Lung Entrapment Secondary to Loculated Rheumatoid Effusions Treated With Alteplase and Dornase.

Rheumatoid arthritis is a multisystemic inflammatory disease that can involve the respiratory system, including the pleural space. Most rheumatoid pleural effusions (PE) are incidentally found and do not require any treatment. Very rarely, however, they can become symptomatic and loculated, leading to lung entrapment or trapped lung. Surgical decortication remains the mainstay of management in such circumstances, although recent studies showed comparable efficacy of intrapleural fibrinolytics (alteplase and dornase alfa) in non-rheumatoid complicated effusions. We present a case of rheumatoid PE leading to lung entrapment successfully treated with intrapleural fibrinolytics without complications and good clinical status at six-month follow-up.

A Diagnostic Dilemma: Clindamycin-Resistant Group A Streptococcal Toxic Shock Syndrome Leading to Acute Respiratory Distress Syndrome (ARDS) With Multiple Possible Sources.

Group A Streptococcal (GAS) infections can potentially progress into streptococcal toxic shock syndrome (STSS) with multiorgan failure. Even with a benign presentation, GAS can rapidly lead to fatal necrotizing infections. While myositis and cutaneous infections are the typical initial presentation of STSS, genitourinary infections are a less common source. This report presents a case of a previously healthy woman with the chief complaint of ankle pain who subsequently developed streptococcal toxic shock syndrome and multiorgan failure from a Group A streptococcus infection of the genitourinary tract. She was treated with antibiotics and medical management for her septic shock and required prone ventilation for her acute respiratory distress syndrome (ARDS) but eventually recovered without surgery. This case highlights the importance of recognizing unusual presentations of Group A Strep infections, which have the potential to lead to rapid deterioration in patients. Also described are antibiotic and ventilator strategies that can be used to treat these severe systemic infections.

Isopropyl Alcohol Intoxication Treated With Hemodialysis: A Case Report and Short Review.

Isopropyl alcohol (IPA) is a common constituent of rubbing alcohol, household cleaning agents, and antiseptic agents. Ingestion of IPA usually leads to self-resolving mild symptoms in most cases but can result in severe symptoms, including central nervous system depression or hemodynamic instability. Treatment is mainly supportive, and hemodialysis is generally reserved for severe intoxication. Limited data are available on the use of hemodialysis to treat IPA intoxication. We are presenting a case of accidental ingestion of IPA in an elderly female with dementia leading to severe intoxication requiring hemodialysis at relatively non-toxic serum levels of IPA. The patient had a prompt recovery without any post-procedural or hospital-acquired complications.

The relationship between women's personality traits and fear of childbirth, birth satisfaction, and postpartum depression

SUMMARY OBJECTIVE: This study was conducted to determine the relationship between women's personality traits and their fear of childbirth, birth satisfaction, and postpartum depression. METHODS: This cross-sectional study was conducted between April and August 2022 among healthy third-trimester pregnant women aged 18-49 years who applied to the obstetrics and gynecology outpatient clinic of a state hospital. Data were collected by the researchers by face-to-face interview method in three stages. Participants were administered the Personal Information Form, the Five-Factor Personality Scale, and the Birth Anticipation/Experience Scale at the first interview; the Birth Satisfaction Scale on the 10th day after normal birth; and the Edinburg Postpartum Depression Scale 4 weeks after birth. RESULTS: There was a significant positive correlation between neurotic personality traits and fear of childbirth and postpartum depression, while there was a negative correlation with other personality traits (p<0.001). There was no significant relationship between birth satisfaction and personality traits (p>0.05). The effect of personality traits on fear of childbirth and postpartum depression was analyzed by multiple linear regression analysis. The regression model tested for the effect of personality traits on fear of childbirth and postpartum depression was found significant (p<0.001). According to the model, 26% of the variability in fear of childbirth and 9.1% of the variability in postpartum depression were explained by personality traits. CONCLUSION: This study showed that neuroticism, which is one of the personality traits of women, had a positive effect on fear of childbirth and postpartum depression. No significant relationship was found between birth satisfaction and personality traits.

The ankle in XLH: Reduced motion, power and quality of life.

