent cohort

Publication date: Available online 22 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Waldemar Reich, Oliver Aust, Alexander Eckert

Abstract

Background

The complex architecture of the midface renders diagnosing and treating fractures challenging, especially for young patients who present the additional risk of suffering growth and development deficiencies, which is to be avoided at all costs.

Objectives

This study sought to characterize pediatric mid-facial fractures considering the possible complications.

Methods

Between September 2008 and September 2018, data was collected on inpatients aged <18 years, treated for mid-facial fractures at the Halle University Hospital. Evaluated parameters were age, gender, cause and type of fracture, associated injuries, treatment, and complications.

Results

In total, 31 patients were examined; 20 were boys. The most common cause of injury was road traffic accident (41.9%). Orbital floor fracture was the most common type of injury (58.1%). In 54.8% of cases, surgery was performed.

Conclusion

The incidence of complications associated with mid-facial fractures was low (n=7), requiring treatment in only three cases (orthodontic, ophthalmological).

http://bit.ly/2CI72D8

Impact of allergic rhinitis on quality of life after powered intracapsular tonsillectomy and adenoidectomy

Publication date: Available online 22 January 2019

Source: American Journal of Otolaryngology

Author(s): Su Jin Kim, Ho Yun Lee, Jung Wook Kang, Oh. Eun Kwon, Kun Hee Lee

Abstract

Background

Allergic rhinitis (AR) has been reported to worsen quality of life (QoL) after adenotonsillectomy. Although powered intracapsular tonsillectomy and adenoidectomy (PITA) has been widely performed, it is not clear whether comorbid AR may worsen QoL in patients who undergo PITA.

Purpose

To evaluate QoL after PITA in relation to AR.

Methods

Children undergoing PITA for sleep-disordered breathing were enrolled and divided into AR and non-AR groups. QoL was evaluated using serial applications of the Obstructive Sleep Apnea-18 (OSA-18) questionnaire and compared between the two groups.

Results

Of 151 enrolled patients, 73 were categorized into the AR and 78 into non-AR groups. After surgery, patients exhibited marked improvement in OSA-18 scores in both groups, with similar results at each follow-up. The degree of improvement in OSA-18 scores was less in the AR group 3 months after surgery; however, this difference was not significant 6 months after surgery.

Conclusions

Although comorbid AR may initially appear to impede improvement in QoL after PITA, QoL was improved similarly 6 months after PITA, irrespective of AR status. In children with comorbid AR, PITA could be safely performed to treat sleep-disordered breathing without concerns regarding worsening of QoL.

http://bit.ly/2T5NJuc

Surgical management of nasal dermoid lesions

Publication date: Available online 23 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Craig Miller, Scott Manning, Randall Bly

Nasal dermoids are the most common congenital midline nasal lesions. They often present as a midline pit or nasal mass and arise from incomplete or failed regression of the dural diverticulum during embryogenesis. Management requires complete resection of the tract and an appropriate surgical approach is based on location, extent, and presence and/or degree of intracranial extension. Classically requiring an open craniotomy for resection, newer strategies employ a minimally disruptive approach to fully excise the lesion and the tract to prevent recurrence. This article presents details on embryology, imaging work up, and surgical technique for resection of these lesions either via an open approach or with an endoscopic-assisted method.

http://bit.ly/2R9drML

Introduction

Publication date: Available online 23 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Meghan N. Wilson

http://bit.ly/2WcFE9a

Hearing function of gold miners with and without a history of tuberculosis treatment: a retrospective data review

Publication date: Available online 23 January 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Katijah Khoza-Shangase

Abstract

Introduction

South Africa has a high prevalence of co-existing tuberculosis and HIV. As ototoxicity linked to the treatments for these conditions occurs with concomitant exposure to other ear toxins such as hazardous noise exposure, it is important to investigate the combination impact of these toxins. Limited published evidence exists on the co-occurrence of these conditions within this population.

Objectives

The objective of this study was to compare the hearing function of gold miners with (treatment group) and without (non-treatment group) the history of tuberculosis treatment, in order to determine which group had increased risk of noise induced hearing loss. Furthermore, possible influence of age and HIV in these two groups was examined.

