Background: Μonoclonal antibodies have been proposed as a novel therapy in patients suffering from chronic rhinosinusitis with nasal polyposis (CRSwNP). The purpose of this systematic review was to evaluate their efficacy and safety.Methodology: A literature search was performed in MEDLINE, Web of Science, the Cochrane Library and multiple trial registries followed by extensive hand-searching for the identification of relevant studies. Only randomized controlled trials (RCTs) comparing the use of monoclonal antibodies with placebo or another therapy in adult patients with CRSwNP were included.Results: Anti-immunoglobin E (IgE) therapy with omalizumab was assessed in two studies, anti-interleukin (IL)-5 therapy in three studies (1 reslizumab, 2 mepolizumab) and finally anti-IL-4 and anti-IL-13 therapy in only one. With the exception of one study, biologic therapy was proved to be effective in reducing total nasal endoscopic polyp score (TPS) in treatment as compared to placebo groups. Monoclonal antibodies brought about improvement in several other outcomes, such as opacification in computed tomography (CT), quality of life measures, nasal airflow, olfaction and type 2 helper T-cell (Th2) associated biomarkers. Overall, the use of these agents was deemed safe and well-tolerated.Conclusions: This is the first systematic review showing encouraging results for the use of all three main categories of monoclonal antibodies in CRSwNP patients and highlights the need for further well-designed and with larger sample sizes RCTs.
Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty in patients after previous rhinoplasty procedure. Purpose of this study is to present the deformities and the surgical maneuvers conducted in revision rhinoplasty patients with functional complaint, anatomical sites at risk, and potential prophylactic maneuvers. This study is a retrospective chart review analysis of 46 consecutive revision rhinoplasty procedures in patients with nasal airway obstruction. Inclusion criteria were at least one previous rhinoplasty and nasal airway obstruction as the epicenter of patients' complaint. Thorough clinical examination to certify the obstruction was performed. Deformities noted were separated in three categories according to functional, cosmetic, and combination of functional and cosmetic implications. Surgical maneuvers conducted were reviewed. Deformities found were checked for statistically significant coexistences. The average patient age was 34.9 years. The mean number of previous septorhinoplasties was 1.33. Nasal ventilation obstruction mainly caused either by septum deviation or nasal valve dysfunction was identified in 91.3% of our patients. Surgical maneuvers conducted included placement of grafts in 89.1% of all cases, septoplasty in 76.1%, lateral wall support in 47.8%, and placement of spreader grafts in 39.1% of patients. The average preoperative Nasal Obstruction Symptom Evaluation (NOSE) score was 61 ± 15 and it improved substantially, even from month 1, postoperatively. Owing to high prevalence of nasal airway obstruction after primary or secondary rhinoplasty, we conducted the first retrospective chart review study to identify the most common deformities in revision rhinoplasty patients with nasal airway obstruction and the appropriate surgical maneuvers to address them. Septum deviation and nasal valve dysfunction were the two pillars of nasal airway obstruction in those patients.
Background: The aim of this study was to assess all available data regarding the efficacy of endoscopic transnasal orbital decompression for Graves' ophthalmopathy. Methodology: MEDLINE, ScienceDirect and the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcome was the reduction in orbital proptosis. Secondary outcomes were the improvement in visual acuity, post-operative diplopia, and complications Results: Twelve prospective and retrospective case series met the inclusion criteria. All of them demonstrated an improvement in postoperative proptosis that ranged from 2.07 mm to 8.2 mm (weighted mean improvement 5.05 mm). Improvement in visual acuity was reported in all but one study. Studies presented a wide range of results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in ten studies, the most serious of which being 3 cases of Cerebrospinal fluid (CSF) leak presented in 2 studies. Conclusions: The present systematic review shows that endoscopic transnasal decompression safely addresses symptoms of Graves' ophthalmopathy. However, high-quality, large-sample, controlled studies need to be performed in the future.
Aedes albopictus, also known as the Asian tiger mosquito, is an aggressive invasive mosquito species that transmits parasites that cause several major human diseases such as dengue, Chikungunya, and Zika. Its recent establishment in many European countries and the reported autochthonous cases of Aedes-transmitted arboviral diseases highlight the importance of effective surveillance programs to plan and implement efficient mosquito-control interventions. Aedes albopictus invaded the Greek island of Crete in 2014 and rapidly spread throughout; however, there are no comprehensive population-related data yet available. Our study focused on spatial and temporal dynamics of Ae. albopictus populations in rural and agricultural areas in Chania (western part of the Crete Island). An oviposition surveillance network, consisting of 51 ovitraps, was established in 2017 and systematically inspected for 2 years. Thirty ovitraps were established in rural areas and 21 in the surrounding agricultural areas. Eggs were collected weekly and transferred to the laboratory for counting and assessment of hatching rates. The spatial and temporal egg distribution was assessed by using geographical information systems and spatial statistical analysis tools. Kernel density and hot spot analysis were employed to identify clusters of high populations of eggs. Oviposition activity (eggs in traps) was recorded during April–May and December (of both years), while the maximum egg-laying rates were observed during September–October. The proportion of traps with eggs was similar between rural and agricultural areas, while the higher number of eggs was recorded in rural compared to agricultural areas during 2017. Egg hatch rates were high (>90%) until the end of September. The proportion of diapausing non-hatched eggs rapidly increased at the end of November. All hatched larvae were identified as Ae. Albopictus, indicating a negative effect of the invasion on the population of the local species Ae. cretinus. This was a systematic attempt to monitor the seasonal and spatial patterns of the Asian tiger mosquito in the island of Crete, the southernmost area of Europe, and a study in Europe that assessed temporal and spatial dynamics of Ae. albopictus soon after its invasion and establishment in an area.
Objectives To examine the methods and infrastructure necessary to establish a national Ménière’s disease registry Design Observational study. Four NHS Trusts and four independent hospitals or clinics, within three distinct urban and rural regions within the UK (“Blinded for review”). Participants Patients with Ménière’s disease. Main outcome measures Data related to the number of participants recruited, method of recruitment, participant demographics, completeness of data, and proportion of participants with bilateral disease. Results 411 participants were recruited into this study, 263 from NHS Trusts, and 148 from independent hospitals or clinics. Online recruitment was used for 73% participants and 27% were recruited via paper. 57% of participants were female and 96% of participants were white. There was no clear advantage to data completeness from either online or postal data collection. Around 20% of participants had audiological evidence of bilateral Ménière’s disease. Conclusion This feasibility study has demonstrated that hundreds of participants with Ménière’s disease can be successfully recruited to enter data into a large data collection platform. It is hoped that this initial feasibility study will pave the way for expansion of the registry to answer fundamental and complex questions alike, regarding the nature of Ménière’s disease.
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