An unusual case of unilateral sinus disease may reveal the presence of a retained foreign body

Introduction: Differential diagnosis of unilateral sinus disease (USD) is important in clinical practice as it can be broad, and for which timely and effective treatment is important. With this report we would like to present a case of a patient with a foreign body retained in the left maxillary sinus for eight years. Presentation of case: A 50-year-old gardener referred to have been injured on the job in 2010. Even though he was wearing his safety helmet with face shield and earmuffs, he had the sensation to have been hit by an object coming from the soil, while he was using his grass trimmer. However, the patient was asymptomatic with no complications. After eight years, the man started experiencing left nasal obstruction associated with purulent discharge and ipsilateral headache. A fetid odor coming from inside the nose and described as “the carcass of a dog” led him to seek medical attention. The patient underwent a functional endoscopic sinus surgery (FESS) with septoplasty and a foreign body, consisting of a metal nail, was retrieved. Discussion: This case highlights a two key learning points. The first one concerns occupational safety measures; full-face shield helmets are the best option and should be employed in order to avoid the penetration of any possibly dangerous materials. Secondly, grass trimmers with more sophisticated designs are required in order to prevent injuries like this. Conclusions: Besides being peculiar because of the onset of clinical symptoms, this case report highlights the importance of full-face shield helmets and certified machinery

COVID-19: what happened to all of the otolaryngology emergencies?

To the Editor, COVID-19 is a global pandemic caused by the novel coronavirus SARS-CoV-2, and Italy was the first European country to experience a large-scale outbreak. With this, every aspect of healthcare, the economy, and society has been deeply affected in Italy, so much so that fundamental changes are expected in the post-COVID-19 era. One aspect is that access to emergency care in Otolaryngology (ORL) patients has already changed in the month following the onset of the COVID-19 outbreak, and, seemingly, many non-COVID illnesses have been disappearing. Although the government did not enact any limitations or prohibitions to emergency access for patients afflicted by acute ORL pathologies, the number of daily urgent consultations to the ORL Departments in Bari and Foggia University Hospitals has significantly reduced and, on some days, was even zero. One possible reason for this change may be patients’ fear of acquiring a nosocomial COVID-19 infection. Even so, it is difficult to believe that some acute diseases, such as massive epistaxis, otitis, or pharyngotonsillitis, could have occurred so rarely or not at all or, alternately, could have been treated at home by patients or their families. Rather, most certainly, primary care physicians, who have been performing telehealth consultations in accordance with the guidelines from the Higher Institute of Health (ISS), have been providing an invaluable service [1]; it is posited that patients who received primary care services this way may have been able to delay or even forego specialist evaluation. This telehealth treatment has not only helped to keep patients at home but has provided other benefits and should be considered in the future. Table ​Table11 shows data regarding the number of emergency department consultations by diagnosis in the 30 days preceding (from February 8th to March 8th, 2020) and 30 days following (from March 9th to April 9th, 2020) the onset of the COVID-19 outbreak at the two main tertiary referral centers in the Puglia region, as well as the percentage reduction for each diagnosis. The data revealed an overall decrease in the number of ORL emergency consultations by 80.8%. Of note, reductions were noted across all subspecialties. Although some illnesses, such as rhinitis, sinusitis, uvular edema, and tinnitus, do not usually require immediate attention, it is more difficult to explain the large reduction, ranging from 80.2% to 88.9%, of other diagnoses, such as vertigo, epistaxis, sudden hearing loss, otitis media, and peritonsillar abscesses, which often merit urgent ORL consultations. The reduction of some diagnoses may be the consequence of national lockdown orders. For example, the 84.6% reduction in the number of nasal bone fractures may be related to the near-absence of motor vehicle accidents reported during this time. In contrast, it is more difficult to explain the reduction of other acute diseases such as sudden hearing loss, whose frequency decreased 83.3%, especially when compared to non-disease conditions, such as cerumen impaction, whose reduction in presentation, interestingly, was slightly more modest at 73.7%. A reduction in the number of emergency ORL consultations by 80.8% during the COVID-19 pandemic creates new paradigms for the future. Over the past few decades, the workload performed by healthcare personnel in emergency departments has increased, and some have even noted a reduction in morale and job satisfaction, as their responsibilities include intervening in not only true emergencies but also managing many patients with non-acute complaints. One possible exacerbating factor is the length of waitlists to access outpatient care in the Italian National Healthcare System (NHS), as some patients may have to wait for months to see an otolaryngologist. This situation has motivated many to seek care in the emergency department to skip wait times and receive specialty evaluation and treatment without charge. Decreasing the utilization of emergency department services by improving access to primary care services has been a long-term aim, articulated since at least 1958, when physicians working at Hartford Hospital published a pioneering piece in The New England Journal of Medicine [2] that showed that only a minimum number of patients who visited the emergency department required inpatient care. At that time, proposed solutions were to increase utilization of outpatient care and to educate patients to seek a preliminary triage consultation with their family physicians; it is possible that the COVID-19 outbreak is pushing our current society in a similar direction. Certainly, the priority now is to fight the pandemic, but in time, many aspects of healthcare should be reviewed and better organization through telemedicine sought [3]. Hopefully, patients will have learnt to more appropriately utilize the numerous resources offered by the Italian NHS for all of its patients

