Endoscopic transnasal orbital decompression for Graves.

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.

Geospatial cluster analyses of pneumonia-associated hospitalisations among adults in New York City, 2010-2014.

Pneumonia is a leading cause of death in New York City (NYC). We identified spatial clusters of pneumonia-associated hospitalisation for persons residing in NYC, aged ⩾18 years during 2010-2014. We detected pneumonia-associated hospitalisations using an all-payer inpatient dataset. Using geostatistical semivariogram modelling, local Moran's I cluster analyses and χ2 tests, we characterised differences between 'hot spots' and 'cold spots' for pneumonia-associated hospitalisations. During 2010-2014, there were 141 730 pneumonia-associated hospitalisations across 188 NYC neighbourhoods, of which 43.5% (N = 61 712) were sub-classified as severe. Hot spots of pneumonia-associated hospitalisation spanned 26 neighbourhoods in the Bronx, Manhattan and Staten Island, whereas cold spots were found in lower Manhattan and northeastern Queens. We identified hot spots of severe pneumonia-associated hospitalisation in the northern Bronx and the northern tip of Staten Island. For severe pneumonia-associated hospitalisations, hot-spot patients were of lower mean age and a greater proportion identified as non-Hispanic Black compared with cold spot patients; additionally, hot-spot patients had a longer hospital stay and a greater proportion experienced in-hospital death compared with cold-spot patients. Pneumonia prevention efforts within NYC should consider examining the reasons for higher rates in hot-spot neighbourhoods, and focus interventions towards the Bronx, northern Manhattan and Staten Island.

Monoclonal antibodies for the treatment of chronic rhinosinusitis with nasal polyposis: a systematic review.

BACKGROUND: Monoclonal 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.