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Background: A centrally limited radiological pattern, marked by mucosal thickening in the central sinonasal cavity with relatively unaffected surrounding sinuses, has been linked to allergy in chronic rhinosinusitis (CRS). However, a comparison between allergic and non-atopic CRS patients is lacking. The role of anatomical variations in the ostiomeatal complex also remains unclear. Methods: Adult CRS patients with allergic rhinitis, asthma, eczema, and positive allergy tests were recruited. CRS patients without atopic disease and negative allergy tests were controls. CT scans were evaluated for the centrally limited radiologic pattern. Anatomical variations in the ostiomeatal complex were also examined. Results: The study included 15 allergic CRS and 17 non-atopic CRS participants. Allergic CRS patients showed a higher prevalence of centrally limited sinus disease compared to non-atopic CRS patients (50% vs. 14.7%, p < 0.01). No anatomical variations were conclusively linked to allergy status or the centrally limited sinus disease. Conclusion: Centrally limited sinus disease on radiology is associated with underlying allergy in CRS but should not be the primary diagnostic tool. Anatomical variants did not clearly relate to allergy status or the radiologic pattern but this requires further studies. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the relationship between human papillomavirus (HPV) infection and the development of salivary gland tumour (SGT) by evaluating the expression of p16 and the oncoproteins HPV16-L1 and HPV18-E6 using immunohistochemical (IHC) staining. Additionally, we assess the agreement between these oncoproteins and p16 in diagnosing HPV-infected SGT. Methods: This cross-sectional study included all SGT cases undergoing surgical resection at Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II (HRPZ) in Malaysia from April 2022 to April 2023. IHC staining was performed on paraffin-embedded tissues at the Pathology Laboratory, HUSM, to evaluate the expression of p16, HPV16-L1, and HPV18-E6 oncoproteins. The clinicopathological data were correlated with the staining results. Results: 49 SGT cases were identified, mainly in middle-aged Malay women, with most tumours originating from the parotid gland. Malignant tumours included mucoepidermoid carcinoma (22.4%), adenoid cystic carcinoma (4.1%), acinic cell carcinoma (4.1%), and adenocarcinoma (2%). Benign tumours primarily consisted of pleomorphic adenoma (49%) and Warthin tumours (16.3%). Positive p16 expression was detected in 67% of cases, while HPV16 and HPV18 were detected in 65% and 90% of tumours, respectively. HPV16-L1 exhibited 75.8% sensitivity and 56.3% specificity, while HPV18-E6 showed 100% sensitivity and 31.2% specificity compared to p16. Conclusion: The study findings suggest a correlation between the presence of high-risk HPV types 16 and 18 and the development of SGT, as evidenced by the overexpression of p16, HPV16-L1, and HPV18-E6 oncoproteins. Both HPV16-L1 and HPV18-E6 tests are acceptable, reliable, and sensitive for detecting high-risk HPV in SGT. [ABSTRACT FROM AUTHOR]

Introduction: Using antibiotics in the treatment of acute sore throats has been linked with antimicrobial resistance (AMR) and needs to be addressed. The consensus sought to improve diagnostic accuracy, decrease unwarranted antibiotic prescriptions and enhance patient outcomes. Methods: A multidisciplinary panel of nine experts reviewed published literature and discussed current practices in managing sore throat. Ten evidence-based statements on sore throat and AMR, diagnostic accuracy and antibiotic prescribing, and symptomatic therapy were developed. A modified Delphi exercise was then carried out. A consensus was reached if at least 70% of the group agreed with the statement. Results: All 10 statements for managing acute sore throat achieved consensus. The major concern of AMR caused by improper antibiotic prescribing, particularly in cases of viral sore throat, was recognized. This underscores the need for improved diagnostic tools, such as the McIsaac score, to reduce needless antibiotic prescriptions. To improve patient satisfaction, effective pain management using non-antibiotic alternatives such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and flurbiprofen throat lozenges was recommended. Pain and inflammation can be adequately managed with low-dose NSAIDs. The potential benefits of topical NSAIDs were acknowledged for their milder safety profile than oral formulations. Conclusion: A consensus was achieved on the use of a clinical diagnostic tool, prudent use of antibiotics, and symptomatic therapy in acute sore throat management. The McIsaac score and point-of-care testing (POCT) for the presence of group A beta-hemolytic Streptococcus (GABHS) can aid in the decision-making process for antibiotic use, reducing needless prescriptions. The mainstay of therapy is symptomatic treatment, which includes the use of NSAIDs. [ABSTRACT FROM AUTHOR]

Background: The Nasal Obstruction Symptom Evaluation (NOSE) is a questionnaire to assess patients with nasal obstruction. The aim of this study was to translate and validate NOSE to the Malay version NOSE (M-NOSE). Methods: The NOSE questionnaire was translated to Malay language and back to English. Psychometric properties consisting of reliability, reproducibility, validity, responsiveness were appraised in patients with nasal obstruction due to deviated nasal septum and healthy asymptomatic controls. Results: A total of 126 participants were recruited. There was significant difference between patients and controls for all items and the total score (all p < 0.001). The correlation was moderate to strong between all items and total score (r = 0.71 to 0.8) and fair to moderate for the inter-items correlations (r= 0.31 to 0.70). Internal consistency for M-NOSE was good (α = 0.81). The test–retest for each item demonstrated no significant difference. There was significant difference of the pre- and post-operative mean for each item and total score (all p < 0.001) with good response sensitivity (effect size, d = 4.91). Conclusions: The M-NOSE has satisfactory reliability, internal consistency, reproducibility and responsiveness. It is a valid and convenient tool in the assessment of the impact and treatment outcome of nasal obstruction. [ABSTRACT FROM AUTHOR]

