Nasal nitric oxide measurement in allergic rhinitis and non-allergic rhinitis: a meta-analysis.

The goal of this meta-analysis was to study nasal nitric oxide (nNO) measurements in allergic rhinitis (AR) and non-allergic rhinitis (non-AR). The protocol was registered with PROSPERO (no: CRD4202124828). Electronic databases from PubMed, Google Scholar, Scopus, Web of Science, and Cochrane were all thoroughly searched and studies were chosen based on the qualifying requirements. The quality of the studies was evaluated by Joanna Briggs Institute evaluation tools, and publication bias using funnel plots. The meta-analysis included 18 studies, whereas the systematic review included 20 studies, totaling 3097 participants (1581 AR, 458 non-AR, and 1058 healthy/control). Patients with AR had significantly greater nNO levels than the control group, although this did not change significantly before or after treatment. AR patients had significantly greater nNO levels than non-AR patients, but there was no significant difference between non-AR patients and healthy controls. Nineteen of the studies were of high quality and the remaining one was of moderate quality. nNO measurement has a promising role in the management of AR and non-AR patients, but more investigations are needed to document clinical benefits.

Overall survival and prognostic factors in diabetic patients with invasive fungal rhinosinusitis.

BACKGROUND: Patients with diabetes mellitus (DM) are susceptible to invasive fungal rhinosinusitis (IFRS). The mortality rate of IFRS varies greatly among the patients with DM. OBJECTIVE: To identify the prognostic factors for the overall survival of patients with DM and IFRS. METHODS: A retrospective study was conducted in four tertiary hospitals in Thailand, Malaysia and Myanmar. Patients diagnosed with IFRS and DM from 2008 to 2019 were identified. The outcome was the overall survival. Variables analyzed for risk factors were age, HbA1C level, ketoacidosis, white blood cell count, hyperglycemia, duration of DM, current use of diabetic medications, serum creatinine level, and the extensions of IFRS to the orbit, the cavernous sinus and intracranial cavity. RESULTS: Sixty-five diabetic patients with IFRS (age 57.9 ± 13.4 years, male 60%) were identified. The mortality rate was 21.5%. The extensions of IFRS to the cavernous sinus (hazard ratio 5.1, 95% CI [1.4-18.2], p = 0.01) and intracranial cavity (hazard ratio 3.4, 95% CI [1.1-11.3, p = 0.05) predicted mortality. Current use of diabetic medications decreased the mortality risk (hazard ratio 0.2, 95% CI [0.1-0.9], p = 0.03). The 6-month overall survival of the patients with and without the cavernous sinus extension were 51.4% and 83.6%, (p = 0.001), with and without intracranial extension 53.3% and 88.9%, (p = 0.001), and with and without current diabetic medications 82.3% and 57.5%, respectively (p = 0.045). CONCLUSIONS: The extensions of IFRS to the cavernous sinus and intracranial cavity increased the risk of death in patients with DM. Survival was primarily related to current use of diabetic medications.

Closing the knowledge gap in Malaysian pharmacists: a virtual Allergic Rhinitis Boot Camp initiative.

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.

A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery.

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.