Alternate anti‐leprosy therapy for “Refractory Leprosy”!

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A Biocultural Analysis of Mortuary Practices in the Later Anglo‐Saxon to Anglo‐Norman Black Gate Cemetery, Newcastle‐upon‐Tyne, England

Abstract

The lack of grave goods in cemeteries from later Anglo‐Saxon England (8th to 11th century AD) has in the past been interpreted as reflecting standardisation of burial rites dictated by Christian doctrine. This study employed a biocultural approach to investigate whether variations in mortuary practices such as burial location, grave form and body disposition within the 8^th to 12^th‐century Black Gate cemetery, Newcastle‐upon‐Tyne represented alternative mediums of social display.

Skeletal markers commonly associated with early life stress (cribra orbitalia and linear enamel hypoplasia), non‐specific stress (tibial periosteal lesions and maxillary sinusitis), oral health (calculus, caries, abscesses and ante‐mortem tooth loss) and biomechanical stress (appendicular and spinal degenerative joint disease and trauma) were examined macroscopically on the skeletal remains of 643 individuals. The aim of the analysis was to investigate whether patterns in age, sex and biological stress in the different burial locations, burial types and body positions evidenced social status or socio‐cultural relationships between the different mortuary practices.

Demographic and biocultural analysis revealed the inclusion of males, females, non‐adults and the elderly in all of the mortuary practices and no evidence for marked inequalities in biological stress between those afforded the different burial practices. The dominant influence for non‐significant trends in the stress data was variation in age‐structure between different areas of burial. However, non‐significant but consistently higher frequencies of stress indicators were observed in graves containing stone inclusions (pillow stones, head‐cists and earmuffs) compared to those constructed from stone (cists and rubble cists) and plain burials, all burial practices with a similar mortality profile.

The distribution of age and stress indicators between the mortuary practices placed in the wider socio‐cultural context provided a deeper insight into the complex contribution of social relationships, life‐course, pragmatism, regional and temporal trends, and cultural and religious beliefs upon treatment of the deceased.

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Alternaria‐induced barrier dysfunction of nasal epithelial cells: role of serine protease and reactive oxygen species

Background

Upper airway barrier dysfunction has been associated with chronic rhinosinusitis and allergic rhinitis. Alternaria is commonly found in nasal secretion and plays a role in the pathogenesis of airway diseases. The aim of this study was to investigate the effects of Alternaria on the junctional complex of nasal epithelial cells.

Methods

Air‐liquid interface nasal epithelial cultures from the inferior turbinate of septal surgery patients were stimulated with Alternaria alternate. Production of intracellular reactive oxygen species (ROS) and transepithelial resistance (TER) was measured. The expression of tight junction (TJ) and adherens junction (AJ) molecules was determined using real‐time reverse transcriptase‐polymerase chain reaction, Western blot analysis, and confocal microscopy. Protease activity in Alternaria was determined using protease inhibitors and heat inactivation.

Results

Alternaria enhanced the production of ROS and reduced the TER. Alternaria decreased the messenger RNA and protein expression of TJs (zonula occludens‐1, occludin, and claudin‐1), but did not influence the AJ molecule. When Alternaria was pretreated with serine protease inhibitor and heat inactivation, ROS, TER, and TJ molecule expression returned to their nonstimulated levels.

Conclusion

Serine protease in Alternaria altered nasal epithelial barrier function. Intracellular ROS induced by Alternaria may influence the barrier function of nasal epithelial cells and enhance the inflammatory process of nasal mucosa.

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Draf IIB with superior septectomy: finding the “middle ground”

Background

Previous studies have demonstrated a high failure rate of endoscopic sinus surgery (ESS) with Draf IIa in patients with diffuse polyposis, asthma, and aspirin‐exacerbated respiratory disease. A high percentage of these patients progress to endoscopic modified Lothrop procedure (EMLP). We describe a modification of the Draf IIb with a superior septectomy (IIb+SS), which may provide similar therapeutic benefit as demonstrated by the distribution of sinus irrigations in the sinus cavity with ESS with IIb+SS vs ESS with EMLP IIb+SS vs ESS with EMLP.

Methods

ESS with IIb+SS was performed on 6 cadaver heads. Fluorescein‐dyed irrigations were performed on each head and penetration was recorded using video endoscopy. EMLP was subsequently performed on each head with repeat dye‐irrigation and video endoscopy. The videos were reviewed by 4 blinded fellowship‐trained rhinologists, and irrigant penetration of the maxillary, ethmoid, frontal, sphenoid sinuses, and olfactory cleft was graded 0 to 3 (3 implying complete staining).

Results

The mean scores when comparing IIb+SS to EMLP were as follows: overall 1.99 vs 1.97 (p = 0.816), maxillary sinus 2.67 vs 2.38 (p = 0.128), ethmoid sinus 1.88 vs 1.98 (p = 0.536), sphenoid sinus 2.58 vs 2.50 (p = 0.467), frontal sinus 1.13 vs 1.38 (p = 0.073), and olfactory cleft 1.71 vs 1.63 (p = 0.529). There was no significant difference between subsites. Interrater reliability was good (Cronbach's alpha = 0.781).