ABSTRACT: Juvenile fibrosarcoma (JFS) is a rare case that accounts for only 1% of all pediatric tumors, which are aggressive and fast-growing. Most arises in the distal extremities than any other parts. This case report presents the case of a 2-year-old girl with complaints of right nasal obstruction. The initial clinical impression was an antrochoanal polyp, which was further supported by radiology. Histopathology showed the appearance of rhabdomyosarcoma. After evaluation, the patient underwent endoscopic endonasal surgery (EES). However, immunohistochemistry shows positive vimentin and Ki67 that lead to the diagnosis of JFS. Six months post-EES, the evaluation showed an impression of recurrence, so revision surgery was planned. After revision, histopathology showed no tumor tissue. This case highlights the diagnosis and management in JFS, emphasizing the importance of close monitoring and follow-up. This report contributes to the understanding and management of JFS, providing insights into diagnosis and treatment strategies. [ABSTRACT FROM AUTHOR]

We report a rare case of localized anterior clinoid mucocele (ACM) with acute visual loss and a literature review of the endoscopic endonasal surgery. We advocate that endoscopic endonasal approach is the best choice. To our knowledge there a limited report on localized ACM that treated via endoscopic endonasal approach. [ABSTRACT FROM AUTHOR]

An increase in the prevalence of allergic rhinitis (AR) worldwide presents a significant burden to the health care system. An initiative was started in Europe designated as Allergic Rhinitis and Its Impact on Asthma (ARIA) to develop internationally applicable guidelines by utilising an evidence-based approach to address this crucial issue. The efforts are directed at empowerment of patients for self-management, the use of digital mobile technology to complement and personalise treatment, and establishment of real-life integrated care pathways (ICPs). This guideline includes aspects of patients' and health care providers' management and covers the main areas of treatment for AR. The model provides better real-life health care than the previous traditional models. This review summarises the ARIA next-generation guideline in the context of the Malaysian health care system. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is one of the most common chronic inflammatory diseases of sinonasal mucosa. Asthma among CRS patients is often underdiagnosed which makes the management of CRS more challenging. Therefore, using serum and tissue eosinophil as an indicator and predictor of asthma in CRS patients is vital for further preventing recurrent and increasing the effectiveness of treatment for CRS. Objective: To determine the association and diagnostic ability of serum and tissue eosinophils in the diagnosis of asthma among CRS patients. Methods: A cross-sectional study was conducted involving 24 CRS patients with asthma and without asthma, respectively, from the Otorhinolaryngology clinic of two tertiary hospitals located on the East Coast of Peninsular Malaysia. Serum and tissue eosinophils (obtained from nasal polyp) levels between both groups were compared. Association between serum and tissue eosinophils with asthma was evaluated using logistic regression analysis, adjusting for important sociodemographic characteristics. The diagnostic ability of serum and tissue eosinophil was then evaluated by assessing the receiver operating characteristic curve. Results: A total of 48 CRS patients with a mean [SD] age of 47.50 [14.99] years were included. Patients with asthma had significantly higher serum [0.48 vs 0.35 × 109/L] and tissue eosinophil [100 vs 8.5 per HPF] levels. Tissue eosinophils were found to be an independent predictor of asthma with adjusted OR 1.05, p < 0.001, after adjusting for age and serum eosinophils. The area under the receiver operating characteristic curve for serum eosinophil was 69.0%. At optimal cut-off value (0.375 × 109/L), the sensitivity and specificity for serum eosinophil was 75.0% and 70.8%. The area under the receiver operating characteristic curve for tissue eosinophil was 93.4%. At the optimal cut-off value (58.0 per HPF), the sensitivity and specificity for tissue eosinophils were 79.2% and 91.7%, respectively. Conclusion: This study indicates a significantly higher level of serum and tissue eosinophils in CRS with asthma. However, there was no correlation between serum and tissue eosinophils in both group. Based on this study, the CRS patient needs to be screened for asthma if the level of serum eosinophil is > 0.375 × 109/L and tissue eosinophil > 58 per HPF. [ABSTRACT FROM AUTHOR]

Purpose: Nitric oxide (NO) is a potential marker in the diagnosis and monitoring of treatment for the management of patients with allergic rhinitis (AR). The study aimed to determine the value of nasal fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment response of AR patients. Methods: The participants were divided into control and allergic rhinitis groups based on the clinical symptoms and skin prick tests. The AR group was treated with intranasal corticosteroid after the diagnosis. The nasal fractional exhaled nitric oxide (FENO) levels were compared between control and AR groups. In the AR group, the visual analogue scale (VAS), Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, and nasal fractional exhaled nitric oxide (FeNO) were assessed pre- and post-treatment. Results: One hundred ten adults were enrolled. The nasal FeNO level was significantly higher in AR compared to control (p < 0.001). Both the subjective (VAS and NOSE), both (p < 0.01) and objective (nasal FeNO, p < 0.001) assessments showed significant different pre- and post-treatment. The threshold level of nasal FeNO in the diagnosis of AR was 390.0 ppb (sensitivity of 73% and specificity of 80%) based on the receiver operator characteristic curve. Conclusion: Nasal FeNO level is significantly higher in AR compared to control group with significant difference pre- and post-treatment. The findings suggest nasal FeNO can serve as an adjunct diagnostic tool together with the monitoring of treatment response in AR. [ABSTRACT FROM AUTHOR]