Methods

A retrospective record review of 102 miners' audiological records, divided into two groups, was conducted, with data analyzed both qualitatively and quantitatively.

Results

Findings suggest that gold miners with a history of tuberculosis treatment have worse hearing thresholds in the high frequencies when compared to those without this history; with evidence of a noise induced hearing loss notch at 6000 Hz in both groups. Pearson's correlations showed values between 0 and 0.3 (0 and −0.3) which are indicative of a weak positive (negative) correlation between HIV and hearing loss, as well as between hearing loss and age in this population.

Conclusions

Current findings highlight the importance of strategic hearing conservation programs, including ototoxicity monitoring, and the possible use of oto-protective/chemo-protective agents in this population.

Resumo

Introdução

A África do Sul apresenta uma alta prevalência de coinfecção de tuberculose e HIV. Como a ototoxicidade associada aos tratamentos para essas condições é observada na exposição concomitante a outros agentes ototóxicos, como a exposição a ruídos perigosos, é importante investigar o impacto da combinação desses agentes. São poucas as evidências publicadas sobre a co-ocorrência dessas condições nesta população.

Objetivo

O estudo teve como objetivo comparar a função auditiva de garimpeiros com (grupo tratamento) e sem (grupo sem tratamento) história de tratamento de tuberculose, a fim de determinar que grupo apresentava maior risco de perda auditiva induzida por ruído. Além disso, avaliou-se a possível influência da idade e do HIV nesses dois grupos.

Método

Os registros audiológicos de 102 garimpeiros, divididos em dois grupos, foram revisados de forma retrospectiva; os dados foram qualitativa e quantitativamente analisados.

Resultados

Os achados indicam os garimpeiros com histórico de tratamento de TB apresentam piores limiares auditivos nas altas frequências quando comparados àqueles sem esse histórico; em ambos os grupos, observou-se perda auditiva induzida por ruído com entalhe audiométrico a 6,000 Hz. As correlações de Pearson mostraram valores entre 0 e 0,3 (0 e -0,3), que são indicativos de uma fraca correlação positiva (negativa) entre o HIV e a perda auditiva, bem como entre a perda auditiva e a idade nessa população.

Conclusões

Os resultados atuais destacam a importância de programas estratégicos de conservação auditiva, incluindo monitoramento de ototoxicidade, e o possível uso de agentes oto-/quimioprotetores nessa população.

http://bit.ly/2Uam37O

Somatosensory evoked potential: Preventing brachial plexus injury in transaxillary robotic surgery

Objectives/Hypothesis

The potential for brachial plexopathy due to arm positioning is a major concern regarding the robotic transaxillary approach. Intraoperative nerve monitoring via somatosensory evoked potential (SSEP) has been suggested to prevent such injury. In this study, we examined the use of SSEP in detecting imminent brachial plexus traction during robotic transaxillary thyroid and parathyroid surgery.

Study Design

Retrospective case series.

Methods

A analysis was performed for all patients undergoing robotic transaxillary surgery with continuous intraoperative SSEP monitoring at a North American institution between 2015 and 2017. A significant intraoperative SSEP change was defined as a decrease in signal amplitude of >50% or an increase in latency of >10% from baseline established during preoperative positioning.

Results

One hundred thirty‐seven robotic transaxillary surgeries using SSEP monitoring were performed on 123 patients. Seven patients (5.1%) developed significant changes, with an average SSEP amplitude reduction of 73% ± 12% recorded at the signals' nadir. Immediate arm repositioning resulted in recovery of signals and complete return to baseline parameters in 14.3 ± 9.2 minutes. There was no difference in age (40.4 ± 9.4 years vs. 44.5 ± 13.4 years; P = .31) or body mass index (27.3 ± 3.7 kg/m² vs. 26.9 ± 6.1 kg/m²; P = .79) between cases with and without SSEP change. Operative time was shorter for patients with significant SSEP change (131.6 ± 14.7 minutes vs. 146.5 ± 46.7 minutes; P = .048). There were no postoperative positional brachial plexus injuries.

