Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study

Background In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS. Methods 120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales. Results Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination. Conclusions The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient’s comfort. To optimize it, however, further research is needed.

Case Report: Stemi With Covid-19

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) causing coronavirus disease 2019 (COVID-19) has reached pandemic levels by March 2020. Patients with cardiovascular disease, particularly with cardiac injury represent a vulnerable population and increased risk of mortality and morbidity. There is still no guidelines for management of cardiovascular disease during the COVID-19 pandemic. CASE ILLUSTRATION An unconscious 52-year-old male brought to ER with complaints of abdominal discomfort and nausea. The patient had a cardiac arrest in ER and ROSC was obtained. The patient was intubated ECG showed anterior STEMI and primary PCI was performed. The endotracheal tube was changed due to blockage of excessive and thick slime. Tracheostomy was performed. Bronchoscopy was performed and found tracheal mucosal edema, hyperemic and easily bleed; mucous plug and blood clots in the tip of tracheostomy cannula. Thoracic CT-Scan showed ground-glass appearance and fibrosis of the 6th thoracic dextra segment. PCR SARS-CoV-2 showed reactive. The patient was discharged from our hospital after three weeks with clinically stable and referred to COVID-19 center hospital nearby his home for another two weeks. After PCR SARS CoV-2 was performed twice showed negative results, the patient was discharged. CONCLUSION SARS-CoV‑2 infection may lead to acute myocardial injury through viral systemic inflammation, although specific mechanism remained uncertain. A thick mucus plaque and stool cell may be a specific clinical features in COVID-19 patients. Tracheostomy has a continuing role in managing weaning from extended periods of mechanical ventilation during the COVID-19 pandemic.

Anaesthesia management of a case of huge neck mass due to cervical spine chondrosarcoma with distorted anatomy

Chondrosarcoma is the tumor which affects bone and soft tissue with only 2% spinal involvement. Anesthetic management becomes challenging in patients with cervical chondrosarcoma. Here, we are presenting a case of huge neck mass due to cervical spine chondrosarcoma in 70 year old male hypertensive patient. The patient has distorted anatomy with mucosal edema with left tracheal deviation and compression from right side. Awake Nasal Fiberoptic intubation was done with cuffed ETT no 8. The neck mass was removed and Anterior Cervical Discectomy and Fusion (ACDF) with bone grafting. The case was managed with adequate analgesia, replacement of fluids and Blood and Blood products. Considering complex cervical spine surgery and airway edema the patient was shifted to Surgical Intensive Care Unit (ICU) for elective ventilation and advanced monitoring. After serial ABG and proper weaning the patient was extubated next morning smoothly. Extensive preoperative evaluation, planning, clinical judgement and skilled experienced personale are essential for proper execution of difficult airway cases.

Tatalaksana Trauma Wajah dengan Panfasial Fraktur

AbstrakFraktur pada wajah dapat menyebabkan defisit fungsional dan estetika jika tidak ditangani dengan baik. Tatalaksana akut yang tepat dari fraktur wajah harus didasarkan pada evaluasi cepat dan menyeluruh. Keberhasilan rekontruksi wajah merupakan keadaan darurat yang perlu dievaluasi dalam waktu 24 jam dari trauma. Berbagai jenis reduksi dan fiksasi tergantung pada fungsi, lokasi, jenis fraktur, dan usia pasien. Kasus ini diajukan untuk memperlihatkan keberhasilan tatalaksana trauma akut maksilofasial. Dilaporkan seorang laki-laki 37 tahun dengan panfasial fraktur yang dilakukan reduksi dan fiksasi 3 hari setelah trauma dengan pemasangan plat dan sekrup, serta fiksasi mukoginggival kombinasi antara arch bardan quickfix. Reduksi, reposisi dan fiksasi dilakukan setelah edema mukosa hebat disertai kombinasi antara arch bar dan quickfix pada mukoginggival merupakan salah satu alternatif untuk mengurangi risiko perdarahan dan memudahkan reposisi.Kata kunci: fraktur wajah, panfasial fraktur,edema mukosa.Management of Maxillofacial Traumawith Panfacial FractureAbstractFacial fractures can cause functional and aesthetic deficits if not treated properly. Appropriate acute management of facial fractures should be based on a rapid and thorough evaluation. Successful facial reconstruction is an emergency that needs to be evaluated within 24 hours of trauma. Different types of reduction and fixation depend on the function, location, type of fracture, and the age of the patient. This case is presented to demonstrate the success of acute maxillofacial trauma management. Reported a 37-year-old man with a facial fracture who underwent reduction and fixation 3 days after trauma with plate and screw installation, and combination mucogingival fixation between arch bar and quickfix. Reduction, reposition and fixation performed after severe mucosal edema accompanied by a combination of arch bar and quickfix on the mucogingival is an alternative to reduce the risk of bleeding and facilitate repositioning.Keywords: facial fracture, panfacial fracture, mucosal edema.