Simple Summary: Salivary glands carcinoma are prevalent in head and neck surgical oncology practice. The treatment is challenging due to late diagnosis and high recurrence risk. The epigenetic event is one of the most important etiologies known for this cancer. At present, numerous pathways and epigenetic alteration has been identified. This epigenetic event may serve as a novel avenue for the development of effective diagnostic and therapeutic agents at near future. This will enhance the management of this type of cancer. In this review, we discuss the main epigenetic events in salivary gland carcinogenesis and highlight their roles in the prognostication and refined management of this cancer. Salivary gland carcinomas (SGCs) are a diverse collection of malignant tumors with marked differences in biological activity, clinical presentation and microscopic appearance. Although the etiology is varied, secondary radiation, oncogenic viruses as well as chromosomal rearrangements have all been linked to the formation of SGCs. Epigenetic modifications may also contribute to the genesis and progression of SGCs. Epigenetic modifications are any heritable changes in gene expression that are not caused by changes in DNA sequence. It is now widely accepted that epigenetics plays an important role in SGCs development. A basic epigenetic process that has been linked to a variety of pathological as well as physiological conditions including cancer formation, is DNA methylation. Transcriptional repression is caused by CpG islands hypermethylation at gene promoters, whereas hypomethylation causes overexpression of a gene. Epigenetic changes in SGCs have been identified, and they have been linked to the genesis, progression as well as prognosis of these neoplasms. Thus, we conduct a thorough evaluation of the currently known evidence on the involvement of epigenetic processes in SGCs. [ABSTRACT FROM AUTHOR]

Objectives: To determine the anatomical variations of the lateral nasal wall and anterior skull base amongst populations in different geographical regions. Design: Systematic review and meta‐analysis. Methods: Using PRISMA guidelines, SCOPUS and PUBMED databases were searched from inception until 1 March 2022. The regions and populations identified were from Europe, Asia, Middle East, Australia‐New Zealand‐Oceania, South America, North America and Africa. Random‐effects model was used to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic and Cochran's Q test. Main outcome measures: Anatomical variations of the lateral nasal wall and anterior skull base confirmed by computed tomography scan. Results: Fifty‐six articles were included with a total of 11 805 persons. The most common anatomical variation of the ostiomeatal complex was pneumatization of the agger nasi (84.1%), olfactory fossa was Keros type 2 (53.8%) and ethmoids was asymmetry of the roof (42.8%). Sphenoethmoidal and suprabullar cells have a higher prevalence in North Americans (53.7%, 95% CI: 46.00–61.33) while asymmetry of ethmoid roof more common in Middle Easterns (85.5%, 95% CI:.00–100). Bent uncinate process has greater prevalence in Asians while supraorbital ethmoid cells and Keros type 3 more common in non‐Asians. The overall studies have substantial heterogeneity and publication bias. Conclusion: Certain anatomic variants are more common in a specific population. The 'approach of analysis' plays a role in the prevalence estimates and consensus should be made in future studies regarding the most appropriate 'approach of analysis' either by persons or by sides. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is an IgE-mediated inflammatory disease of the upper airway. AR affects the patients' quality of life, is a known risk factor for asthma and a socio-economic burden. Allergen-specific immunotherapy (AIT), comprising sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT), involves administering increasing doses of the causative allergen to induce clinical and immunologic tolerance to the allergens. It is the only currently available treatment for AR that has been proven to induce disease-modifying effects (i.e., long-term remission of allergic symptoms or potential prevention of asthma and new sensitizations). Although AIT is conventionally recommended for patients who are non-responsive to symptom-relieving pharmacotherapy, it is presently recommended as a first-line treatment for patients with moderate to severe AR who prefer a treatment with the potential for long-term remission. In light of the relatively recent implementation of AIT in Malaysia, guidelines on its appropriate indication and application are important to attain optimal outcomes. This consensus statement was developed by an expert group formed by the Malaysian Society of Allergy and Immunology to provide evidence-based recommendations for the practice of AIT in Malaysia. Patient and product selection, choice of AIT, and strategy towards an effective treatment outcome in AIT are presented. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of topical tranexamic acid (TXA) in reducing intraoperative and immediate postoperative bleeding during functional endoscopic sinus surgery (FESS) among patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods: This is a double-blind randomized clinical trial, involving 26 patients with CRSwNP, who underwent FESS for failed medical therapy. The intervention nostril was packed with ribbon gauze soaked in 500 mg/5 ml TXA. The control nostril was packed with ribbon gauze soaked in Moffett's solution, containing 2 ml 10% cocaine, 1 ml adrenaline 1:1000, and 4 ml 0.9% sodium bicarbonate. Both nostrils were packed for 15 min before FESS. Intraoperative bleeding was recorded in the initial 30 min after commencing the surgery. The recordings were reviewed by two surgeons using Boezaart's scoring system. The scores were taken at 15 and 30 min of surgery. The mean score was then calculated. At the end of the surgery, the intervention nostril was packed with Merocel® soaked in 500 mg/5 ml TXA and the control nostril was packed with Merocel® soaked in normal saline. The amount of bleeding within 24 h post-surgery was evaluated using a bolster gauze. Results: There was no significant difference in intraoperative bleeding between the intervention (1.54 ± 0.71) and control nostrils (1.69 ± 0.55) with p = 0.172. The amount of bleeding in the postoperative period was significantly reduced in the intervention nostril (1.33 ± 0.55) compared to the control nostril saline (1.81 ± 0.48) with p = 0.001. Conclusions: We found that the nasal packing soaked in TXA reduced intraoperative and immediate postoperative bleeding. It is a safe, efficacious and cost-effective alternative to Moffett's solution during FESS and also an alternative to normal saline post-surgery among patients with CRSwNP. Trial registration number: FF-2015-232, 2015. [ABSTRACT FROM AUTHOR]