Conclusions

SSEP is a novel, safe, and reliable tool in detection of position‐related brachial plexus neuropathy. Intraoperative monitoring using SSEP can play a vital role in early recognition and prevention of injury during robotic transaxillary thyroid and parathyroid surgery.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2RFEZ1n

Comparative Assessment of Drug‐Induced Sleep Endoscopy Scoring Systems in Pediatric Sleep Apnea

Objectives/Hypothesis

A wide variety of drug‐induced sleep endoscopy (DISE) scoring systems has been used to evaluate sites of upper airway obstruction in children and adults; however, a universally accepted DISE scoring system dedicated to children has not been developed. We evaluated the utility of DISE scoring systems in the assessment of obstructive sleep apnea (OSA) using a single cohort of pediatric patients.

Study Design

Retrospective chart review.

Methods

The medical records of surgically naïve–healthy children with OSA who had undergone DISE were reviewed. Information about demographics, past medical history, and severity of OSA were obtained. A literature review was conducted to identify DISE scoring systems used in children with OSA. Recordings of DISE were analyzed without knowledge of patient information and severity of OSA. The effect of age, obesity, severity of OSA, and oxygen nadir on DISE score was assessed.

Results

Sixty‐eight patients (46 male, 22 female, age range: 19 months–18 years) were included. Forty‐three patients were obese and 25 were nonobese. The severity of OSA was mild in 12 patients, moderate in 13 patients, and severe in 43 patients. DISE scoring systems did not document differences among the groups of patients with mild OSA, moderate OSA, and severe OSA (P > .05). DISE scores were not different among the studied age and weight categories (P > .05).

Conclusions

The DISE scoring systems did not show differences in DISE scores in surgically naïve–healthy children with varying age, weight, and OSA severity categories. Our findings provide preliminary evidence for the need of a universally applicable pediatric DISE scoring system for OSA.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2CISGlE

Pediatric dysphagia: Is interarytenoid mucosal height significant?

Objectives

The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS).

Methods

A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%).

Results

There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1–5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%).

Conclusion

There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2RGpPJ2

Validation of the Chinese Velopharyngeal Insufficiency Effects on Life Outcomes Instrument

Objectives/Hypothesis

To translate the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) instrument into Chinese and test its psychometric properties.

Study Design

Quality of life instrument translation and validation.

Methods

The original English version of the VELO instrument was translated into Mandarin, back‐translated, and adapted among the Chinese population, based on the standardized guidelines for the cross‐culture adaption process. Velopharyngeal insufficiency (VPI) patients were identified by a professional speech and language pathologist. Internal reliability of the VELO instrument was assessed by the Cronbach's α coefficient. Discriminant validity was tested by the Mann‐Whitney U test. Construct validity was assessed by factor analysis.

Results

A total of 113 patients with VPI and 72 parents of the patients were enrolled. The mean age of the VPI patients was 14.8 years. Internal reliability was excellent; Cronbach's α coefficients were 0.92 and 0.94 for VPI patients and their parents, respectively. The Chinese VELO discriminated well between the VPI group and the controls, with a mean (standard deviation) score that was significantly lower for the VPI group (74.8 [25.7]) than the control group (98.0 [15.9]) (P < .001). The total scores and scores in the emotional domain or perception domain showed differences between VPI patients and their parents. Similar to the original study, the factor loading after rotation followed hypothesized domains largely, in spite of items from several domains loaded on the same factor.

Conclusions

The translated Chinese version of the VELO instrument demonstrated an acceptable reliability, discriminant validity, and construct validity. These psychometric properties suggested theoretical evidence for the further use of the VELO instrument among Chinese patients with VPI.

Level of Evidence

3b Laryngoscope, 2019

http://bit.ly/2CFKYIW

Table of contents

http://bit.ly/2RLc6ko

Masthead

http://bit.ly/2CGhhrl

History of NSAID Use in the Treatment of Headaches Pre and Post-industrial Revolution in the United States: the Rise and Fall of Antipyrine, Salicylic Acid, and Acetanilide

Abstract

Purpose of Review

Non-steroid anti-inflammatory drugs (NSAIDs) constitute a vital class of medications in today's headache regimen. However, up until the nineteenth century, they were largely unknown to most of the medical community. The purpose of this review is to explore the evolution of NSAIDs in the treatment of headaches spurred on by the Industrial Revolution in the USA.