Background: X-linked hypophosphatemia (OMIM 307800) is a rare bone disease caused by a phosphate-wasting condition with lifelong clinical consequences. Those affected suffer from bone pain, complex skeletal deformities, impaired mobility and a reduced quality of life. Early osteoarthritis and reduced range of motion of the lower limbs are known pathologies in XLH patients. However, XLH-specific data on the affected compartments such as the ankle joint through the evaluation of radiographic and gait analysis data is still lacking. Patients and methods: In this cross-sectional study, patients with genetically verified XLH, age ≥ 16 - 50 years and a complete record of gait analysis and or radiographic analysis data were included. Clinical examination, radiological and gait analysis data were compared to norms using the dataset of our gait laboratory registry. Radiographic analysis included tibial deformity analysis and assessment of osteoarthritis and enthesopathies. Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF36v2, American Orthopedic Foot and Ankle Society score (AOFAS) and the Foot and Ankle Outcome Score (FAOS) were used. Twentythree participants with 46 limbs were eligible for the study. Results: A total of 23 patients (n=46 feet) met the inclusion criteria. Patients with XLH had significantly reduced gait quality, ankle power and plantar flexion (p < 0.001) compared to a historic gait laboratory control group. Ankle valgus deformity was detected in 22 % and ankle varus deformity in 30 % of the patients. The subtalar joint (59.1%) as well as the anterior tibiotalar joint (31.1%) were the main localizations of moderate to severe joint space narrowing. Ankle power was decreased in moderate and severe subtalar joint space narrowing (p < 0.05) compared to normal subtalar joint space narrowing. No lateral or medial ligament instability of the ankle joint was found in clinical examination. Tibial procurvatum deformity led to lower ankle power (p < 0.05). Conclusions: This study showed structural and functional changes of the ankle in patients with XLH. Subtalar ankle osteoarthritis, patient reported outcome scores and clinical ankle restriction resulted in lower gait quality and ankle power.

Potential Anti-SARS-CoV-2 Prodrugs Activated by Phosphorylation and Their Role in the Aged Population.

The COVID-19 pandemic has flared across every part of the globe and affected populations from different age groups differently. People aged from 40 to 80 years or older are at an increased risk of morbidity and mortality due to COVID-19. Therefore, there is an urgent requirement to develop therapeutics to decrease the risk of the disease in the aged population. Over the last few years, several prodrugs have demonstrated significant anti-SARS-CoV-2 effects in in vitro assays, animal models, and medical practice. Prodrugs are used to enhance drug delivery by improving pharmacokinetic parameters, decreasing toxicity, and attaining site specificity. This article discusses recently explored prodrugs such as remdesivir, molnupiravir, favipiravir, and 2-deoxy-D-glucose (2-DG) and their implications in the aged population, as well as investigating recent clinical trials.

Omicron Variant of SARS-CoV-2: An Indian Perspective of Vaccination and Management.

Omicron variants have highly influenced the entire globe. It has a high rate of transmissibility, which makes its management tedious. There are various subtypes of omicron, namely BA.1, BA.2, BA.3, BA.4, and BA.5. Currently, one omicron subvariant BF.7 is also immersed in some parts of India. Further studies are required for a better understanding of the new immersing SARS-CoV-2 subvariant of the omicron. They differ in the mutation of the spike proteins, which alters their attachment to the host receptor and hence modifies their virulence and adaptability. Delta variants have a great disastrous influence on the entire world, especially in India. While overcoming it, another mutant catches the pace. The Indian population is highly affected by omicron variants. It alters the entire management and diagnosis system against COVID-19. It demanded forcemeat in the health care system, both qualitatively and quantitively, to cope with the omicron wave. The alteration in spike protein, which is the major target of vaccines, leads to varied immunization against the subvariants. The efficacy of vaccines against the new variant was questioned. Every vaccine had a different shielding effect on the new variant. The hesitancy of vaccination was a prevalent factor in India that might have contributed to its outbreak. The prevalence of omicron, monkeypox, and tomato flu shared some similarities and distinct features when compared to their influence on the Indian population. This review emphasizes the changes omicron brings with it and how the Indian health care system outrage this dangerous variant.