Background: A good control of intraoperative bleeding is key for adequate anatomical visualization during endoscopic sinus surgery (ESS). The objective of this review was to assess the practice of hot intranasal saline irrigation (HSI) in achieving intraoperative hemostasis and good surgical field quality during ESS. Methods: An electronic search was performed via PubMed, SCOPUS, Google Scholar, and Cochrane from inception to June 2022. The included trials were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. The primary outcome assessed was the intraoperative bleeding score of the surgical field. The mean arterial pressure, duration of the surgery, amount of blood loss and surgeon's satisfaction score were assessed as the secondary outcomes. The risk of bias for each study was evaluated using the Cochrane risk of bias tool. Results: A total of 254 records were identified after removal of duplicates. Based on the title and abstract 246 records were excluded, leaving seven full texts for further consideration. Five records were excluded following full text assessment. Three trials with a total of 212 patients were selected. Hot saline irrigation was superior to control in the intraoperative bleeding score (MD − 0.51, 95% CI − 0.84 to − 0.18; P < 0.001; I2 = 72%; very low quality of evidence) and surgeon's satisfaction score (RR 0.18, 95% CI 0.09 to 0.33; P < 0.001; I2 = 0%; low quality of evidence). The duration of surgery was lengthier in control when compared to HSI (MD − 9.02, 95% CI − 11.76 to − 6.28; P < 0.001; I2 = 0; very low quality of evidence). The volume of blood loss was greater in control than HSI (MD − 56.4, 95% CI − 57.30 to − 55.51; P < 0.001; I2 = 0%; low quality of evidence). No significant difference between the two groups for the mean arterial pressure was noted (MD − 0.60, 95% CI − 2.17 to 0.97; P = 0.45; I2 = 0%; low quality of evidence). Conclusions: The practice of intranasal HSI during ESS is favorable in controlling intraoperative bleeding and improving the surgical field quality. It increases the surgeon's satisfaction, reduces blood loss, shortens operative time and has no effect on intraoperative hemodynamic instability. Trial registration: PROSPERO registration number: CRD42019117083. [ABSTRACT FROM AUTHOR]

The goal of allergic rhinitis (AR) management is to achieve satisfactory symptom control to ensure good quality of life. Most patients with AR are currently treated with pharmacotherapy. However, knowledge gaps on the use of pharmacotherapy still exist among physicians, particularly in the primary care setting, despite the availability of guideline recommendations. Furthermore, it is common for physicians in the secondary care setting to express uncertainty regarding the use of new combination therapies like intranasal corticosteroid plus antihistamine combinations. Inadequate treatment leads to significant reduction of quality of life that affects daily activities at home, work, and school. With these concerns in mind, a practical consensus statement was developed to complement existing guidelines on the rational use of pharmacotherapy in both the primary and secondary care settings. [ABSTRACT FROM AUTHOR]

Introduction: Small cell neuroendocrine carcinoma (NEC) that arises from the tonsil is a particularly rare head and neck carcinoma. This kind of neoplasm mainly originated from the bronchopulmonary area; however, there were reported cases of extrapulmonary areas. The prognosis is poor as the tumour is an aggressive tumour and have a high risk of metastasis. Case Report: We experienced a patient presented with painless right neck swelling and hard tonsillar hypertrophy for past six month. Computer tomography showed the tumour extended to the parapharyngeal space and metastasized to the thoracolumbar vertebras. The intraoral biopsy of the tonsil confirmed primary small cell neuroendocrine carcinoma of the tonsil. The clinical presentation, radiological imaging, histopathological investigations, and methods of treatment are discussed. Conclusions: Due to the rarity of this disease, there is no definitive treatment yet for this disease. The physicians must thoroughly understand the nature and characteristic of the disease to find the best treatment. The latest discoveries in chemotherapy drugs and radiotherapy may improve the treatment modalities in the future. [ABSTRACT FROM AUTHOR]

Copyright of Medeniyet Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Atopy may not contribute directly to the pathogenesis of chronic rhinosinusitis (CRS) and could be a coexisting disease, but it may play a disease-modifying role in CRS. The aim of this study was to determine the effect of atopy on the incidence of osteitis in patients with CRS. Methods: A cross-sectional study at a tertiary center was conducted. Computed tomography of paranasal sinuses (CTPNS) of 75 CRS patients was analyzed. Skin prick test was used to determine the atopy among the CRS patients. The evaluation consisted of symptom score, Lund–Kennedy endoscopic score and CTPNS assessment by Lund Mackay (LM) staging system and Global Osteitis Scoring Scale (GOSS). Results: About 54.7% of CRS patients had atopy (n=41), and 64% (n=48) had osteitis changes. No significant difference (p 0.05) was found for symptom and endoscopic scores in atopic and non-atopic CRS. Atopic and non-atopic CRS patients demonstrated comparable LM and GOSS scores (both p 0.05). Logistic regression analysis revealed that gender, nasal polyps and bronchial asthma were significantly associated with the incidence of osteitis. Significant correlation was found between LM and GOSS scores in atopic CRS (r=0.81, p< 0.05). Correspondingly, both scores were found to be significantly correlated in non-atopic CRS (r=0.74, p< 0.05). Conclusion: Atopic sensitization has no effect on the incidence and severity of osteitis in patients with CRS. The present study suggests that osteitis occurs independently from the atopic pathway. [ABSTRACT FROM AUTHOR]

