Bilateral same-day myringoplasty: a feasible option?

PURPOSE: Retrospective evaluation of bilateral same-day myringoplasty outcomes. METHODS: Patients who underwent bilateral same-day myringoplasty from 2005 to 2019. RESULTS: Thirty-eight patients underwent bilateral myringoplasty. Mean age was 44.5 years and 55.3% patients were male. Tragal perichondrium-cartilage composite graft was the most frequently used graft material (82.9%). Perforation closure was achieved in 78.9%. Postoperative Pure Tone Average and Air-Bone Gap decreased significantly (p < 0.05), except for the Air-Bone Gap of the right ear (p = 0.058). The complications were cholesteatoma (1.3%), otorrhea (6.6%) and tympanic membrane retraction (1.3%). CONCLUSIONS: Bilateral same-day myringoplasty is a feasible procedure in selected patients. Good anatomic and functional outcomes, as well as a low rate of complications, are achieved with this procedure, improving patient comfort and allowing for a reduction in operation time and costs.

Serum soluble mediators as prognostic biomarkers for morbidity, disease outcome, and late-relapsing hepatitis in yellow fever patients.

This study described a soluble mediator storm in acute Yellow Fever/YF infection along the kinetics timeline towards convalescent disease. The analyses of the YF Viral RNAnemia, chemokines, cytokines, and growth factors were performed in YF patients at acute/(D1-15) and convalescent/(D16-315) phases. Patients with acute YF infection displayed a trimodal viremia profile spreading along D3, D6, and D8-14. A massive storm of mediators was observed in acute YF. Higher levels of mediators were observed in YF with higher morbidity scores, patients under intensive care, and those progressing to death than in YF patients who progress to late-relapsing hepatitis/L-Hep. A unimodal peak of biomarkers around D4-6 with a progressive decrease towards D181-315 was observed in non-L-Hep patients, while a bimodal pattern with a second peak around D61-90 was associated with L-Hep. This study provided a comprehensive landscape of evidence that distinct immune responses drive pathogenesis, disease progression, and L-Hep in YF patients.

Halogenated Flavones and Isoflavones: A State-of-Art on their Synthesis.

BACKGROUND: Flavonoid is a family of compounds present in the everyday consumption plants and fruits, contributing to a balanced diet and beneficial health effects. Being a scaffold for new drugs and presenting a wide range of applicability in the treatment of illnesses give them also an impact in medicine. Among the several types of flavonoids, flavone and isoflavone derivatives can be highlighted due to their prevalence in nature and biological activities already established. The standard synthetic route to obtain both halogenated flavones and isoflavones is through the use of already halogenated starting materials. Halogenation of the flavone and isoflavone core is less common because it is more complicated and involves some selectivity issues. OBJECTIVE: Considering the importance of these flavonoids, we aim to present the main and more recent synthetic approaches towards their halogenation. METHODS: The most prominent methodologies for the synthesis of halogenated flavones and isoflavones were reviewed. A careful survey of the reported data, using mainly the Scopus database and halogenation, flavones and isoflavones as keywords, was conducted. RESULTS: Herein, a review is provided on the latest and more efficient halogenation protocols of flavones and isoflavones. Selective halogenation and the greener methodologies, including enzymatic and microbial halogenations, were reported. Nevertheless, some interesting protocols that allowed the synthesis of halogenated flavone and isoflavone derivatives in specific positions using halogenated reagents are also summarized. CONCLUSION: Halogenated flavones and isoflavones have risen as noticeable structures; however, most of the time, the synthetic procedures involve toxic reagents and harsh reaction conditions. Therefore, the development of new synthetic routes with low environmental impact is desirable.

Ferrocene and ferrocenium inclusion compounds with cucurbiturils: a study of metal atom dynamics probed by Mössbauer spectroscopy.

Temperature-dependent 57Fe Mössbauer effect (ME) spectroscopic studies were carried out on ferrocene (Fc), 1,1'-dimethylferrocene (1,1'(CH3)2Fc) and ferrocenium hexafluorophosphate (FcPF6) guest species in cucurbit[n]uril (n = 7, 8) inclusion complexes. The solid inclusion complexes were isolated by freeze-drying of dilute aqueous solutions and/or microwave-assisted precipitation from concentrated mixtures. The presence of genuine 1 : 1 (host : guest) inclusion complexes in the isolated solids was supported by liquid-state 1H and solid-state 13C{1H} MAS NMR, elemental and thermogravimetric analyses, powder X-ray diffraction, FTIR spectroscopy, and diffuse reflectance UV-Vis spectroscopy. The ME spectra of the complexes CB7·Fc and CB7·1,1'(CH3)2Fc consist of well-resolved doublets with hyperfine parameters (isomer shift and quadrupole splitting at 90 K) and temperature-dependent recoil-free fraction data that are very similar to those for the neat parent compounds, Fc and 1,1'(CH3)2Fc, suggesting that the organometallic guest molecules do not interact significantly with the host environment over the experimental temperature range. The ME spectra for CB7·FcPF6 and CB8·FcPF6 consist of a major broad line resonance attributed to a paramagnetic FeIII site. From the temperature-dependence of the recoil-free fraction it is evident that the charged guest species in these systems interact with the host environment significantly more strongly than was observed in the case of the neutral guest species, Fc and 1,1'(CH3)2Fc. Moreover, the ME data indicate that the vibrational amplitude of the ferrocenium guest molecule is significantly larger in the CB8 host molecule than in the CB7 homologue, as expected on the basis of the different cavity sizes.

