Kashif Mazhar

SEVERITY OF DIABETIC RETINOPATHY AND HEALTH-RELATED QUALITY OF LIFE: THE LOS ANGELES LATINO EYE STUDY

OBJECTIVE To assess the impact of diabetic retinopathy (DR) and its severity on health-related quality of life (HRQOL) in a population-based sample of Latinos with type 2 diabetes mellitus (DM). DESIGN Cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES). PARTICIPANTS We included 1064 LALES participants with DM. METHODS We measured HRQOL by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-item Short Form Health Survey (SF-12). We assessed DR by masked standardized grading of stereoscopic photographs from 7 standard fields. Severity of DR in eyes was graded using a modified Airlie House classification. The severity scores from each eye were then concatenated to create a single per person grade ranging from 1 (no DR in either eye) to 15 (bilateral PDR). Multiple linear regression analyses were performed to determine the independent relationship between severity of DR and HRQOL after adjusting for covariates. MAIN OUTCOME MEASURES Scores on the NEI-VFQ-25 and SF-12. RESULTS More severe DR was associated with worse HRQOL scores on all of the NEI-VFQ-25 and SF-12 subscales (P<0.05). Individuals with DR from grade 2 (minimum nonproliferative diabetic retinopathy [NPDR]) through grade 8 (unilateral moderate NPDR) show a modest decline in HRQOL. However, the decline becomes significantly steeper between steps 8 (unilateral moderate NPDR) and 9-15 (bilateral moderate NPDR to bilateral PDR). The domains with the most significant impact were for vision-related daily activities, dependency, and mental health. CONCLUSIONS Greater severity of DR was associated with lower general and vision-specific HRQOL. Persons with bilateral moderate NPDR had the most substantial decrease in quality of life compared with those with less severe DR. The prevention of incident DR and, more important, its progression from unilateral to bilateral NPDR is likely to have a positive impact on a persons HRQOL and should be considered an important goal in management of individuals with DM.

The Supraclavicular Artery Island Flap in Head and Neck Reconstruction: Applications and Limitations

IMPORTANCE The supraclavicular artery island (SAI) rotational flap may have advantages compared with free-tissue transfer in head and neck reconstruction. Because this flap has not been extensively described for head and neck reconstruction of oncologic defects, guidelines for its indications would benefit the reconstructive surgeon. OBJECTIVE To describe the applications and limitations of the SAI flap as an alternative to free-tissue transfer in reconstruction of head and neck defects. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series of 45 patients with defects related to malignant and nonmalignant disease undergoing reconstructive surgery from August 18, 2010, through September 28, 2012, at an academic, tertiary referral center. Each defect was deemed unsuitable for primary or local flap closure and would require regional tissue or free-tissue transfer. Mean follow-up was 10.3 (range, 1-31) months. INTERVENTION Use of the SAI flap for reconstruction of soft-tissue defects of the head and neck. MAIN OUTCOMES AND MEASURES Defect site, flap dimensions, time to raise the flap, and complications. RESULTS Defects of the oral cavity, oropharynx, laryngopharynx, esophagus, trachea, temporal bone, and cervicofacial skin underwent reconstruction. Mean flap dimensions were 6.1 cm wide and 21.4 cm long, with a mean skin paddle length of 7.9 cm. Harvest time was less than 1 hour. Donor-site complications included minor dehiscence in 6 patients and prolonged wound care in 2. Partial skin flap necrosis occurred in 8 patients, whereas 2 had complete loss of the skin paddle. Seven patients developed a salivary fistula, 4 of which healed spontaneously. Flap length greater than 22 cm correlated with flap necrosis (P = .02). A history positive for smoking correlated with an increased risk of flap dehiscence (P = .02). CONCLUSIONS AND RELEVANCE The SAI flap provides an alternative to free-tissue transfer for soft-tissue reconstruction after head and neck oncologic surgery. This flap is easy to harvest and versatile. However, the SAI flap has limitations in length and, because it is a rotational flap, is less capable of reconstructing some complex head and neck defects.