Background: The International Frontal Sinus Anatomy Classification (IFAC) is introduced to simplify the classification of different frontal cell variants based on their topographical structures. The objectives of our study were to determine the prevalence of the frontal cell variants according to IFAC and their association with the development of frontal sinusitis. Methodology: A retrospective chart review on computed tomography paranasal sinus (CTPNS) was conducted. A total of 200 patients who had clinical and endoscopic findings of chronic rhinosinusitis (CRS) and undergone CTPNS were reviewed. The CTPNS was evaluated for the presence of frontal cell variants according to IFAC and mucosal changes consistent with frontal sinus involvement. Result: A total of 400 sides of the CTPNS were analyzed. The agger nasi cells (ANCs) were the most common (95.5%) followed by supra bulla cells (SBCs) (60.8%), supra bulla frontal cells (SBFCs) (53.0%), supra agger cells (SACs) (50.0%), supra agger frontal cells (SAFCs) (36.0%), frontal septal cells (FSCs) (8.3%), and supraorbital ethmoidal cells SOECs (5.5%). There was significant association between SOEC (p = 0.001) and FSC (p = 0.044) with the development of frontal sinusitis. Conclusions: Apart from ANCs, the posterior-based cells (SBCs and SBFCs) have higher prevalence than the anterior-based cells (SACs and SAFCs). Despite being the least, both SOECs and FSCs are significantly associated with frontal sinusitis. [ABSTRACT FROM AUTHOR]

Bilastine is a non-sedating second generation H1 oral antihistamine (OAH) for treating allergic rhinitis (AR) patients. The effect of bilastine has not previously been evaluated in a meta-analysis. The aim of this review was to determine the efficacy and safety of bilastine in treating AR. An electronic literature search was performed using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Science Direct and Google Scholar up to March 2021. Randomized controlled trials comparing bilastine with placebo and standard pharmacotherapy were included. The included studies must have diagnosis of AR established by clinicians and the outcomes must have a minimum of 2 weeks of follow-up period. The primary outcomes assessed were total symptom score (TSS), nasal symptom score (NSS) and non-nasal symptom score (NNSS). The secondary outcomes were discomfort due to rhinitis, quality of life (QOL) and adverse events. The risk of bias and quality of evidence for all studies were appraised. The meta-analysis was done using Review Manager 5.3 software based on the random-effects model. The search identified 135 records after removal of duplicates. Following screening and review of the records, fifteen full-text articles were assessed for eligibility. Five trials involving 3,329 patients met the inclusion criteria. Bilastine was superior to placebo in improving TSS, NSS, NNSS, rhinitis discomfort score and QOL but has comparable efficacy with other OAHs in TSS, NSS, NNS, rhinitis discomfort score and QOL. There was no difference in adverse effects when bilastine was compared against placebo and other OAHs except for somnolence. Bilastine has fewer incidence of somnolence compared to cetirizine. The overall quality of evidence ranged from moderate to high quality. Bilastine is effective and safe in treating the overall symptoms of AR with comparable efficacy and safety with other OAHs except somnolence. Whilst bilastine has similar efficacy to cetirizine, somnolence is notably less in bilastine. [ABSTRACT FROM AUTHOR]

Background: In primary care, general practitioners (GPs) and pharmacists are at the frontline to identify, classify and manage patients suffering from allergic rhinitis (AR). The Allergic Rhinitis and its impact on Asthma (ARIA) guidelines aid clinicians in disease management by providing evidence-based recommendations. A recently published ASEAN primary care survey demonstrated that the awareness of ARIA guidelines was high among GPs but notably lower in pharmacists. Hence, this study seeks to evaluate the effectiveness of a Boot Camp education initiative in bridging the unmet needs in pharmacist awareness and education. Methods: The boot camp was organised as a virtual event. The participants answered the same questionnaire before (pre-assessment) and immediately after (post-assessment) the boot camp session. Statistical analysis was performed on the data paired between the pre- and post- assessments using SPSS v. 25.0 software. Results: The boot camp survey results showed that second-generation oral antihistamines and allergen avoidance are the most preferred options for AR treatment in pharmacy practice, irrespective of the disease severity. In both pre- and post-assessments, efficacy was ranked as the most important factor considered for choosing an antihistamine and which affects patient adherence. With the boot camp initiative, there was a statistically significant increase in awareness about the patient profiling tool (from 31.6% to 88.2%) and ARIA guidelines (from 40.4% to 91.2%) among the pharmacists (p<0.05). The proportion of pharmacists who were able to identify, classify and refer AR patients was significantly increased in post-assessment (p<0.05). Post the boot camp, among the proportion of pharmacists (91.2%) who were already aware of ARIA, a high percentage of them further agreed that ARIA guidelines were useful in identifying and treating patients with AR, as well as classifying AR, respectively (97.6%, 95.2%, and 93.5%). Conclusions: Based on improvements in knowledge and understanding of disease management post assessment, the Allergic Rhinitis Boot Camp initiative is effective and relevant to pharmacy practice. Outreach programs like this reiterate the emphasis on patient compliance and importance of utilizing ARIA guidelines in pharmacy practice that facilitates better management of AR in primary care. [ABSTRACT FROM AUTHOR]

