Early surgical intervention for nasal deformity in Binder's syndrome.

OBJECTIVE: To assess benefits of surgical intervention at an early age and focus on surgical techniques using exclusively autologous cartilage grafts. METHODS: Five children aged 8-15 years, treated between March 2016 and 2020, underwent augmentation rhinoplasty using autologous cartilage, with post-operative follow up ranging from 1.5 to 2 years. Photographs and Rhinoplasty Outcome Evaluation questionnaire scores were examined. RESULTS: Augmentation was achieved without complications. No restricted skin or mucosal pockets were encountered. Patients showed improved confidence and perspective with regard to self-image, and were less socially self-conscious. There was significant improvement in all Rhinoplasty Outcome Evaluation questionnaire scores. CONCLUSION: Early surgery allows augmentation with easier release of skin and mucosal pockets, and without the tension otherwise encountered if primary augmentation is performed at a later age. It offers a chance to improve confidence and self-perception in a growing child conscious about their appearance, which may make them socially withdrawn. Autologous cartilage gives better results than bone grafts, and is comparable with silicone but without its complications.

Predictors of premenstrual impairment among women undergoing prospective assessment for premenstrual dysphoric disorder: a cycle-level analysis.

BACKGROUND: Women who experience significant premenstrual symptoms differ in the extent to which these symptoms cause cyclical impairment. This study clarifies the type and number of symptoms that best predict premenstrual impairment in a sample of women undergoing prospective assessment for premenstrual dysphoric disorder (PMDD) in a research setting. Central research goals were to determine (1) which emotional, psychological, and physical symptoms of PMDD are uniquely associated with premenstrual impairment, and (2) how many cyclical symptoms optimally predict the presence of a clinically significant premenstrual elevation of impairment. METHOD: A total of 267 naturally cycling women recruited for retrospective report of premenstrual emotional symptoms completed daily symptom reports using the Daily Record of Severity of Problems (DRSP) and occupational, recreational, and relational impairment for 1-4 menstrual cycles (N = 563 cycles). RESULTS: Multilevel regression revealed that emotional, psychological, and physical symptoms differ in their associations with impairment. The core emotional symptoms of PMDD were predictors of impairment, but not after accounting for secondary psychological symptoms, which were the most robust predictors. The optimal number of premenstrual symptoms for predicting clinically significant premenstrual impairment was four. CONCLUSION: Results enhance our understanding of the type and number of premenstrual symptoms associated with premenstrual impairment among women being evaluated for PMDD in research contexts. Additional work is needed to determine whether cognitive symptoms should receive greater attention in the study of PMDD, and to revisit the usefulness of the five-symptom diagnostic threshold.

Noninvasive markers for staging fibrosis in chronic delta hepatitis.

BACKGROUND: Serum fibrosis markers are useful in staging chronic hepatitis B (HBV) and C (HCV) virus but have not been evaluated in chronic hepatitis D virus (HDV). AIM: To evaluate the utility of serum fibrosis markers [fibrosis-4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, aspartate aminotransferase ratio (AAR), age-platelet index (API), AST-to-platelet-ratio-index (APRI) and Hui score] in HDV infection. METHODS: Clinical and histologic laboratory data from HBV, HCV and HDV patients were evaluated and serum fibrosis markers were calculated. The ability of fibrosis markers to detect advanced fibrosis (Ishak ≥4) and cirrhosis (Ishak = 6) were evaluated and compared between viral infections. RESULTS: A total of 1003 subjects (HCV = 701, HBV = 240 and HDV = 62) with mean age of 46 ± 11 and 66% male were evaluated. HDV subjects had higher ALT and AST than HCV and lower platelets than both HBV and HCV. Histologically, HDV had the greatest percentage of Ishak ≥4 and necroinflammation. FIB-4 performed best in detecting advanced fibrosis and cirrhosis in all viral cohorts. In HDV, area under the receiver operator curve (AUROC) 95% confidence intervals for detecting advanced fibrosis were: FIB-4 = 0.70 (0.55-0.84), API = 0.69 (0.55-0.82), APRI = 0.68 (0.54-0.82), Hui score = 0.63 (0.49-0.78), AAR = 0.63 (0.48-0.77). The AUROC for detecting cirrhosis in HDV were: FIB-4 = 0.83 (0.69-0.97), API = 0.80 (0.66-0.95), APRI = 0.75 (0.61-0.89), Hui score = 0.70 (0.49-0.91) and AAR = 0.70 (0.48-0.93). Adjustment of published cut-offs led to marginal improvements in FIB4 for advanced fibrosis and of APRI for cirrhosis in HDV. CONCLUSIONS: Serum fibrosis markers have lower performance accuracy in chronic HDV infected patients compared to HBV and HCV patients. Other noninvasive fibrosis markers should be explored to assist in the management of these patients.

Potential dietary exposure to p-nonylphenol from food-contact use of tris(nonylphenyl)phosphite (TNPP).

The potential exposure to p-nonylphenol from the use of tris(nonylphenyl)phosphite (TNPP) in food-contact materials was calculated. The calculation was made on the basis of migration data from moulded plaques prepared from linear low-density polyethylene (LLDPE), films prepared from LLDPE and polyvinyl chloride (PVC) films. The data were obtained using the customary expermental procedures developed by the US Food and Drug Administration (FDA). The potential migration of p-nonylphenol to food from the use of TNPP as a component of food-contact articles was determined using food-simulating solvents and time and temperature conditions recommended by the FDA. Using the data obtained from these studies, along with procedures based on the FDA's conventional method for estimating potential dietary exposure using food simulating migration data, the potential dietary exposure to p-nonylphenol from the use of TNPP was determined to be approximately 25.5 parts per billion (ppb). Because the conditions of the migration tests exaggerate actual use conditions, this value overstates the potential dietary exposure.

Preliminary study on the effect of a herbal formulation "Deepaniyavati" in hyperlipidemia.

To examine the effect of "DeepaniyaVati", a herbal formulation in the management of hyperlipidemia, a randomized group pre-test post-test study trial was carried out on fifty male (30 to 70 yrs) hyperlipidemic volunteers who were asked to follow their normal routine diet and activity pattern throughout the investigation period. The formulation, prepared by mixing nine plant products in equal proportion, when given in a daily dose of 2g, twice a day for a period of one month, brought about an observable improvement in all the lipid parameters by significantly reducing total cholesterol (10%), low density lipoprotein cholesterol (12.76%), very low density lipoprotein cholesterol (27.4%), triglycerides (34.7%) and bringing these values much nearer to the normal levels. In control group, no such effect was noticed. A concomitant significant increase in the HDL-C levels suggests the possible utility of "Deepaniya Vati" in the management of hyperlipidemia and the need for further detailed study.

Compressive myelopathy in fluorosis: MRI.

We examined four patients with fluorosis, presenting with compressive myelopathy, by MRI, using spin-echo and fast low-angle shot sequences. Cord compression due to ossification of the posterior longitudinal ligament (PLL) and ligamentum flavum (LF) was demonstrated in one and ossification of only the LF in one. Marrow signal was observed in the PLL and LF in all the patients on all pulse sequences. In patients with compressive myelopathy secondary to ossification of PLL and/or LF, fluorosis should be considered as a possible cause, especially in endemic regions.