The importance of monitoring wet age-related macular degeneration patients during Coronavirus disease 19 pandemic: A retrospective study of assessment of functional and structural outcomes.

OBJECTIVES: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the gold standard treatment for wet age-related macular degeneration (wet AMD). Coronavirus disease 2019 (COVID-19) has led to the cancellation of many scheduled intravitreal anti-VEGF injection visits. We compared the functional and structural visual outcomes of wet AMD patients who did not adhere to their planned intervals (group 1) with those who did (group 2). METHODS: Wet AMD patients of Swiss Visio Montchoisi and RétinElysée were included. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) changes between their first visit after the end of the first national lockdown in Switzerland (27 April 2020, first post-lockdown visit) and their last visit before the beginning of the first national lockdown in Switzerland (13 March 2020, last pre-lockdown visit) were assessed. The BCVA outcome was defined as unfavorable when there was a loss of≥5 ETDRS letters in the first post-lockdown visit compared to the BCVA at last pre-lockdown visit. The OCT outcome was defined as unfavorable when there was an increase in at least one of the parameters, intraretinal fluid (IRF), subretinal fluid (SRF), or pigment epithelial detachment (PED), at the first post-lockdown visit compared to the last pre-lockdown visit. MAIN RESULTS: Group 1 (89 patients, 109 eyes) had a 13.41% greater rate of unfavorable BCVA outcomes and a 38.27% greater rate of unfavorable OCT outcomes than group 2 (96 patients, 122 eyes) (P=0.04, P<0.0001, respectively). Multivariate analysis showed that the more the patients deviated from their programmed injections and the higher the BCVA pre-lockdown, the higher the rate of unfavorable BCVA outcomes (P=0.03 and P=0.02, respectively). OCT outcomes were not a predictive factor for an unfavorable BCVA outcome. CONCLUSIONS: The cancellation of many intravitreal anti-VEGF injection appointments resulted in worse functional and structural outcomes in wet AMD patients. The COVID-19 pandemic led many patients to refrain from their routine intravitreal anti-VEGF injection appointments, allowing us to analyze the role of designated intervals in the treatment of wet AMD. During any future lockdown due to COVID-19 or similar circumstances, continuity of care for wet AMD patients should be maintained.

Pollution assessment of potentially toxic elements in soils of different taxonomy orders in central Greece.

Four hundred fifty soil samples of the orders of Alfisols, Inceptisols, Endisols, and Vertisols from Karditsa, Trikala, and Larissa (Central Greece) were collected over a three-year period. In these samples we analyzed potentially toxic elements (PTEs) and soil properties known to affect their mobility. High regression coefficients were observed between soil pH and PTE concentrations in Alfisols, reflecting that soil pH is the dominant characteristic influencing PTEs. In Inceptisols, there was a significant interaction among the studied PTEs, probably due to PTEs having the same origin. The Endisol samples had high sand content and electrical conductivity values, resulting in high availability of all studied PTEs. In Vertisols, clay content proved to be the most important parameter influencing PTE levels. Factor analysis was also used in order to clarify the possible sources of metals in the studied areas.

Perilymphatic fistula of the round window after whiplash injury: another cause of inner ear conductive hearing loss.

Perilymphatic fistula is usually associated with sudden or fluctuating sensorineural hearing loss. We present a case of whiplash injury in a patient who showed conductive hearing loss at low frequencies due to a perilymphatic fistula occurring in the round window. Although no middle ear pathology was found, the symptoms and laboratory findings were mimicking the so called "third mobile window" phenomenon, but without the presence of inner ear dehiscence. Following early surgical exploration with patching of the round window the hearing was restored and the patient was free of symptoms.

Pre-treatment gelatinases' serum levels and post-treatment changes in laryngeal cancer patients.

INTRODUCTION: Laryngeal cancer, especially in the advanced stages, is a highly devastating disease, characterized by increased invasiveness and high rates of metastasis. Gelatinases A and B (MMP-2 and -9 respectively) are of particular interest due to their contribution to various stages of carcinogenesis. There is a growing body of evidence with regard to the prognostic value of certain MMPs and their possible role as tumour markers. AIM: To identify the pattern of alteration of serum gelatinases A and B in patients with laryngeal cancer following treatment, and a possible correlation with various clinicopathological parameters. MATERIALS AND METHODS: Forty nine patients were included in this study. Pre-treatment and post-treatment serum samples were collected and processed by gelatin zymography and western blotting. RESULTS: Only the latent forms of MMP-2 and -9 were identified. Both gelatinases were increased in the serum of laryngeal cancer patients compared to healthy individuals. Patients with supraglottic tumours and active smokers had significantly higher pre-treatment levels of proMMP-2 than patients with glottic tumours (p < 0.05) and ex-smokers (p < 0.05), respectively. Patients with primary disease and patients with lymph node involvement showed lower serum proMMP-9 pre-treatment levels than patients with recurrence (p < 0.05) and patients without neck disease (p < 0.1), respectively. During the follow-up period the proMMP-2 serum levels increased significantly in the first ten to fifteen days after treatment, gradually decreasing over the following months. The proMMP-9 serum levels showed a gradual decrease after treatment, which was statistically significant (p<0.05). CONCLUSIONS: The post-treatment alteration pattern of proMMP-9 serum levels shows a possible role of this molecule as a tumour marker in laryngeal cancer. Further research is necessary to clarify the contribution of both gelatinases to the disease progress and determine their role as prognostic factors and tumour markers.

Laryngeal cancer: epidemiological data from Νorthern Greece and review of the literature.

