Radiological significance of isolated ethmoid sinus infections in asymptomatic patients of recurrent acute rhinosinusitis

Background: Recurrent acute rhinosinusitis (RARS) being a low form chronic rhinosinusitis (CRS), is relatively under diagnosed many times because of lack of awareness regarding pattern of the disease presentation. Aim of the study is to evaluate the radiological significance of isolated ethmoid sinusitis in patients of RARS during the asymptomatic interval in between acute episodes of rhinosinusitis.Methods: Total 124 patients with history suggestive of RARS who had undergone computed tomography study of brain during April 2015 to October 2016 for indications other than sinonasal diseases, were evaluated for isolated ethmoid sinusitis in the department of Radiology. Patients having any inflammatory or expansile sinonasal masses were excluded.Results: Of total 124 patients of RARS aged from 18 to 70 years (mean age of 38.6 years), the study population included only seventy-two (58%) patients having isolated ethmoid sinus infections, were classified in to mild unilateral group I (46%) cases with grade I or II sinus infections and relatively severe bilateral group II (54%) cases having grade III or IV infections. Infective process involving two to three ethmoid cells each on either side is the most common variety encountered in 39% cases. Prevalence of infective process was fairly equal among all age groups. Statistical correlation between the severity of RARS in patients having group II variety of isolated ethmoid sinus infections was found highly significant.Conclusions: Isolated ethmoid sinus infections are commonly encountered CT findings in adult RARS patients while they are asymptomatic from acute episodes of rhinosinusitis

Radiological significance of the sinonasal anatomical variants in recurrent acute rhinosinusitis patients

Background: Recurrent acute rhinosinusitis (RARS), a low form chronic rhinosinusitis is frequently under evaluated. The significance of sinonasal anatomical variants of osteomeatal complex (OMC) and spheno-ethmoidal (SE) recess regions in patients of RARS is assessed.Methods: Retrospective analysis of coronal sinonasal computed tomography images of 120 RARS patients presented with sinonasal anatomical variants during November 2013 to October 2016 was carried out. Patients with acute and expansile sinonasal lesions are excluded.Results: Sinonasal anatomical variants in the regions of OMC and SE recess are responsible for obstruction of normal mucociliary drainage of corresponding paranasal sinuses in presence of inflammation predisposing to RARS. Anatomical variants of nasal septum were, deviated nasal septum (DNS) in 86 (72%) and septal spur in 58 (48%) patients. Anatomical variants in OMC region were, pneumatized middle turbinate (concha bullosa) in 50 (48%), paradoxical middle turbinate in 38 (28%), giant ethmoid bulla in 35 (32%), agger nasi cell in 29 (38%), Haller cell in 23 (15%), pneumatised uncinate process in 20 (18%), medialized uncinate process in 18 (22%) and septated maxillary sinus in 5 (4%) patients. Anatomical variants in SE recess were superior concha bullosa in 14 (12%) and septal bullosa in 11 (9%) patients.Conclusions: OMC pattern of recurrent rhinosinusitis is often prevalent in patients of RARS due to abundance of anatomical variants in the OMC region. DNS or ethmoid bulla when gets associated with concha bullosa increased the incidence of RARS. Present analysis would help surgeons to evaluate RARS patients for selective endoscopic sinus surgery

PD-L1 expression and its significance in advanced NSCLC: real-world experience from a tertiary care center

Abstract Background Targeted therapies against programmed death ligand-1 (PD-L1) in non-small cell lung cancer (NSCLC) have revolutionized the management in recent years. There is paucity of data on the significance of PD-L1 expression in NSCLC from India. We aimed to study the prevalence of PD-L1 expression and its relation with different clinico-pathological parameters in advanced NSCLC from a tertiary care center in Eastern India. Methods All consecutive patients with advanced NSCLC diagnosed from January 2020 to December 2021 were prospectively evaluated for PD-L1 expression in formalin fixed-paraffin embedded tumor tissue specimens using immunohistochemistry analysis. A PD-L1 expression of < 1%, 1–49%, and ≥ 50% were considered negative, low, and high expression positive respectively, and association with various parameters was performed. Results Out of the 94 patients (mean age 59.6 ± 14 years and 63.8% males), PD-L1 positivity was seen in 42 (44.7%) patients, with low positivity (1–49%) in 29 patients and high positivity (≥ 50%) in 13 patients. Epidermal Growth Factor Receptor (EGFR) mutations were seen in 28 patients (29.8%). There were no significant differences in PD-L1 positivity with respect to gender, age, and molecular mutation status. PD-L1 positivity was significantly associated with tobacco use (p = 0.04), advanced tumor stage (p < 0.001), and higher nodal stage (p < 0.001). Median overall survival in the cohort was 17 months and it was not significantly different between the PD-L1 positive and negative groups. Conclusions Forty-five percent of advanced NSCLC patients in our cohort showed positive PD-L1 expression and it is associated with tobacco use and aggressive tumor characteristics