A proposal for an evidence-based model of the screening for the colorectal carcinoma in an Italian setting

Introduction. The aim of this paper is to improve the feasibility perception of policymakers, health care workers and target population about the cost-effectiveness of the implementation of colorectal screening as Public Health strategy. Methods. Retrospective study by application of a three-step model designed for a local setting in Sicily (Palermo and its Province) in order to distribute Fecal Occult Blood Tests (FOBTs), offer colonoscopy and surgery, by district allocation of pharmacies, public digestive endoscopic centres and oncologic and general surgery units. Mean adherence to consolidated colorectal screening programs in Italy was applied in order to evaluate the feasibility of an operative model in our area. Results. Applying the model to the target population (269,368 individuals of both sexes), it can be expected a mean percentage of 79% delivered invitation and a mean participation rate of 46.3% accounting for a total of 213,070 invited individuals and 98,651 participating in the first round of the program. Furthermore, considering the national mean of 6% positive FOBT, 82% of colonscopy adhesion and 7% CRC detection rate, it can be scheduled a burden for health care structures involved in the program accounting for 49,325 FOBTs, 2,338 colonscopies and 141 surgeries for each year. Discussion. This work demonstrates the feasibility of a colorectal screening project in our area, showing a sustainable impact for local health care involved structures. Furthermore, this program may be spread as an applicative model to other areas, adapting the project to the needs of the local setting in which the colorectal screening will be organized

Nasal delivery devices: A comparative study on cadaver model

Nasal nebulization is a more effective method of delivering topical medication than nasal spray. The purpose of this study was to assess the deposition patterns of nebulization in delivering topical agents to the nasal cavities in the human cadaveric model using a color-based method. We have compared these following nasal devices: Single-dose vial irrigation, syringe-irrigation, common nasal spray, Spray-sol, MAD nasal, and Rinowash nasal douche. Endoscopic images were recorded at six anatomical regions prior to and following each nasal device application and four reviewers evaluated the amount of surface area staining. At the nasal vestibule, the blue dye distribution achieved with Spray-sol was more extensive than nasal sprays. At inferior turbinate and nasal cavity floor, single dose vial, syringe, MAD nasal, Spray-sol, and Rinowash demonstrated a greater extent of dye distribution than nasal spray. At the middle turbinate, the average score of both Spray-sol and MAD nasal was significantly higher than other nasal investigated devices. At the nasopharynx, Spray-sol nebulization covers a surface significantly greater than other devices. Compared to traditional sprays, Spray-sol and MAD nasal provided a more effective method of delivering topical agents to the deeper and higher portions of the nasal cavities

Cold-Azurin, a New Antibiofilm Protein Produced by the Antarctic Marine Bacterium Pseudomonas sp. TAE6080

Biofilm is accountable for nosocomial infections and chronic illness, making it a serious economic and public health problem. Staphylococcus epidermidis, thanks to its ability to form biofilm and colonize biomaterials, represents the most frequent causative agent involved in biofilm-associated infections of medical devices. Therefore, the research of new molecules able to interfere with S. epidermidis biofilm formation has a remarkable interest. In the present work, the attention was focused on Pseudomonas sp. TAE6080, an Antarctic marine bacterium able to produce and secrete an effective antibiofilm compound. The molecule responsible for this activity was purified by an activity-guided approach and identified by LC-MS/MS. Results indicated the active protein was a periplasmic protein similar to the Pseudomonas aeruginosa PAO1 azurin, named cold-azurin. The cold-azurin was recombinantly produced in E. coli and purified. The recombinant protein was able to impair S. epidermidis attachment to the polystyrene surface and effectively prevent biofilm formation

Advances in pre-treatment evaluation of pancreatic ductal adenocarcinoma: a narrative review

