Background Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics. Methods At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses. Results A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p =0.011) and oral steroid courses for CRS (p = 0.003). Conclusion While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.
Infection with the intestinal parasite Giardia duodenalis is one of the most common causes of diarrheal disease in the world. Previous work has demonstrated that the cells and mechanisms of the adaptive immune system are critical for clearance of this parasite. However, the innate system has not been as well studied in the context of Giardia infection. We have previously demonstrated that Giardia infection leads to the accumulation of a population of CD11b + , F4/80 + , ARG1 + , and NOS2 + macrophages in the small intestinal lamina propria. In this report, we sought to identify the accumulation mechanism of duodenal macrophages during Giardia infection and to determine if these cells were essential to the induction of protective Giardia immunity. We show that F4/80 + , CD11b + , CD11c int , CX3CR1 + , MHC class II + , Ly6C 2 , ARG1 + , and NOS2 + macrophages accumulate in the small intestine during infections in mice. Consistent with this resident macrophage phenotype, macrophage accumulation does not require CCR2, and the macrophages incorporate EdU, indicating in situ proliferation rather than the recruitment of monocytes. Depletion of macrophages using anti-CSF1R did not impact parasite clearance nor development of regulatory T cell or Th17 cellular responses, suggesting that these macrophages are dispensable for protective Giardia immunity. ImmunoHorizons, 2019, 3: 412-421.
Esophageal and gastric mucosal injuries are well-documented adverse effects of doxycycline leading to odynophagia, chest pain, and abdominal pain. There are no clear diagnostic criteria for such adverse effects; hence, the diagnosis depends heavily on thorough history. There is a paucity of literature describing life-threatening complications from doxycycline-induced mucosal injury, such as hemorrhage and perforation. We present the first case report describing a gastric perforation from doxycycline use.
Adult acquired buried penis (AABP) is a condition of entrapment of the phallus resulting most commonly from morbid obesity and formation of cicatrix with other etiologies including genital lymphedema, hidradenitis and trauma. The incidence of this syndrome is invariably connected to the increasing prevalence of obesity. The purpose of this review is to examine the current literature in AABP with a focus on the morbidity of AABP and perioperative management. The discussion and literature surrounding buried penis reconstruction started with the goal of correcting a cosmetic problem and has recently become fairly successful in this aim with an over 85% rate of successful reconstruction in many series with a more uniform surgical approach. The most recent trends have examined the significant burden of morbidity and even mortality that AABP can place on patients as it contributes to risk of penile cancer, urethral strictures and mood disorders. Studies in this space have shown that surgical repair can be successful in improving quality of life for patients with AABP and the removal of the offending pathophysiology suggests its success in correcting the physical morbidities. New directions for research and management of this condition should include a focus on educating providers and patients to make reconstruction more accessible to patients in need as AABP continues to journey toward mainstream acceptance as a surgical condition.
IntroductionTo confirm the safety and examine outcomes of a day of surgery discharge following artificial urinary sphincter implantation in a population discharged without a catheter. MethodsWe retrospectively identified 110 patients, 31 of whom were discharged on the day of surgery, from a single surgeon following artificial urinary sphincter implantation. After institutional board review approval, patient charts were reviewed capturing demographics as well as three, thirty, and ninety-day outcomes. Further outcomes specific to urinary retention were obtained. ResultsPatients who were discharged the same day were older (71 vs. 68), had shorter operative times (92 minutes vs 109 minutes), and were less likely to have been smokers (6% vs 31%). There were no differences in the proportion of patients who underwent prior radiation or prior implant surgery. There was no significant difference in the number of patients who had emergency department visits, urinary retention, office calls, office visits, or unplanned office visits at all time points following surgery. There was no significant difference in overall urinary retention (15% vs 5%), retention presenting after the initial surgical event (6% vs 5%), or need for a suprapubic tube (0% vs 5%). ConclusionsDay of surgery discharge is a safe discharge strategy for patients who have undergone artificial urinary sphincter placement. Furthermore, catheter-free days of discharge surgery did not have a significantly greater risk of urinary retention, office calls, emergency department (ED) visits, or office visits compared to our overnight observation population. This approach should be considered for all patients undergoing artificial urinary sphincter (AUS) implantation.
had a slightly lower rate of recurrence than STDS however this was not significant (39.0% vs. 47.4%, p[0.518). The overall complication rate was 1.7%. There were 3 complications, an infection in the aspiration alone group, a postoperative bleed in the STDS group, and a repeat procedure for severe pain in the STDS group. These were not statistically significant.CONCLUSIONS: Ethanol was the most effect sclerotic agent in our patient cohort. Though similarly effective, STDS is interestingly roughly twice as expensive as ethanol at our institution. Hydrocele recurrence was not significantly improved with STDS however, though it did delay timing to recurrence onset. We conclude that ethanol sclerosis is both more effective, and cost effective, than STDS sclerosis. Future studies with increased patient numbers may help confirm these conclusions.
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