Copyright of Medeniyet Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Jordan Medical Journal is the property of University of Jordan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Intralymphatic immunotherapy (ILIT) is a potential treatment option for allergic rhinitis (AR). We aimed to determine the efficacy (primary outcomes) and safety (secondary outcomes) of ILIT in treating patients with AR. Methods: An electronic literature search was performed using MEDLINE and Cochrane Central Register of Controlled Trials CENTRAL (from their inception to December 2020). A random‐effects model was used to estimate the pooled prevalence with 95% confidence intervals. This study is registered with PROSPERO (CRD42019126271). Results: We retrieved a total of 285 articles, of which 11 satisfied our inclusion criteria. There were 452 participants with age ranged from 15 to 58 years old. Intralymphatic immunotherapy was given in three doses with intervals of four weeks between doses in 10 trials. One trial gave three and six doses with an interval of two weeks. Both primary and secondary outcomes showed no difference between ILIT and placebo for all trials. There was no difference in the combined symptoms and medication score (SMD ‐0.51, 95% CI −1.31 to 0.28), symptoms score (SMD −0.27, 95% CI −0.91 to 0.38), medication score (SMD −6.56, 95% CI −21.48 to 8.37), rescue medication (RR 12.32, 95% CI 0.72–211.79) and the overall improvement score (MD −0.07, 95% CI −2.28 to 2.14) between ILIT and placebo. No major adverse events noted. Conclusions: Intralymphatic immunotherapy possibly has a role in the treatment of AR patients. This review found it is safe but not effective, which could be contributed by the high variation amongst the trials. Future trials should involve larger numbers of participants and report standardized administration of ILIT and outcome measures. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this meta-analysis is to assess the pooled prevalence of taste disorders and their subtypes in patients with COVID-19. Data Sources: PubMed, Scopus, Web of Science, Embase, and Google Scholar databases were searched to identify studies published between December 1, 2019, and June 23, 2020, without language restrictions. There was no restriction on the study design; therefore, observational studies, clinical trials, and case series were included. In addition, preprints were considered if data of interest were reported. Review Methods: Two authors independently screened articles for eligibility. A random effects model was used to estimate the pooled prevalence with 95% CIs. Quality assessment was done with critical appraisal tools of the Joanna Briggs Institute. The robustness of the pooled estimates was checked by subgroup and sensitivity analyses. Results: Fifty-nine studies were included (N = 29,349 patients, 64.4% female). The pooled prevalence of taste disorders in patients with COVID-19 was 48.1% (95% CI, 41.3%-54.8%). The prevalence of taste disorders in studies with objective assessments was higher as compared with subjective assessments (59.2% vs 47.3%). The disorders were observed in 55.2% of European patients; 61.0%, North American; 27.1%, Asian; 29.5%, South American; and 25.0%, Australian. Ageusia, hypogeusia, and dysgeusia were detected in 28.0%, 33.5%, and 41.3% of patients with COVID-19. We identified 91.5% of the included studies as high quality. Conclusions: The prevalence of taste disorders in patients with COVID-19 was 48.1%. Objective assessments have higher prevalence than subjective assessments. Dysgeusia is the most common subtype, followed by ageusia and hypogeusia. [ABSTRACT FROM AUTHOR]

Introduction: Chronic rhinosinusitis (CRS) is a common condtion in the world leading to a significant burden on society in term of healthcare comsumption and productivity loss result in Quality of Life (QoL). The pathogenesis of CRS has not been fully eludicated. Increased inflammation and decreased number and/or impaired function of T regulatory cell (Tregs) has been reported. Based on EPOS the pharmacology treatment of CRS management is amoxicilin-clavulanic acid. Objective: To determine the efficacy of amoxicilinclavulanic acid treatment in decreasing the disease severity, reducing nasal symtomps, increasing Tregs and improvement QoL. Materials and Methods: A prospective cohort study, with comparative pre and posttest design in 25 samples. Subjects was treated with nasal irrigation solution (NaCl 0.9%), corticosteroid nasal spray, and amoxicillin-clavulanic acid for 1 month. The severity of the disease was assessed Visual Analog Scale (VAS), nasoendoscopic score by Lund and Kennedy. Quality of Life using Sinonasal Outcome Test-22 (SNOT- 22). Tregs cell and Mean Fluorescence Intensity (MFI) by flowcytometry. Results: A total of 25 patients were include with a mean age of 30.5±96.8 years. On the 1 month after treatment found reducing of VAS (p<0.05) except for loss of smell (p=0.063), nasoendoscopic score (p<0.05), SNOT-22 (p<0,05) except for psychological domain (p=0.212). Level of T-Reg total (p=0,814), and level MFI T-Reg (p=0,388) showed no significant increase after 1 month amoxicilin-clavulanic acid treatment. Conclusion: Amoxicillin-clavulanic acid treatment in CRS patients significantly improved nasal symtomps, QoL, but does not increased levels of regulatory T-cell. [ABSTRACT FROM AUTHOR]

Recurrence rate of nasal polyps is high following endoscopic sinus surgery. To improve the surgical outcome, steroid impregnated nasal dressing is used postoperatively We aimed to compare the effect of Tualang honey impregnated nasal dressing with steroid impregnated nasal dressing on wound healing and surgical outcomes in post endoscopic sinus surgery patients. A prospective, randomized, controlled trial was carried out at two tertiary hospitals. 32 patients diagnosed with chronic rhinosinusitis and had underwent endoscopic sinus surgery were enrolled. The study group received 2 mL of Tualang honey nasal dressing and the control group received nasal dressing with 2 mL of triamcinolone 20 mg/mL as positive control. A 2 cm nasal dressing was placed longitudinally into the middle meatuses of both nasal cavities. Postoperative healing assessments of edema, crusting, secretions, scarring and symptoms were performed at postoperative day 7, 14, 28 and at 3 months using Sinonasal Outcome Test 22 questionnaire and modified Lund-Kennedy scoring system. There were no significant differences noted in the scores of Sinonasal Outcome Test 22 and modified Lund-Kennedy at Day 7, 14 and 28 (p>0.05) for both groups. At 3rd month, patients in the triamcinolone group had lesser symptoms and better endoscopic findings (p<0.05). Tualang honey is not as effective as steroid in achieving good wound healing and surgical outcomes in post endoscopic sinus surgery patients. Thus, it is not suitable as a substitute for steroid to reduce symptoms and prevent recurrence of disease. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Olfactory dysfunction has been observed as one of the clinical manifestations in COVID‐19 patients. We aimed to conduct a systematic review and meta‐analysis to estimate the overall pooled prevalence of olfactory dysfunction in COVID‐19 patients. Study Design: Systematic review and meta‐analyses. Methods: PubMed, Scopus, Web of Science, Embase, and Google Scholar databases were searched to identify studies published between 1 December 2019 and 23 July 2020. We used random‐effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic and Cochran's Q test. Robustness of the pooled estimates was checked by different subgroup and sensitivity analyses This study is registered with PROSPERO (CRD42020183768). Results: We identified 1162 studies, of which 83 studies (n = 27492, 61.4% female) were included in the meta‐analysis. Overall, the pooled prevalence of olfactory dysfunction in COVID‐19 patients was 47.85% [95% CI: 41.20–54.50]. We observed olfactory dysfunction in 54.40% European, 51.11% North American, 31.39% Asian, and 10.71% Australian COVID‐19 patients. Anosmia, hyposmia, and dysosmia were observed in 35.39%, 36.15%, and 2.53% of the patients, respectively. There were discrepancies in the results of studies with objective (higher prevalence) versus subjective (lower prevalence) evaluations. The discrepancy might be due to false‐negative reporting observed in self‐reported health measures. Conclusions: The prevalence of olfactory dysfunction in COVID‐19 patients was found to be 47.85% based on high‐quality evidence. Due to the subjective measures of most studies pooled in the analysis, further studies with objective measures are advocated to confirm the finding. Level of Evidence: 2 Laryngoscope, 131:865–878, 2021 [ABSTRACT FROM AUTHOR]

Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin‐converting enzyme 2 (ACE2). As a result of SARS‐CoV‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT1R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT1R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects, helpful in mitigating COVID‐19 severity. [ABSTRACT FROM AUTHOR]

Background: In treating allergic rhinitis, montelukast has the potential to be used as an alternative or addition to an oral antihistamine or intranasal corticosteroid. Objective: The objective of this systematic review was to assess the effectiveness of montelukast in treating allergic rhinitis. Methods: An electronic literature search was performed using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from 1966 to 21 January 2019. The eligibility criteria were randomized controlled trials comparing montelukast with placebo or other standard treatments. The primary outcomes assessed were daytime nasal symptom score (DNS) and night-time nasal symptom score (NNS). The secondary outcomes assessed were composite nasal symptom score (CSS), daytime eyes symptom score (DES), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). The meta-analysis was conducted using Review Manager 5.3 software based on the random-effects model. Results: Fifteen studies of 10387 participants met the inclusion criteria. Montelukast was more effective than placebo in improving DNS (mean difference [MD] − 0.12, 95% confidence interval [CI] − 0.15 to − 0.08; p < 0.001), NNS (MD − 0.09, 95% CI − 0.13 to − 0.05; p < 0.001), CSS (MD − 0.08, 95% CI − 0.11 to − 0.06; p < 0.001), DES (MD − 0.17, 95% CI − 0.33 to − 0.02; p < 0.030), and RQLQ (MD − 0.34, 95% CI − 0.49 to − 0.20; p < 0.001). Oral antihistamine was superior to montelukast in improving DNS (MD 0.08, 95% CI 0.03–0.13; p = 0.002), CSS (MD 0.03, 95% CI − 0.02 to 0.07; p = 0.27), DES (MD 0.06, 95% CI 0–0.12; p = 0.040), and RQLQ (MD 0.03, 95% CI − 0.05 to 0.12; p = 0.430). Montelukast was superior to oral antihistamine in improving NNS (MD -0.03, 95% CI − 0.08 to 0.03; p = 0.330). Intranasal fluticasone spray was superior to montelukast in improving DNS (MD 0.71, 95% CI 0.44–0.99; p < 0.001) and NNS (MD 0.63, 95% CI 0.29–0.97; p < 0.001). Combined montelukast and oral antihistamine was superior to oral antihistamine in improving DNS (MD − 0.15, 95% CI − 0.27 to − 0.03; p = 0.010), NNS (MD − 0.16, 95% CI − 0.28 to − 0.05; p = 0.006), CSS (MD − 0.12, 95% CI − 0.25 to − 0.01; p = 0.070), DES (MD − 0.12, 95% CI − 0.30 to 0.06; p = 0.180), and RQLQ (MD − 0.10, 95% CI − 0.28 to 0.08; p = 0.290). Combined montelukast and OAH was superior to montelukast in improving DNS (MD 0.15, 95% CI 0.08–0.21; p < 0.001), NNS (MD 0.05, 95% CI − 0.09 to 0.19; p = 0.510), CSS (MD 0.1, 95% CI 0.03–0.17; p = 0.007), DES (MD 0.18, 95% CI 0–0.36; p = 0.050), and RQLQ (MD 0.07 95% CI − 0.15 to 0.29; p = 0.530). Conclusions: Montelukast is more effective than placebo in treating the overall symptoms of allergic rhinitis while the combined therapy of montelukast and an oral antihistamine is superior to either montelukast or an oral antihistamine alone. [ABSTRACT FROM AUTHOR]

Background: The width of frontal sinus outflow tract is determined by pneumatisation pattern of frontal recess cell. The purpose of this study is to determine correlation between volume of agger Nasi cell (ANC) with frontal beak thickness, A-P length of frontal isthmus (FI) and frontal recess (FR). Materials and Methods: A cross sectional study was conducted in 140 adult patients who had computed tomography (CT) brain done in HUSM from Jan 2010 to June 2018. Multiplanar reconstructed images then retrieved from PACS system. Prevalence and pattern of pneumatisation of frontal recess cell reviewed. Agger Nasi cell volume measured with analysis of its correlation to frontal beak thickness, length of frontal recess and frontal isthmus done by researcher using Pearson correlation test. Result: ANC found in 131 out of 140 adult patients (93.6%). Mean ANC volume 434.48 with standard deviation of 256.63. For frontal beak (FB) thickness, anterior-posterior (A-P) length of FI & FR, mean values were 6.24 (SD 1.61), 7.06 (SD 2.92) and 4.95 (SD 2.97) respectively. No significant correlation was found between volume of ANC with FB thickness, A-P length of FI and FR. Conclusion: There was no statistically significant correlation between volume of ANC with the frontal beak thickness, anterior posterior length of frontal isthmus and frontal recess (p>0.05). Since ANC is commonly found in population, it is still essential for radiologist to consider reporting the ANC volume and pattern of pneumatisation when endoscopic surgery is planned. [ABSTRACT FROM AUTHOR]