Effects of titanium prepared platelet rich fibrin on facial nerve regeneration: an experimental study / Efeitos da fibrina rica em plaquetas preparada com titânio na regeneração do nervo facial: um estudo experimental

Abstract Introduction: Facial nerve damage is a condition that causes functional, psychological, and cosmetic problems; and treatment methods need to be improved. Objective: We investigated the efficacy of titanium-prepared platelet-rich fibrin as a healing enhancer at the region of transection of the facial nerve. Methods: Twenty-seven New Zealand male rabbits were used in this study, divided into three experimental groups. Group 1, the sham group (n=7); Group 2, the suture group (n = 10); and Group 3, the suture + T-PRF group (n = 10). In Group 1, the facial nerve trunk was dissected, and no additional surgical intervention was performed. For Group 2, a transection was made to the facial nerve trunk and the nerve endings were sutured together. In Group 3, nerve endings were sutured after transection, and a titanium-prepared platelet-rich fibrin membrane was wrapped in a tube around the damaged area. All animals were followed up weekly for the presence of corneal reflex, whisker movement and low ears. Bilateral facial electromyography was performed both preoperatively and postoperatively at the 1st, 3rd, 5th, 7th, 10th weeks. Tissue samples obtained at the 10th week were histopathologically examined, and intra-group and inter-group comparisons were performed. Results: Subjects in Group showed improvement in whisker movement and ear drop one week earlier than Group 2. In Group 3, the nerve stimulation threshold required to trigger the compound muscle action potential had returned to values similar to the preoperative control values (11.31 ±2.16V) by 5 weeks postoperatively (12.51 ±3.97V), (p = 0.249). Conclusion: Titanium-prepared platelet-rich fibrin administration contributed to partial nerve healing both on a functional and an electrophysiological level.

Resumo Introdução: A lesão do nervo facial é uma condição que causa problemas funcionais, psicológicos e cosméticos e os métodos de tratamento precisam ser melhorados. Objetivo: Investigamos a eficácia da fibrina rica em plaquetas preparada com titânio como um intensificador de cura na transecção do nervo facial. Método: Vinte e sete coelhos machos da raça New Zealand foram usados neste estudo, divididos em três grupos experimentais. Grupo 1, o grupo simulado (n = 7); Grupo 2, o grupo de sutura (n = 10); e Grupo 3, o grupo sutura + fibrina rica em plaquetas preparada com titânio (n = 10). No Grupo 1, o tronco do nervo facial foi dissecado e nenhuma intervenção cirúrgica adicional foi feita. No Grupo 2, uma secção transversal foi feita no tronco do nervo facial e as terminações nervosas foram suturadas. No Grupo 3, as terminações nervosas foram suturadas após a transecção e uma membrana de fibrina rica em plaquetas preparada com titânio foi envolvida em um tubo ao redor da área danificada. Todos os animais foram acompanhados semanalmente quanto à presença do reflexo corneal, movimento dos bigodes e orelhas baixas. A eletromiografia facial bilateral foi feita no pré e pós-operatório na 1ª, 3ª, 5ª, 7ª e 10ª semanas. Amostras de tecido obtidas na 10- semana foram examinadas histopatologicamente e comparações intra- e intergrupos foram feitas. Resultados: Os animais do Grupo 1 apresentaram melhoria no movimento dos bigodes e orelhas baixas uma semana antes do Grupo 2. No Grupo 3, o limiar de estimulação do nervo necessário para acionar o potencial de ação muscular composta retornou a valores semelhantes aos valores de controle pré-operatório (11,31 ± 2,16 volts) em 5 semanas de pós-operatório (12,51 ± 3,97 volts), (p = 0,249). Conclusão: A administração de fibrina rica em plaquetas preparada com titânio contribuiu para a cicatrização parcial do nervo ao nível funcional e eletrofisiológico.

Mechanistic Insights into the Oxygen Atom Transfer Reactions by Nonheme Manganese Complex: A Computational Case Study on the Comparative Oxidative Ability of Manganese-Hydroperoxo vs High-Valent MnIV═O and MnIV-OH Intermediates.