Effect of Xinyi Biyan Pill in Adjuvant Treatment of Patients with Chronic Rhinosinusitis and Its Influence on Serum Inflammatory Factors and Immune Function

Objective. To explore the effect of Xinyi Biyan Pill in adjuvant treatment of patients with chronic rhinosinusitis (CRS) and its influence on serum inflammatory factors and immune function. Methods. From January 2017 to April 2020, 112 CRS patients admitted to this hospital were randomly divided into the control group (n = 52) and the study group (n = 60). The control group was treated with endoscopic sinus surgery (ESS), after the operation, levofloxacin capsules were taken orally, budesonide nasal spray was given, and the nasal cavity was flushed with normal saline; on the basis of that mentioned above, the study group was treated with Xinyi Biyan Pill orally after the surgery. The clinical efficacy and the symptom relief time of nasal congestion and runny nose, hyposmia, mucosal edema, and vesicles disappearance of the two groups after treatment were observed; the serum inflammatory factors’ (C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8)) and immune function indexes’ (total immunoglobulin E (TIgE), eosinophil cationic protein (ECP), CD3+, CD4+, and CD4+/CD8+) expression levels before and after treatment in the two groups were detected; the recurrence of CRS after 1 year of treatment in the two groups was recorded. Result. After treatment, the total clinical effective rate of the study group (92.98%) was significantly higher than that of the control group (78.00%) ( P < 0.05 ). After treatment, the symptom relief time of nasal congestion and runny nose, hyposmia, mucosal edema, and vesicle disappearance in the study group was shorter than that in the control group ( P < 0.05 ). After treatment, the expression levels of serum CRP, IL-6, and IL-8 in the two groups were significantly lower than those before treatment, and the study group was significantly lower than the control group ( P < 0.05 ). After treatment, the expression levels of serum TIgE and ECP of the two groups were significantly lower than those before treatment, the expression levels of serum CD3+, CD4+, and CD4+/CD8+ of the two groups were significantly higher than those before treatment, and the study group had significant changes compared with the control group ( P < 0.05 ). After 1 year of treatment, the recurrence rate of CRS in the study group (1.79%) was significantly lower than that in the control group (12.00%) ( P < 0.05 ). Conclusion. Xinyi Biyan Pill has a significant clinical effect in adjuvant treatment of CRS patients. It can effectively reduce the expression level of serum inflammatory factors, improve the body’s immune function, and prevent short-term recurrence. It is worthy of clinical promotion.

Comparison of Absorbable Packing versus No Packing in Wound Healing after Endoscopic Sinus Surgery: A Systematic Review and Pooled Analysis

<b><i>Introduction:</i></b> Nasal packing after endoscopic sinus surgery (ESS) is controversial. The aim of this systematic review was to compare absorbable packing versus no packing in wound healing after ESS for the treatment of chronic rhinosinusitis. <b><i>Data Source:</i></b> English electronic databases, including Cochrane Library, EMBASE, MEDLINE, and PubMed, were searched, and only randomized controlled trials were included. <b><i>Methods:</i></b> The outcome measures were the presence of synechiae/adhesion formation, mucosal edema, crusting, granulation formation, and infection. The McNemar’s test was used for pooled analysis. <b><i>Results:</i></b> Four studies with 148 participants were included. The pooled analysis showed that absorbable packing may offer benefit in reducing adhesion at 6–8 weeks (odds ratio [OR]: 0.3864; 95% confidence interval [CI]: 0.2136–0.7235) and 12 weeks (OR: 0.2396, 95% CI: 0.08267–0.7709) postoperatively compared with no packing. There was no significant difference between the packed and the unpacked side at 2, 6–8, and 12 weeks after ESS in terms of presence of crusting, edema, and granulation formation. <b><i>Conclusion:</i></b> There is insufficient evidence to suggest that absorbable packing after ESS does not increase mucosal edema, granulation formation, and infection. However, the absorbable packing may be more effective than no packing for the prevention of mucosal adhesion after ESS. The use of absorbable nasal packing after ESS is recommended when used to reduce postoperative mucosal adhesion. More research in this area is clearly needed.

Incidence of concha bullosa and its role in chronic rhinosinusitis

<p class="abstract"><strong>Background:</strong> Pneumatization of nasal turbinates is called concha bullosa. Most often it involves the middle turbinate and is one of the commonest variants of sinonasal anatomy. Bulbous and extensive type of concha bullosa may lead to narrowing or even complete blockage of osteomeatal complex. This alters the normal airflow and drainage pathways of mucous, resulting in mucosal edema which obstructs the ethmoidal infundibulum and osteomeatal obstruction leading to sinusitis. The aim of the study was to determine the incidence of concha bullosa and assess its role in causation of chronic rhinosinusitis. The objective was to determine the incidence of concha bullosa and assess its role in chronic rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> A retrospective study of 120 patients suffering from chronic sinusitis of age group 18 years to 70 years old were taken between March 2018 to January 2021 at Malla Reddy institute of medical sciences (MRIMS) who had nasal symptoms significant enough to warrant a CT paranasal sinus (CT PNS) with positive findings. All PNSs involved were identified for sinus disease. Concha bullosa identified and graded into small, moderate and large. Patients with history of previous nasal surgeries were excluded.</p><p class="abstract"><strong>Results:</strong> Our study showed 54% cases of chronic sinusitis with concha bullosa.</p><p class="abstract"><strong>Conclusions:</strong> Concha bullosa may be one of the predisposing factors of chronic rhinosinusitis and hence surgical manipulation by functional endoscopic sinus surgery (FESS) is important to prevent recurrence of sinusitis.</p>