Background and Objective: Despite advances in the multidisciplinary management of pancreatic cancer, overall prognosis remains poor, due to early progression of the disease. There is a need to also take action in staging, to make it increasingly accurate and complete, to define the setting of the therapeutic strategy. This review was planned to update the current status of pre-treatment evaluation for pancreatic cancer. Methods: We conducted an extensive review, including relevant articles dealing with traditional imaging, functional imaging and minimally invasive surgical procedures before treatment for pancreatic cancer. We searched articles written in English only. Data in the PubMed database, published in the period between January 2000 and January 2022, were retrieved. Prospective observational studies, retrospective analyses and meta-analyses were reviewed and analysed. Key Content and Findings: Each imaging modality (endoscopic ultrasonography, endoscopic retrograde staging laparoscopy) has its own diagnostic advantages and limitations. The sensitivity, specificity and accuracy for each image set are reported. Data that support the increasing role of neoadjuvant therapy (radiotherapy and chemotherapy) and the meaning of a patient-tailored treatment selection, based on tumour staging, are also discussed. Conclusions: A multimodal pre-treatment workup should be searched as it improves staging accuracy, orienting patients with resectable tumors towards surgery, optimizing patient selection with locally advanced tumors to neoadjuvant or definite therapy and avoiding surgical resection or curative radiotherapy in those with metastatic disease

High-Definition 3D Exoscope in Pediatric Otorhinolaryngology: A Systematic Literature Review

This PRISMA-compliant systematic review aimed to investigate the use of and the most common procedures performed with the novel 3D 4K exoscope in surgical pediatric head and neck settings. Methods: Search criteria were applied to PubMed, EMBASE and the Cochrane Review databases and included all studies published up to January 2023 reporting 3D 4K exoscope-assisted surgeries in pediatric patients. After the removal of duplicates, selection of abstracts and full-text articles, and quality assessment, we reviewed eligible articles for number of patients treated, age, surgical procedures, and outcomes. Results: Among 54 potentially relevant records, 5 studies were considered eligible and included in this systematic review, with reported treatment data for 182 patients. The surgical procedures belong to the otologic field (121 cases), head and neck surgery (25 cases) and transoral surgery (36 cases). Exoscopy allowed high quality visualization of anatomical structures during cochlear implantation and during reconstruction in head and neck surgery; moreover, it improved the surgical view of surgeons, spectators and ENT students. Conclusions: The use of 3D 4K exoscopy has shown promising potential as a valuable tool in pediatric ORL-head and neck surgery; nevertheless, further validation of these encouraging outcomes is necessary through larger-scale studies specifically focused on pediatric patients

STRUCTURAL AND FUNCTIONAL-CHARACTERIZATION OF THE PROMOTER REGIONS OF THE NFKB2 GENE

In order to clarify the transcriptional regulation of the NFKB2 gene (lyt-10, NF-kappa Bp100), we have characterized the structure and function of its promoter regions. Based on the nucleotide sequence of cDNA clones and the 5' flanking genomic region of the NFKB2 gene, RT-PCR analysis in a number of human cell lines demonstrated the presence of two alternative noncoding first exons (Ia and Ib). Two distinct promoter regions, P1 and P2, were identified upstream of each exon, containing multiple sites of transcription initiation, as shown by RNase protection analysis. Sequence analysis of these regions showed a CAAT box upstream of exon Ia and high G-C content regions within both P1 and P2. Consensus binding sites for transcription factors, including SP1, API and putative NF-kappa B (kappa B sites), were found upstream of each exon. In particular, six kappa B sites were identified, all but one of them capable of binding NF-kappa B complexes in vitro. Transfection in HeLa cells of plasmids containing PI and P2 sequences linked to a chloramphenicol acetyltransferase reporter gene indicated that both P1 and P2 can act independently as promoters. Co-transfection of NF-kappa B effector plasmids (NF-kappa Bp5a and RelA) with a reporter gene linked to P1 and P2 showed that the NFKB2 promoter regions are regulated by NF-kappa B factors. RelA transactivates the NFKB2 promoter in a dose-dependent manner, whereas NF-kappa Bp52 acts as a repressor, indicating that the NFKB2 gene may be under the control of a negative feedback regulatory circuit

Nasal delivery devices: A comparative study on cadaver model

Nasal nebulization is a more effective method of delivering topical medication than nasal spray. The purpose of this study was to assess the deposition patterns of nebulization in delivering topical agents to the nasal cavities in the human cadaveric model using a color-based method. We have compared these following nasal devices: single-dose vial irrigation, syringe-irrigation, common nasal spray, Spray-sol, MAD nasal, and Rinowash nasal douche. Endoscopic images were recorded at six anatomical regions prior to and following each nasal device application and four reviewers evaluated the amount of surface area staining. At the nasal vestibule, the blue dye distribution achieved with Spray-sol was more extensive than nasal sprays. At inferior turbinate and nasal cavity floor, single dose vial, syringe, MAD nasal, Spray-sol, and Rinowash demonstrated a greater extent of dye distribution than nasal spray. At the middle turbinate, the average score of both Spray-sol and MAD nasal was significantly higher than other nasal investigated devices. At the nasopharynx, Spray-sol nebulization covers a surface significantly greater than other devices. Compared to traditional sprays, Spray-sol and MAD nasal provided a more effective method of delivering topical agents to the deeper and higher portions of the nasal cavities