Solid-state study of the structure and host-guest chemistry of cucurbituril-ferrocene inclusion complexes.

Inclusion complexes of ferrocene (Fc) with cucurbit[n]urils (n = 7, 8) have been prepared via a rapid microwave-assisted hydrothermal approach. Solids were isolated and characterised by elemental analysis, powder X-ray diffraction (PXRD), spectroscopic, and thermoanalytical methods. The UV-Vis spectra support the presence of Fc in Fc@CB7 and a mixture of Fc and ferrocenium ions in Fc@CB8. Partial oxidation of Fc to Fc+ takes place in situ mainly due to the presence of acid of crystallisation in CB8. On the basis of PXRD, the complex Fc@CB8 is classified into an isostructural series that is formed by several CB8-containing compounds that crystallise in the space group I41/a and have similar unit cell dimensions and CB8 packing motifs. The FT-IR and Raman spectra of Fc@CB7 are compared with those of the CB7 host and the Fc guest starting materials, revealing significant frequency shifts of some Fc-centered vibrational modes upon complexation. Blueshifts of the Fe-Cp stretching and ring tilt bands are attributed to encapsulation of Fc monomers in a constrained environment, leading to restricted motion effects and/or a change in the Fc conformation from staggered to eclipsed. The absence of comparable shifts for Fc@CB8 point to a weaker host-guest interaction as a consequence of the larger cavity size. The different host-guest interactions are also evident through a comparison of the 13C{1H} CP MAS NMR spectra. Thermogravimetric analysis for the inclusion compounds reveals that sublimation of Fc is inhibited by molecular encapsulation to the extent that oxidative decomposition of the organoiron species takes place concurrently with cucurbituril decomposition, leading to the formation of hematite, α-Fe2O3.

Lingual thyroid: can we 'wait and see'?

A 42-year-old Caucasian woman presented with a sensation of fullness in the throat and dry cough of 1-month duration. Physical examination showed a mass located in the midline of the tongue base. Cervical ultrasound confirmed the absence of thyroid gland tissue in the normal position. MRI of the neck showed a mass suggestive of lingual thyroid and scintigraphy confirmed the diagnosis. Thyroid function was normal. Despite normal thyroid function, to decrease the size of the mass and perhaps solve the problem, we decided to start levothyroxine suppression therapy. The patient had palpitations and one episode of angina pectoris as a side effect, resulting in the medication being interrupted. After 3 years of follow-up, she remains in clinical surveillance and without symptoms.

Silent sinus syndrome: an underdiagnosed entity.

We describe a case of a 33-year-old Caucasian woman with right facial asymmetry and no sinonasal symptoms. She was referred to the ophthalmology department as having right palpebral ptosis. On physical examination, she presented painless enophthalmos and hypoglobus of the right eye. The MRI of the brain only showed sinonasal inflammatory signs of the right maxillary sinus. The CT scan revealed opacification of the right maxillary sinus, with retraction of the sinus walls. We confirmed the diagnosis of silent sinus syndrome. The patient underwent functional endoscopic sinus surgery. One year after surgery, despite clinical and aesthetic improvement, slight enophthalmos remained, but there were no other complications. In our case, the diagnosis of facial asymmetry as ptosis led to an initial imaging investigation to exclude neurological causes. Silent sinus syndrome should be included in the differential diagnosis of facial asymmetry. Despite the clinical suspicion, the diagnosis can only be confirmed by imaging studies.

Pediatric atrophic rhinosinusitis: what can we do?

A 5-year-old female had history of chronic foul smelling nasal discharge. Rhinoscopy showed greenish crusts lining the nasal cavities and inferior turbinates were shriveled significantly. Nasal cavity cultures of crusts by swab revealed Klebsiella ozaenae making the diagnosis of primary atrophic rhinosinusitis. After several unsuccessful treatment, we have decided to try sulfamethoxazole-trimethoprim prophylaxis and 1 year later there was a complete clinical improvement. There are many medical therapies and surgical options described, but none of them showed effective at long term. We present antibiotic prophylaxis as a viable alternative for long term control of the disease.