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Fulltext Cerebral white matter microstructural changes in isolated maxillofacial trauma and associated neuropsychological outcomes

Sreedharan S, Veeramuthu V, Hariri F, Hamzah N, Ramli N, Narayanan V

Int J Oral Maxillofac Surg, 2020 Sep;49(9):1183-1192.
PMID: 32224001 DOI: 10.1016/j.ijom.2020.03.002

Isolated traumatic maxillofacial injury without concomitant brain injury may cause delayed post-concussive symptoms. Early identification allows optimal diagnosis, prognostication, and therapeutic intervention. The aim of this prospective observational study was to investigate longitudinal microstructural changes of the white matter (WM) tracts based on diffusion tensor imaging (DTI) indices in patients with isolated maxillofacial injuries, immediately and 6 months post-trauma, and to correlate these DTI indices with neuropsychological changes observed. Twenty-one patients with isolated maxillofacial injuries and 21 age-matched controls were recruited. DTI was performed and indices were calculated for 50 WM tracts. The neuropsychological evaluation was done using the screening module of the Neuropsychological Assessment Battery. Patients were subjected to repeat DTI and neuropsychological evaluation at 6 months post-trauma. Reduced fractional anisotropy (FA) and increased median (MD) and radial diffusivity (RD) in the acute phase were seen in major association, projection, and commissural fibre bundles, indicative of vasogenic oedema. These changes correlated with attention and executive function deficits in the acute phase, as well as improvement in memory and visuospatial function in the chronic phase. Isolated maxillofacial trauma patients develop WM microstructural damage, which may impair cognitive performance acutely and over time. DTI indices can serve as predictive imaging biomarkers for long-term cognitive deficits in isolated maxillofacial injuries.
Fulltext Bone Changes in Chronic Rhinosinusitis: Pathological or Physiological?

Pokharel M, Khadilkar MN, Sreedharan S, Pai R, Shenoy V, Bhojwani K, et al.

Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):178-184.
PMID: 35813780 DOI: 10.1007/s12070-020-02076-5

Bone remodelling is a normal physiological process which occurs in all bones. Hence bone changes should also be detected in undiseased or minimally diseased ethmoids as well as in chronic rhinosinusitis (CRS) patients. To test this hypothesis, we compared ethmoid bone histology between two groups of patients; a study group of CRS patients and a group of patients whose radiological, endoscopic and symptom scores were significantly less when compared to the CRS group. The study group had 75 patients who underwent functional endoscopic sinus surgery for CRS. The control group included 16 patients who had significantly different endoscopic and radiological scores from the study group. On histopathology, the bone harvested from the ethmoid sinuses were grouped as no remodelling activity (Score 1), mild activity (Score 2) and marked activity (Score 3). Thirty-six percent of patients in the study group and 37.5% of patients in the control group had Score 2 and 3 bone changes and the difference was not statistically significant (χ2 = 1.824, p = 0.402). Correlation of bone changes in CRS done with parameters like Lund-Mackay radiological, surgical and symptom scores and Lund-Kennedy endoscopic scores showed no statistical significance. Similar bone changes were detected in CRS patients and the control group. The bone changes seen in histopathology in CRS patients could partly be due to the normal physiological remodelling occurring in all bones.
Fulltext Predictors of Surgical Outcomes After Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis

Anne J, Sreedharan S, Dosemane D, Shenoy V, Kamath PM, Zubair SM

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):835-841.
PMID: 36452725 DOI: 10.1007/s12070-020-01855-4

Chronic rhinosinusitis has an incidence of 15% in India. Functional endoscopic sinus surgery (FESS), in case of failed medical management, is the current treatment protocol in Chronic rhinosinusitis. This study aims to assess the outcome of FESS as measured by subjective quality of life indices; Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22. It also assesses the predictive factors which influence the outcome after FESS. The study was conducted among 100 patients with Chronic Rhinosinusitis who underwent FESS, after failure of medical management. Immunocompromised or pregnant patients and patients with history of previous sinus surgery or malignancy were excluded from the study. The evaluation was done using Lund Kennedy endoscopy scores, Lund Mackay CT scan scores and RSDI and SNOT-22 questionnaires (baseline and 3 months post-op). Statistical analysis was done using Wilcoxon signed-rank test, Kruskall Wallis test, Mann Whitney test and Chi-square test. p
Fulltext Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults with Type 2 Diabetes in Malaysia: Results from a Prospective, Non-interventional Real-World Study

Mohamed M, Lim SC, Mumtaz M, Uppal S, Mukherjee D, Kassim MSM, et al.

J ASEAN Fed Endocr Soc, 2023;38(1):37-44.
PMID: 37252419 DOI: 10.15605/jafes.038.01.12

OBJECTIVES: Insulin degludec (IDeg)/insulin aspart (IAsp; IDegAsp) is a co-formulation of 70% IDeg and 30% IAsp. According to several randomized controlled trials, IDegAsp is effective and safe for patients with type 2 diabetes mellitus (T2DM). A subgroup analysis of the ARISE study was conducted to explore the safety and efficacy of IDegAsp among Malaysian patients with T2DM in real-world settings.
METHODOLOGY: ARISE, an open-label, multicenter, non-interventional, prospective study was conducted between August 2019 and December 2020. Adult Malaysian patients with T2DM who were enrolled from 14 sites received IDegAsp as per the local label for 26 weeks. The primary endpoint was change in glycated hemoglobin (HbA1c) levels from baseline to end of study (EOS).
RESULTS: Of the 182 patients included in the full analysis set, 159 (87.4%) completed the study. From baseline to EOS, HbA1c (estimated difference [ED]: -1.3% [95% CI: -1.61 to -0.90]) and fasting plasma glucose levels (ED: -1.8 mmol/L [95% CI: -2.49 to -1.13]) were significantly reduced (p<0.0001). The patient-reported reduced hypoglycemic episodes (overall and nocturnal) during treatment. Overall, 37 adverse events were observed in 23 (12.6%) patients.
CONCLUSION: Switching or initiating IDegAsp treatment resulted in significant improvements in glycemic control and a reduction in hypoglycemic episodes.