Purpose: The allergic phenotype of chronic rhinosinusitis (CRS) and central compartment atopic disease (CCAD) have been described. The CCAD is a radiological phenotype in patients with CRS that presents as a central mucosal disease due to allergy. The subset of patients having chronic rhinosinusitis with nasal polyps (CRSwNP) has not been well characterized. We aim to describe the clinical and radiological characterizations of patients presenting with the allergic phenotype of CRSwNP. Patients and Methods: A cross-sectional study at a tertiary hospital was performed. Adult patients diagnosed with CRSwNP who had both allergology and radiological assessments were enrolled. The symptoms of allergic rhinitis, Lund–Kennedy (LK) endoscopic scoring, Lund–Mackay (LM) computed tomography scan of paranasal sinuses (CTPNS) scoring, CCAD features, skin prick test (SPT) and level of specific IgE were assessed. All the patients underwent SPT for house dust mites. Results: A total of 38 patients were enrolled. Symptoms, endoscopic and CTPNS scores were higher in the allergy and CCAD groups compared to the nonallergy and nonCCAD groups. The symptom of "need to blow nose" was statistically significant in allergy vs nonallergy (p=0.01) and CCAD vs nonCCAD (p=0.02). There were significant differences in the endoscopic scores in both allergy and CCAD (allergy vs nonallergy, p=0.01; CCAD vs nonCCAD, p=0.03), and CT scores in both allergy and CCAD (allergy vs nonallergy, p=0.02; CCAD vs nonCCAD, p=0.02). All patients with CCAD have worse scoring than nonCCAD (LK score, p=0.03; LM score, p=0.02). Patients with allergy have more polypoidal involvement of the middle turbinates (left middle turbinate, p=0.141; right middle turbinate, p=0.074) and CCAD (left middle turbinate, p=0.017; right middle turbinate, p=0.009) than nonallergy and nonCCAD patients. Conclusion: Allergic phenotype of CRSwNP has a worse clinical and radiological disease burden. Optimal treatment of allergy is essential for a better outcome. [ABSTRACT FROM AUTHOR]

The diagnostic procedure for upper aerodigestive tract (UADT) tumours is by white light endoscopy (WLE) combined with biopsy. However, WLE has difficulty identifying minute epithelial changes which hinders early diagnosis. Storz Professional Image Enhancement System (SPIES) is designed to enhance the visualization of microvasculature on the mucosal surface and detect any epithelial changes. In this study, we aimed to evaluate the use of Ni endoscopic classification with SPIES endoscopy in the detection of UADT tumours. Fifty-nine patients with suspected UADT tumours underwent WLE followed by SPIES endoscopy. All the tumours were biopsied and sent for histopathological examination (HPE). The kappa index (κ) was used to evaluate the agreement between the methods. The level of agreement between SPIES using Ni classification and HPE showed almost perfect agreement as compared to moderate agreement between WLE and HPE. The sensitivity and specificity for WLE and HPE were 77.5% and 84.2% respectively with positive predictive value (PPV) of 91.2% and negative predictive value (NPV) of 64%. The sensitivity and specificity for SPIES endoscopy using Ni classification and HPE were 97.5% and 94.7% respectively with PPV of 97.5% and NPV of 94.7%. SPIES endoscopy using Ni classification is a valid tool for earlier tumour detection. [ABSTRACT FROM AUTHOR]

Keros and Gera classifications are widely used to assess the risk of skull base injury during endoscopic sinus surgery. Although, both classifications are useful preoperatively to stratify risk of patients going for surgery, it is not practical to measure the respective lengths during surgery. In this study, we aimed to propose a new radiological classification (Thailand-Malaysia-Singapore (TMS)) to assess the anatomical risk of anterior skull base injury using the orbital floor (OF) as a reference. A total of 150 computed tomography images of paranasal sinuses (300 sides) were reviewed. The TMS classification was categorized into 3 types by measuring OF to cribriform plate and OF to ethmoid roof. Most patients were classified as TMS type 1, Keros type 2 and Gera class II, followed by patients classified as TMS type 3, Keros type 1 and Gera class 1. TMS has significant correlation with Keros classification (p < 0.05). There was no significant correlation between Keros and Gera classifications (p = 0.33) and between TMS and Gera classifications (p = 0.80). The TMS classification has potential to be used for risk assessment of skull base injury among patients undergoing ESS. It serves as an additional assessment besides the Keros and Gera classifications. [ABSTRACT FROM AUTHOR]

Thyroid abscesses are the most rare conditions of the thyroid gland but it could be potentially life threatening. Most patients are immunocompromised or has an underlying chronic thyroid disorder. We report a case of a 58 year-old lady with underlying uncontrolled diabetes mellitus and a long standing uninvestigated goiter who presented with lethargy, a new anterior neck swelling with dysphagia and change of voice. Ultrasound and computed tomography were performed and showed collection with multiple air pockets in the right thyroid lobule extending to the anterior mediastinum. She was started on intravenous antibiotics and underwent serial bedside aspiration. Her symptoms improved and complete resolution was achieved after serial aspirations and antibiotics. [ABSTRACT FROM AUTHOR]

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