Recent Findings

The currently available data on the impact of NSAIDs reflects their significant contribution to headache treatment.

Summary

The emergence of mass production spurred on by the Industrial Revolution, lead to widespread use of antipyrine, salicylic acid, and acetanilide. However, along with it came the growing awareness of consumer safety, leading to their ultimate downfall, and the subsequent birth of the Food and Drug Act.

http://bit.ly/2FRceHO

Unknown primary (CUP) of the head and neck : No advantages of bilateral radiotherapy, the strategy of ipsilateral radiotherapy can be recommended for the adjuvant treatment

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Nguyen‐Son Le  Stefan Janik MD, PhD  Helmut Simmel MD  Boban M. Erovic MD, PD, MBA

First published: 19 January 2019 https://doi.org/10.1002/hed.25637

This work was presented at the 61st Annual Meeting of the Austrian Society of Oto‐Rhino‐Laryngology – Head and Neck Surgery, Vienna, Austria

Abstract

Background

The purpose of this study was to analyze and compare ipsilateral and bilateral adjuvant radiotherapy in patients with cancer of unknown primary (CUP) of the head and neck.

Methods

Overall survival, recurrence‐free survival, and radiation‐induced side effects were assessed in 76 patients with CUP who underwent ipsilateral (n = 29) or bilateral (n = 47) radiotherapy.

Results

At a median follow‐up of 41 months, the 5‐year overall survival and recurrence‐free rate were 67.9% and 71.5%, respectively. No statistically significant difference between ipsilateral and bilateral radiotherapy could be found regarding 5‐year overall survival, recurrence‐free survival, occurrence of a primary tumor, and distant metastasis. The analysis of radiation‐induced acute side effects showed a significant benefit of ipsilateral radiotherapy.

Conclusion

As the main parameters of the study regarding the outcome and radiation‐induced side effects showed no advantages of bilateral radiotherapy, the strategy of ipsilateral radiotherapy can be recommended for the adjuvant treatment of CUP patients.

Acanthosis Nigricans & Metabolic Syndrome : Metabolic syndrome refers to a clustering of metabolic risk factors including central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides and hypertension. High prevalence of Acanthosis Nigricans (AN) in subjects with metabolic syndrome. Also there was a positive correlation between severity of Acanthosis Nigricans (AN) and Metabolic syndrome.

Acanthosis nigricans: A cutaneous marker for metabolic syndrome p. 16

Nirali Girish Shah, Swapna S Khatu, Neeta R Gokhale, Yuvraj E More, Deepak Khismatrao

DOI:10.4103/mjdrdypu.mjdrdypu_44_18  

Background: Acanthosis Nigricans (AN) is an easily identifiable dermatoses characterized by thickened, hyperpigmented plaques. Metabolic syndrome refers to a clustering of metabolic risk factors including central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides and hypertension. AN is a skin marker associated with this syndrome. Aims and Objectives: This study aimed to determine the relationship between AN and metabolic syndrome by studying its clinico-epidemiological features and also the relation of severity of AN over neck with metabolic syndrome. Methodology: This is a case-control study. One hundred consecutive patients of AN attending dermatology OPD of a tertiary care hospital were included in this study. They were evaluated for AN and severity of AN over neck was assessed. Age and sex matched 100 controls were included in the study. Epidemiological, clinical and anthropometric characteristics (height, weight, waist circumference) were measured of all the cases and controls. Body Mass Index (BMI) was calculated. Fasting Blood Sugar, High Density Lipoprotein and Serum Triglyceride levels were estimated. Result: The average age of the patients was 32.4 years and females (62%) were more than the males (38%). Neck was involved in all the patients. There was statistically significant correlation of increasing severity of AN with each component of Metabolic syndrome. On comparing between cases and controls, each component of metabolic syndrome was raised in cases as compared to the controls. 70% cases had Metabolic syndrome which was statistically significant. Conclusion: There was a high prevalence of AN in subjects with metabolic syndrome. Also there was a positive correlation between severity of AN and Metabolic syndrome.

Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation

Abstract

Purpose

Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria.

Methods

Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation.

Results

16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30–45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (p_{heterogeneity} = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days.

Conclusions

Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.

http://bit.ly/2DtmwMw