BACKGROUND: Cancer of the larynx accounts for 1% to 2.5% of all human neoplasms and is the most common malignancy of the Head and Neck region. The purpose of this study is to analyze epidemiological data of patients with laryngeal cancer and to point out the geographical variations. METHODS: This is the first systematic recording of the laryngeal cancer epidemiological data in Northern Greece. During the period 1992-2010 1,638 patients were diagnosed with and treated for malignant head and neck tumors. One thousand one hundred and four cases (67.4%) were malignant laryngeal tumors, 98.4% of which (1,088 cases) were squamous cell carcinomas (SCC). Only 16 patients (1.5%) presented with other types of malignancies. RESULTS: The average age of the SCC patients was 62.1 years. Only 35 patients were women (3.2%). More than 60% of the patients were farmers or labor workers, 86.9%, were smokers, 43.2% were consuming alcohol on a daily basis and 36.1% had a positive family history of malignancy. Concerning tumor location, 60.2% were glottic cancers. T staging revealed that 1.2% of the cases were carcinomas in situ, 28% T1 tumors, 19% T2, 32 % T3, and 20% T4. Tumor grading showed that 43% of the cases were G1, 42.1% were G2, and 11.8% were G3. CONCLUSIONS: The pathogenesis of laryngeal carcinoma is the result of the combined action of endogenous and environmental factors. The recording and analysis of the epidemiology of the disease is important for its better study and understanding.

Spontaneous haematoma of the pharynx due to a rare drug interaction.

Spontaneous haemorrhage is a well known complication of oral anticoagulation therapy. Various sites of bleeding have been reported in the literature, most commonly being the gastrointestinal tract, genitourinary system and central nervous system. Spontaneous haematoma is rarely reported to involve the upper aerodigestive tract, being potentially a life threatening condition. We report a case of a 67 year-old female patient who developed spontaneous hematoma of the upper aerodigestive tract as a consequence of a rare interaction between acenocoumarol and clindamycin. Reversal of anticoagulation, careful observation, and when necessary prompt intervention to secure the airway are the main aspects of management. We highlight the need for a thorough evaluation of patients who develop new painful or other symptoms while being on anticoagulation therapy. Clinicians should be highly alerted as these could potentially be manifestations of haemorrhagic complications.

Palatine tonsillar metastasis from lung adenocarcinoma.

Tonsillar metastasis from lung cancer is an extremely rare event and is usually related to metastatic spread of the neoplastic disease to other organs with poor prognosis. We present the unusual case of a 71-year-old man who developed a huge metastasis to the left palatine tonsil from a lung adenocarcinoma. The tumor was exophytic with necrotic and hemorrhagic areas, occupying a large portion of the oropharynx and producing airway obstruction, thus necessitating tracheostomy. Radiation therapy was delivered in an attempt to reduce the size of the tumor. Although a mild decrease of the tonsillar mass was noted, the designed therapy had to be discontinued because of a rapid deterioration of the patient's general condition. The patient finally died of disseminated disease. This case highlights the need for a thorough evaluation of a suspicious tonsillar enlargement, as this may be a sign of a primary malignancy elsewhere in the body.

Amino-acid synthesis in adult Dacus oleae (Gmelin) (Diptera Tephritidae) determined with [U-14C] glucose.

The ability of adult Dacus oleae for amino-acid synthesis from [U-14C] glucose was investigated. The relatively high specific activity radiometric measurements indicated that both sexes were able to synthesize the amino acids: alanine, aspartic acid, cystine, glutamic acid, glycine, hydroxyproline, proline and tyrosine; therefore, these amino acids are considered as nutritionally dispensable for D. oleae. On the other hand, the amino acids: arginine, histidine, leucine, isoleucine, lysine, methionine, phenylalanine, serine, threonine, and valine, showed a very low specific activity and therefore are considered as nutritionally indispensable. It was not possible to conclude about tryptophane, since the acid hydrolysis destroyed this amino acid.

The importance of dietary amino acids on the reproduction and longevity of adult Dacus oleae (Gmelin) (Diptera Tephritidae).

When the amino-acid mixture of an effective chemically defined diet was replaced by single amino acids, keeping the total nitrogen at the same level, the egg production of Dacus oleae was minimal with all the 19 amino acids tested. Male survival was adversely affected by the amino acids : alanine, aspartic acid, glutamic acid, glycine, hydroxyproline, lysine, serine and tyrosine, while female survival was shortened when the amino acids : glycine, hydroxyproline and lysine were added. The creation of amino-acid imbalances, by deleting the 19 amino acids individually, from the complete amino-acid mixture, showed that the amino acids : arginine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, serine, threonine, tryptophane and valine were indispensable to the adult Dacus oleae flies, as far as egg production is concerned. Survival of the male flies was significantly shortened when the amino acids : alanine, hydroxyproline and tryptophane were omitted. Significant differences in longevity between males and females were scored, when the amino acids : alanine, aspartic acid, cystine, glycine and tryptophane, were omitted.

Effects of varying the dietary nitrogen to carbohydrate ratio upon the biological performance of adult Dacus oleae. (Diptera Tephritidae).

By varying the dietary proportions of nitrogen to carbohydrate in a chemically defined diet, it was found that the olive fruit adult fly cannot utilize amino nitrogen as an energy source, while the most critical ingredient for prolonged survival was the carbohydrate part of the diet. Increase of the nitrogen contents above 2.6%, up to 6.4%, shortened adult life span by 50%. The best reproduction rate was scored under a N/C ratio of 1.6/40, while higher nitrogen contents reduced egg deposition. Fertility was adversely affected by low sucrose concentrations as well as by total absence of amino nitrogen, while higher nitrogen concentrations proved also detrimental egg hatchability.