Dacryoendoscopic Findings of Patients With Nasolacrimal Obstruction Associated With Cancer Treatment

PurposeTo investigate the etiology of lacrimal drainage obstruction(LDO) of people who underwent systemic chemotherapy(CTx) or radioactive iodine treatment(RAI) by using dacryoendoscopy and at the same time performing microendoscopic silicone tube insertion(MESI) to treat epiphora.MethodFrom July 2017 to December 2020, the medical records of 11 patients(16 eyes) who diagnosed LDO after the CTx or RAI and underwent MESI were reviewed retrospectively. ResultsThe mean age was 69.0±8.2 years and prevalence of female was higher(2:9). The mean duration of the epiphora was 28.3±35.5 months, and the mean start period of epiphora after treatment was 29.5±36.5 months. In all patients, the tear meniscus height was significantly reduced after surgery. Dacryoendoscopic findings were as follows (n,(%)): mucus, 10(62.5); granulation, 4(25.0); fibrotic membrane, 6(37.5); stenosis, 5(31.3); edema, 4(25.0). Levels of obstruction were as follows (%): canaliculus, 10(62.5); lacrimal sac, 11(68.8); nasolacrimal duct, 5(37.3); inferior turbinate, 4(25.0). There was no difference in level of obstruction, but the granulation finding was significantly often in RAI (p=0.038), while mucosal edema was more often in CTx(p=0.025). ConclusionsThe dacryoendoscope enabled us to observe the nasolacrimal system in real time and examine the lesions causing LDO. Even though CTx or RAI is considered as mandatory treatment for the patients, it could affect their whole body including LDS. However, MESI can be a treatment of choice for LDO after the treatment. It is important to refer the patients suffering from epiphora to ophthalmologists for improving their quality of life by non-invasive treatment during and after additional treatment.

Granulomatous colitis in a patient with metastatic melanoma under immunotherapy: a case report and literature review

Background Immune checkpoint inhibitors (ICPIs) have changed the way advanced malignancies are currently confronted, improving cancer patients’ outcomes but also generating distinct immune-related (ir) adverse events. ICPIs-induced colitis is a common complication showing different clinical and histological manifestations. In the literature review, 14 cases with ICPIs related colon granulomas have been reported in 5 studies with either limited or unavailable information regarding histology. Granulomatous reactions can be mistakenly perceived as disease recurrence or progression. Better understanding and identification of this infrequent histological display can help to avoid misdiagnosis and mismanagement. Case presentation A 63-year-old female patient with metastatic melanoma was admitted to the hospital with symptoms of nausea, persistent diarrhea and shivering fever under consecutive treatments with ICPIs, initially pembrolizumab and subsequently ipilimumab. Sigmoidoscopy was performed revealing mucosal edema, hyperemia and erosions of the rectum and sigmoid colon. Histological evaluation of sigmoid colon mucosa biopsies revealed an unusual colitis pattern characterized by multiple intracryptal granulomas attributed to ICPIs therapy. Steroids were administered and the patient recovered. ICPIs treatment was discontinued. The patient was subsequently treated with chemotherapy but follow up radiology showed disease progression. A re-challenge with another ICPI regimen was decided and the patient is currently under immunotherapy with stable disease regarding melanoma status and without any sign of colitis recurrence. Conclusions The present report provides detailed histological description of a distinctive ICPIs-induced granulomatous colitis and highlights the need for awareness of the distinct adverse events and reaction patterns in the context of immunotherapy.

Recent Advances in Diagnosis and Management of Crohn’s Disease

The initiation of Crohn’s disease, an inflammatory bowel disease, has been primarily associated with crypt inflammation and abscesses, which further progresses towards the development of mucosal lesion and ulcers followed by mucosal edema. Despite many years of research for the confirmatory role of inflammation in this disease, various pathways and diagnosis for this inflammatory cascade is still unrevealed, which in fact is of utmost importance in the assessment of disease activity and for tailoring the therapy. Till now, various histopathological as well as endoscopic examinations has been found to be effectively and accurately assess inflammatory activity, but they are invasive, time consuming and expensive and therefore are unsuitable for routine use. Consequently, the latest research is focusing on various biomarkers of intestinal inflammation and the corresponding biological therapy. So, this chapter will cover the recent advances in diagnosis and pharmacological therapies for the same.