Understanding the comparative oxidative abilities of high-valent metal-oxo/hydroxo/hydroperoxo species holds the key to robust biomimic catalysts that perform desired organic transformations with very high selectivity and efficiency. The comparative oxidative abilities of popular high-valent iron-oxo and manganese-oxo species are often counterintuitive, for example, oxygen atom transfer (OAT) reaction by [(Me2EBC)MnIV-OOH]3+, [(Me2EBC)MnIV-OH]3+, and [(Me2EBC)MnIV═O]2+ (Me2EBC = 4,11-dimethyl-1,4,8,11-tetraazabicyclo[6.6.2]hexadecane) shows extremely high reactivity for MnIV-OOH species and no reactivity for MnIV-OH and MnIV═O species toward alkyl/aromatic sulfides. Using a combination of density functional theory (DFT) and ab initio domain-based local pair natural orbital coupled-cluster with single, double, and perturbative triples excitation (DLPNO-CCSD(T)) and complete-active space self-consistent field/N-electron valence perturbation theory second order (CASSCF/NEVPT2) calculations, here, we have explored the electronic structures and sulfoxidation mechanism of these species. Our calculations unveil that MnIV-OOH reacts through distal oxygen atom with the substrate via electron transfer (ET) mechanism with a very small kinetic barrier (16.5 kJ/mol), placing this species at the top among the best-known catalysts for such transformations. The MnIV-OH and MnIV═O species have a much larger barrier. The mechanism has also been found to switch from ET in the former to concerted in the latter, rendering both unreactive under the tested experimental conditions. Intrinsic differences in the electronic structures, such as the presence and absence of the multiconfigurational character coupled with the steric effects, are responsible for such variations observed. This comparative oxidative ability that runs contrary to the popular iron-oxo/hydroperoxo reactivity will have larger mechanistic implications in understanding the reactivity of biomimic catalysts and the underlying mechanisms in PSII.

The effect of Hippophae rhamnoides L. extract on acrylamideinduced brain injury in rats

ABSTRACT Purpose: Reactive oxygen species (ROS), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) have been shown in the pathogenesis of acrylamide neurotoxicity. Hippophae rhamnoides L. extract (HRE) has a cytoprotective effect by stabilizing the production of ROS, IL-1β and TNF-α. The objective of the article was to investigate the effect of HRE on acrylamide-induced brain damage in rats biochemically and histopathologically. Methods: To the HRE+acrylamide only (ACR) group (n=6) of the animals, HRE was administered orally at a dose of 50 mg / kg into the stomach by gavage. The same volume of solvent (olive oil) was administered orally to the ACR (n=6) and healthy (HG) (n=6) groups. One hour after HRE administration, acrylamide was given orally at a dose of 20 mg/kg to HRE+ACR and ACR groups in the same way. This procedure was repeated once a day for 30 days. At the end of this period, brain tissues extracted from animals killed with 50 mg/kg thiopental anesthesia were examined biochemically and histopathologically. Results: It has been shown that HRE prevents the increase of malondialdehyde (MDA), myeloperoxidase (MPO), IL-1β and TNF-α with acrylamide and the decrease of total glutathione (tGSH) and glutathione reductase (GSHRd) levels in brain tissue. Conclusions: HRE may be useful in the treatment of acrylamide-induced neurotoxicity.

Treatment of Status Epilepticus: What Are the Guidelines and Are We Following Them?

OBJECTIVES: Status epilepticus (SE) is associated with high morbidity and mortality. The American Epilepsy Society (AES) has established guidelines regarding proper dosing of antiepileptic drugs (AEDs). There are also recommendations for appropriate weaning off anesthetic agents in SE. Our aim was to determine the frequency with which guidelines were being followed during routine clinical care. METHODS: A retrospective chart review was completed for patients with a diagnosis of SE within the last 10 years. All patients with SE on anesthetic agents were included when analyzing AED dosing. Patients with anoxic brain injury were excluded when reviewing anesthetic wean times. RESULTS: Seventy-six patients were identified on anesthetic agents. Five patients had anoxic brain injury and were excluded from the anesthetic weaning analysis. Medications were under dosed as follows: lorazepam 0.05 mg/kg (N=51), midazolam 0.07 mg/kg (N=14), fosphenytoin 17.9 mg/kg (N=47), levetiracetam 21.7 mg/kg (N=42), valproate sodium 16.7 mg/kg (N=12), phenobarbital 4.1 mg/kg (N=4), lacosamide 215 mg (N=13), and topiramate 333 mg (N=3). Anesthetic agents were weaned as follows: <24 hours 32/71 (45%), 24 to 48 hours 11/71 (15%), 48 to 72 hours 12/71 (17%), and >72 hours 11/71 (15%). Seizure recurrence rates were: 8/32 (25%) <24 hours, 2/11 (18%) 24 to 48 hours, 1/12 (8.3%) 48 to 72 hours, and 1/11 (9%) at >72 hours. CONCLUSIONS: This retrospective review demonstrates how guidelines and recommendations for SE are not consistently followed. Under dosing of AEDs and aggressive weaning of anesthetic agents may result in higher morbidity and mortality.

Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis

Abstract Background: Demodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role. Objective: To investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis. Methods: This prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups. Results: In terms of gender and age, no significant difference was found between the patients and controls (p > 0.05). Demodex infestation rates were significantly higher in patients than in controls (p = 0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p = 0.001; p = 0.024; p = 0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p = 0.001 and p = 0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p = 0.294). Study limitations: Small sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation. Conclusion: The findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.

Ultrawide Color Gamut Perovskite and CdSe/ZnS Quantum-Dots-Based White Light-Emitting Diode with High Luminous Efficiency.

We demonstrate excellent color quality of liquid-type white light-emitting diodes (WLEDs) using a combination of green light-emitting CsPbBr3 and red light-emitting CdSe/ZnS quantum dots (QDs). Previously, we reported red (CsPbBr1.2I1.8) and green (CsPbBr3) perovskite QDs (PQDs)-based WLEDs with high color gamut, which manifested fast anion exchange and stability issues. Herein, the replacement of red PQDs with CdSe/ZnS QDs has resolved the aforementioned problems effectively and improved both stability and efficiency. Further, the proposed liquid-type device possesses outstanding color gamut performance (132% of National Television System Committee and 99% of Rec. 2020). It also shows a high efficiency of 66 lm/W and an excellent long-term operation stability for over 1000 h.

Liquid Type Nontoxic Photoluminescent Nanomaterials for High Color Quality White-Light-Emitting Diode.

High-brightness white-light-emitting diodes (w-LEDs) with excellent color quality is demonstrated by using nontoxic nanomaterials. Previously, we have reported the high color quality w-LEDs with heavy-metal phosphor and quantum dots (QDs), which may cause environmental hazards. In the present work, liquid-type white LEDs composed of nontoxic materials, named as graphene and porous silicon quantum dots are fabricated with a high color rendering index (CRI) value gain up to 95. The liquid-typed device structure possesses minimized surface temperature and 25% higher value of luminous efficiency as compare to dispensing-typed structure. Further, the as-prepared device is environment friendly and attributed to low toxicity. The low toxicity and high R9 (87) component values were conjectured to produce new or improve current methods toward bioimaging application.

Impact of overactive bladder on retrograde ejaculation

ABSTRACT Purpose: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation. Materials and Methods: Retrospective analysis of prospective collected database made. Questionnaires conducted in urology polyclinics in five different centers. Main Outcome Measure(s): International Index of Erectile Function - 5 (IIEF - 5), Overactive Bladder 8 - Question Awareness Tool (OAB - V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic. Results: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post - ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non - symptomatic patients. Consequently, following three - month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05). Conclusion: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients.

Vitamin D levels in actinic keratosis: a preliminary study

Abstract: Background: Recent studies that investigated the effect of vitamin D on skin cancer risk have exhibited inconsistent results. Objective: The aim of the study was to evaluate vitamin D status in patients with actinic keratosis. Methods: A cross-sectional study was conducted on 31 patients with actinic keratosis and 29 healthy controls. Serum vitamin D levels in the study group were determined by liquid chromatography/tandem mass spectrometry. Results: Serum 25(OH)D levels in patients with actinic keratosis were significantly higher than those of the healthy controls (P=0.04). Prevalence of 25(OH)D deficiency was significantly higher in the healthy controls (75.9%) compared to the patients with actinic keratosis (54.8%), but the difference was not statistically significant (P= 0.09). Study limitations: The cross-sectional design of the study, data on smoking based on patient self-report, and subjects' different dietary habits, which can influence 25(OH)D levels, are the study's limitations. Conclusion: Serum vitamin D level can be used as a marker for ultraviolet B radiation from sun exposure; therefore, it can be used in individuals at risk of actinic keratosis. Oral intake of vitamin D through diet or supplements is proposed instead of prolonged ultraviolet exposure to maintain adequate vitamin D serum levels. Further research is needed to elucidate the role of vitamin D in skin carcinogenesis.

Long-term Outcomes of Subtotal Septal Reconstruction in Rhinoplasty.