Conclusion

Performing ESS with IIb+SS provides similar irrigation delivery benefits to ESS with EMLP, without the need for altering natural sinus outflow and creating circumferential scarring. Further studies evaluating its use in patients that are high risk for revision surgery are needed.

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Gastroesophageal reflux disease increases the risk of chronic rhinosinusitis: a nested case‐control study using a national sample cohort

Background

The purpose of this study was to evaluate the relations between gastroesophageal reflux disease (GERD) and chronic rhinosinusitus (CRS) in a Korean population.

Methods

Subjects from the Korean National Health Insurance Service‒National Sample Cohort, all ≥20 years old, were assessed from 2002 to 2013. In total, 23,489 CRS participants were matched with 93,956 controls at a ratio of 1:4 with respect to age, group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed previous history of GERD in the CRS and control groups. The CRS group included patients identified using International Classification of Diseases 10th edition (ICD‐10) codes (J32) who had treated their CRS ≥2 times and had undergone head and neck computed tomography (CT). The GERD group included patients identified using the ICD‐10 (K21) code who had treated their GERD ≥2 times and had taken a proton pump inhibitor (PPI) for ≥2 weeks. Crude and adjusted odds ratios (ORs) were analyzed using unconditional logistic regression analyses. The 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed according to age and sex.

Results

The rate of GERD was higher in the CRS group (17.1% [4020 of 23,489]) than in the control group (9.1% [8522 of 93,956]; p < 0.001). The adjusted OR of GERD was 2.04 (95% CI, 1.96‐2.13; p < 0.001) in the CRS group. The results of the subgroup analyses were consistent.

Conclusion

The ORs of GERD were increased in CRS participants. This relationship was consistent in all age and sex groups.

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Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

Background

Previous studies on the impact of wait times for endoscopic sinus surgery (ESS) in medically recalcitrant chronic rhinosinusitis (rCRS) have not examined its influence on the 5 distinct symptoms domains of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), and have not applied evidence‐based surgical indications. Our primary study objective was to investigate the impact of ESS wait times on postoperative SNOT‐22 global and symptom domain scores in patients with rCRS deemed "appropriate" surgical candidates.

Methods

This was a retrospective analysis of adult patients with rCRS undergoing ESS, categorized as "appropriate" surgical candidates. Primary outcome measure was change in SNOT‐22 global/symptom domain score (preoperative – 6‐month postoperative). Correlational analyses were performed between wait time and change in SNOT‐22 global and symptom domain scores. For significant negative correlations, the threshold wait time to generate a worsening in health‐related quality‐of‐life (HRQoL) equivalent to the mean clinically important difference (MCID) was calculated.

Results

A total of 104 patients with a mean ± standard deviation (SD) wait time of 310.8 ± 155.9 days were analyzed. Postoperative SNOT‐22 global and symptom domain scores significantly improved postoperatively. Wait time for ESS was negatively correlated with change in SNOT‐22 global, rhinologic, extranasal rhinologic, and ear/facial domain scores (p < 0.05), and a wait time threshold of 287, 452, 421, and 381 days corresponded to a decrease equivalent to the MCID, respectively.

Conclusion

We identified less improvement in HRQoL after ESS with increasing surgical wait time. Moreover, prolonged wait times may result in less improvement in disease‐specific symptoms, but do not appear to worsen psychological or sleep dysfunction.

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Socioeconomic factors impact quality of life outcomes and olfactory measures in chronic rhinosinusitis

Background

Healthcare disparities related to socioeconomic factors may adversely impact disease states and treatment outcomes. Among patients with chronic rhinosinusitis (CRS), the impact of socioeconomic factors on outcomes following endoscopic sinus surgery (ESS) remains uncertain.

Methods

Adult patients with refractory CRS were prospectively enrolled into an observational, multi‐institutional cohort study between March 2011 and June 2015. Socioeconomic factors analyzed included household income, insurance status, years of education completed, race, age, and ethnicity. Income was stratified according to the Thompson and Hickey model. The 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Brief Smell Identification Test (BSIT) were completed preoperatively and postoperatively.

Results

A total of 392 patients met inclusion criteria. Higher age and male gender were associated with better mean preoperative SNOT‐22 scores (both p < 0.02), whereas Medicare insurance status and male gender were associated with worse preoperative mean BSIT scores (both p < 0.02). Postoperatively, higher household income ($100,001+/year) and lower age were associated with a greater likelihood of improving at least 1 minimal clinically important difference (MCID) on SNOT‐22 scores (OR = 2.40 and 1.03, respectively, both p < 0.05), while no factors were associated with increased odds of achieving a MCID on BSIT scores.

Conclusions

Preoperative olfactory function and postoperative quality of life (QOL) improvement were associated with metrics of socioeconomic status in patients with CRS electing ESS. The odds of experiencing a clinically meaningful QOL improvement were more than twice as likely for patients with the highest household income level compared to other income tiers. Further investigation is warranted to identify barriers to postoperative improvement.

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