Self-Reported Use of Eye Care among Latinos: The Los Angeles Latino Eye Study

PURPOSE To identify the prevalence and determinants of self-reported eye care use in Latinos. DESIGN Population-based ocular epidemiologic study in Latinos aged 40+ years living in La Puente, California. PARTICIPANTS A total of 5455 participants. METHODS Univariate, multivariable, and stepwise logistic regression analyses were conducted to identify predisposing, enabling, and need variables associated with self-reported eye care use. MAIN OUTCOME MEASURES Prevalence of self-reported use: eye care visit, having had a dilated examination in the past 12 months, ever having had a dilated examination, and odds ratios for factors associated with self-reported use. RESULTS Overall, 36% of participants reported an eye care visit and 19% reported having a dilated examination in the past year. Fifty-seven percent reported ever having had a dilated eye examination. Greater eye care use was associated with older age, female gender, bilingual language proficiency (English and Spanish), more education, having health insurance, having a usual place for care, having a regular provider of care, a greater number of comorbidities, visual impairment, and lower vision-specific quality of life scores. CONCLUSIONS Multiple modifiable factors are associated with greater use and access to eye care for Latinos. Modification of these factors should be a priority because visual impairment has significant impacts on well-being and mortality.

Use of the Supraclavicular Artery Island Flap for Reconstruction of Cervicofacial Defects

Objective To describe the supraclavicular artery island (SAI) flap as an alternative flap for reconstruction of cervicofacial defects. Study Design Case series with chart review. Setting Academic, tertiary referral center. Subjects and Methods Twenty-two patients with defects of the face, temporal bone, and neck were reconstructed with an SAI flap. Each defect was deemed unsuitable for primary or local flap closure and would require regional or free tissue transfer. Outcome measures included size and location of the defect, time to raise the flap, flap size and viability, and complications. Mean follow-up was 7.4 months (range, 1-31 months). Statistical analysis was performed using SAS 9.1 (SAS Institute, Cary, North Carolina). Results Defects of the cervical skin (n = 10), face (n = 8), and temporal bone (n = 4) were reconstructed. Mean flap dimensions were 6.1 cm (range, 5-7 cm) wide and 21.8 cm (range, 16-28 cm) long. The proximal portion of the flap was deepithelialized to match the defect, resulting in a mean skin paddle length of 9.6 cm (range, 5-18 cm). Minor donor site dehiscence occurred in 3 patients. Partial skin flap necrosis occurred in 2 patients, while 1 patient had complete loss of the skin paddle. There was no statistical correlation between flap necrosis and flap length (P = .3, χ2) or defect location (P = .13, χ2). Conclusion The SAI flap is a viable alternative to cervicofacial advancement or microvascular reconstruction of cervicofacial defects in select cases. This flap is reliable, easy to harvest, and versatile, and it provides a good color match for cervicofacial defects.

Self-Reported Use of Eye Care among Latinos

PURPOSE To identify the prevalence and determinants of self-reported eye care use in Latinos. DESIGN Population-based ocular epidemiologic study in Latinos aged 40+ years living in La Puente, California. PARTICIPANTS A total of 5455 participants. METHODS Univariate, multivariable, and stepwise logistic regression analyses were conducted to identify predisposing, enabling, and need variables associated with self-reported eye care use. MAIN OUTCOME MEASURES Prevalence of self-reported use: eye care visit, having had a dilated examination in the past 12 months, ever having had a dilated examination, and odds ratios for factors associated with self-reported use. RESULTS Overall, 36% of participants reported an eye care visit and 19% reported having a dilated examination in the past year. Fifty-seven percent reported ever having had a dilated eye examination. Greater eye care use was associated with older age, female gender, bilingual language proficiency (English and Spanish), more education, having health insurance, having a usual place for care, having a regular provider of care, a greater number of comorbidities, visual impairment, and lower vision-specific quality of life scores. CONCLUSIONS Multiple modifiable factors are associated with greater use and access to eye care for Latinos. Modification of these factors should be a priority because visual impairment has significant impacts on well-being and mortality.