IMPORTANCE: Significant nasal septal deviation may require complex reconstruction to achieve complete correction. Subtotal septal reconstruction is a method for addressing deviations in the L-strut. OBJECTIVES: To review the long-term outcomes of subtotal septal reconstruction and provide objective evidence of functional and aesthetic improvement. DESIGN, SETTING, AND PARTICIPANTS: This medical record review obtained data on 144 patients who underwent subtotal septal reconstruction from September 1, 2008, to September 1, 2013. Data analysis was performed from September 1, 2013, to September 1, 2014. MAIN OUTCOMES AND MEASURES: Functional outcomes were measured using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and objective aesthetic outcomes were measured using 3-dimensional (3-D) stereophotogrammetry. Follow-up times were classified as time point 1 (TP1; preoperative), time point 2 (TP2; early postoperative), and time point 3 (TP3; final postoperative). RESULTS: Of the 144 patients who underwent subtotal septal reconstruction, 104 (72.2%) were female; the mean (SD) age was 37.3 (13.7) years; 57 underwent primary septorhinoplasty; and 87 (60.5%) underwent revision septorhinoplasty. The NOSE scores improved in all 5 categories of nasal obstruction, with mean (SD) survey completion at 270 (260.1) days. Aesthetic results were measured with 3-D imaging after a mean (SD) follow-up of 613.5 (434.4) days postoperatively. No statistically significant loss was found in mean (SD) nasal length over time (TP2 to TP 3, -0.16 [1.36] mm; 95% CI, -0.54 to 0.22 mm; P = .41) or between mean (SD) postoperative loss of projection (TP2 and TP3, -0.19 [0.92] mm, 95% CI, -0.45 to 0.07 mm; P = .17). An increase in mean (SD) rotation (nasolabial angle) generated with septorhinoplasty (4.24° [11.08°]; 95% CI, 1.14°-7.34°; P = .01) and a mean (SD) decrease in rotation detected during postoperative healing (-2.63° [6.96°]; 95% CI, -4.63° to -0.63°; P = .01) were found. Although measurement of symmetry was improved in the early postoperative period (TP1 to TP2, -0.16 [1.26] mm; 95% CI, -0.52 to 0.20 mm; P = .40), this finding did not become statistically significant until the final measurement (TP1 to TP3, -0.43 [1.07] mm; 95% CI, -0.73 to -0.13 mm; P = .007; TP2 to TP3, -0.28 [0.87] mm; 95% CI, -0.53 to -0.03 mm; P = .03). A mean (SD) decrease in columellar show was achieved with surgery (-0.66 [1.37] mm; 95% CI, -1.05 to -0.27 mm; P = .001). No statistically significant change was found in the alar-columellar association from TP2 to TP3 in this patient population, confirming no unwanted alar or columellar retraction over time (0.10 [0.61] mm; 95% CI, -0.07 to 0.27 mm; P = .25). A total of 114 patients (79.2%) required costal cartilage harvest for adequate reconstruction. CONCLUSIONS AND RELEVANCE: Subtotal septal reconstruction yields improved functional and aesthetic outcomes and has the potential to be a useful tool for the rhinoplasty surgeon in the treatment of severe septal deviation. LEVEL OF EVIDENCE: 4.

Dynamic thiol/disulfide homeostasis in patients with age-related macular degeneration / Homeostase dinâmica de tiol/dissulfureto em pacientes com degeneração macular relacionada à idade

ABSTRACT Purpose: We evaluated dynamic thiol/disulfide homeostasis (TDH), malondialdehyde (MDA) levels, and catalase (CAT) activity in patients with age-related macular degeneration (AMD). All analyzes were conducted on plasma samples. Methods: Thirty-two patients with AMD and 38 age-matched healthy controls were included. Native thiol, total thiol, and disulfide levels and TDH status were determined using a novel, automated assay. MDA levels and CAT activity were determined. Percentages were compared using the chi-squared test. The Student's t-test and Mann-Whitney U-test were used to compare quantitative variables. Results: Native thiol levels were significantly lower (p=0.004) in patients with AMD (272.02 ± 52.41 µmol/l) than in healthy individuals (307.82 ± 47.18 µmol/l), whereas disulfide levels were significantly higher (p<0.001) in patients with AMD than in controls (21.64 ± 5.59 vs. 14.48 ± 5.37 µmol/L). Dynamic TDH was also significantly lower (p<0.001) in patients with AMD than in controls (13.41 ± 4.3 vs. 25.41 ± 14.52 µmol/l). No significant differences were evident in total thiol or MDA levels. Mean CAT activity was significantly higher (p=0.043) in patients with AMD compared with controls (0.035 vs. 0.018 k/ml). Conclusions: The antioxidant/oxidant balance demonstrated by dynamic TDH is shifted to the oxidative side in patients with AMD.

RESUMO Objetivo: Avaliar a homeostase dinâmica de tiol/dissulfureto e os níveis de malon dialdeído (MDA) e catalase (CAT) em pacientes com degeneração macular relacionada à idade (DMRI). Todas as análises foram realizadas em amostras de plasma. Métodos: Foram incluídos 32 pacientes com degeneração macular relacionada à idade e 38 controles saudáveis de idade similar. Os níveis de tiol, tiol total, dissulfureto e estado de homeostase de tiol/dissulfureto foram determinados utilizando um novo ensaio automatizado. Os níveis de atividade de MDA e CAT foram também determinados. As porcentagens foram comparadas pelo teste do qui-quadrado. O teste t de Student e o teste U de Mann Whitney foram utilizados para comparar variáveis quantitativas. Resultados: Os níveis de tiol nativo foram significativamente menores (p=0,004) nos pacientes com degeneração macular relacionada à idade (272,02 ± 52,41 µmol/l) do que nos indivíduos saudáveis (307,82 ± 47,18 µmol/l), enquan to os dissulfetos foram significativamente maiores em pacientes com degeneração macular relacionada à idade (21,64 ± 5,59 µmol/l versus 14,48 ± 5,37 µmol/l, respectivamente, p<0,001). A homeostase dinâmica de tiol/dissulfureto também foi significativamente menor nos pacientes com degeneração macular re la cionada à idade (13,41 ± 4,3 µmol/l) versus os controles (versus 25,41 ± 14,52 µmol/l, p<0,001). Não foram observadas diferenças significativas nos níveis de tiol total ou MDA. A atividade média de CAT foi significativamente mais elevada (p=0,043) em doentes com degeneração macular relacionada à idade (0,035 k/ml vs. 0,018 k/ml). Conclusões: O equilíbrio antioxidante/oxidante demonstrado pela homeostase dinâmica de tiol/dissulfeto é deslocado para o lado oxidativo em pacientes com de generação macular relacionada à idade.

Evaluation of morphological changes in pharynx with dynamic CT and MRI in snoring patients / Anomalías morfológicas de la faringe en roncadores

Background: Identifying the craniofacial abnormalities that cause snoring and the narrowest area of the upper airway creating obstructions can help to determine the proper method of treatment. Aim: To identify the factors that can cause snoring and the areas of the airway that are the most likely to collapse with upper airway imaging. Material and Methods: Axial pharynx examinations with CT (computerized tomography) and magnetic resonance imaging (MRI) were performed to 38 patients complaining of snoring and 12 patients who did not complain of snoring. The narrowest areas of nasopharynx, hypophraynx, oropharynx, bilateral para-pharyngeal fat pad and para-pharyngeal muscle thickness were measured. Results: In snoring patients, the narrowest part of the upper airway was the retro-palatal region in the oropharynx, as measured with both imaging methods. When patients with and without snoring were compared, the former that a higher body mass index and neck diameter and a narrower oropharynx area. In dynamic examinations, we determined that as para-pharyngeal muscle thickness increased, medial-lateral airway diameter and the oropharynx area decreased. Conclusions: The narrowest section of the airway is the retro-palatal region of the oropharynx, measured both with CT and MRI.

Antecedentes: La identificación de las anomalías craneofaciales que causan el ronquido es importante para decidir la terapia adecuada. Objetivo: Identificar los factores que causan el ronquido y las zonas de la vía aérea superior que son más susceptibles de colapsar, usando imágenes. Material y Métodos: Se efectuaron exámenes axiales de la faringe con tomografía computada (TC) y resonancia magnética (RM) en 38 pacientes que roncaban y 12 que no lo hacían. Se determinaron las zonas más estrechas de la nasofaringe, hipofaringe, orofaringe y el grosor del tejido adiposo y musculatura parafaríngeos. Resultados: En los pacientes que roncaban la zona más estrecha de la vía aérea superior fue la zona retro-palatal en la orofaringe. Los pacientes roncadores tenían un índice de masa corporal y diámetro cuello mayores y un área orofaríngea menor. En los exámenes dinámicos observamos que a medida que el grosor de los músculos parafaríngeos aumentó, disminuyó el área medial y lateral de la vía aérea y el área de la orofaringe. Conclusiones: La zona más estrecha de la vía aérea superior es la región retropalatal de la orofaringe, medida tanto con TC como con RM.