Relationship of eosinophils and plasma cells to biofilm in chronic rhinosinusitis.

Background This study investigates the relationship of eosinophils and plasma cells to biofilm in chronic rhinosinusitis (CRS). A prospective observational study was performed at the Keck Hospital, University of Southern California, Department of Otolaryngology, Los Angeles, CA. Methods A total of 29 patients, 20 undergoing endoscopic sinus surgery for CRS and 9 control patients undergoing septoplasty for nasal obstruction without history or evidence of CRS, were included in this study. Contiguous sinonasal mucosa sample sections were examined by hematoxylin and eosin (H&E), fluorescence in situ hybridization (FISH), and immunohistochemistry (IHC) for biofilm, microbes, eosinophil major basic protein (EMBP), and cluster designation 27 (CD27). EMBP and CD27 were used as eosinophil and plasma cell markers, respectively. Results Biofilm was visualized in 15 of 20 patients with CRS on H&E sections, confirmed by microbial presence using FISH. Biofilm was not identified in tissue samples of the nine control patients. On IHC analysis, CD27 and EMBP expression were significantly higher in patients with CRS compared with control (p < 0.05) and had greater expression in biofilm-positive patients compared with biofilm-negative patients. Nasal polyps correlated with higher expression of CD27 and EMBP, but in CRS patients without polyps CD27 and EMBP was also significantly greater in biofilm-positive specimens compared with biofilm-negative specimens. Conclusion Biofilm presence in CRS appears to correlate to host inflammatory response involving plasma cell and eosinophil recruitment.

Bacterial biofilms and increased bacterial counts are associated with airway stenosis.

Objectives Most airway stenoses are acquired secondary to the use of prolonged endotracheal intubation. Antibiotics have been shown to decrease local inflammation and granulation tissue formation in the trachea. However, antibiotic therapy is not 100% effective in preventing or treating granulation tissue formation. Development of bacterial biofilms may explain this finding. This study evaluates the difference between tracheal stenotic segments and normal trachea in terms of (1) presence of bacterial biofilms, (2) quantitative bacterial counts, and (3) inflammatory markers. Study Design Cross-sectional study. Setting Tertiary care academic medical center. Subjects A total of 12 patients were included in the study. Tissue from stenotic segments from 6 patients with airway stenosis undergoing open airway procedures were compared with tracheal tissue from 6 patients without airway stenosis undergoing tracheostomy. Methods Scanning electron microscopy for biofilm detection, quantitative polymerase chain reaction for quantitative analysis of bacterial count, and immunohistochemistry were performed for inflammatory markers transforming growth factor β1 (TGF-β1) and SMAD3. Results Compared with the patients without airway stenosis, patients in the airway stenosis group showed presence of bacterial biofilms, a significantly higher expression of 16S rRNA gene copies per microgram of tissue (187.5 vs 7.33, P = .01), and higher expression of TGF-β1 (91% vs 8%, P < .001) and SMAD3 (83.5% vs 17.8%, P < .001). Conclusion Bacterial biofilms, increased bacterial counts, and higher expression of TGF-β1 and SMAD3 are associated with airway stenosis.

P196 Inhibition of Sphingosine Kinase Potentiates Radiation Therapy in Head and Neck Squamous Cell Carcinoma

Objectives: To examine the expression of sphingosine kinase (SPK) levels in patients with head and neck squamous cell carcinoma (HNSCC) at different clinical stages. To demonstrate that SPK inhibition leads to higher levels of ceramide in HNSCC cells, which enhances irradiation-induced apoptosis and also inhibits tumor invasion and migration. Design: Expression of SPK was determined by Western blot, real-time polymerase chain reaction (RT-PCR), and immunohistochemical staining from fresh and archival tissues and HNSCC cell lines. Sphingosine kinase siRNA was tested to block the tumor growth invasiveness and migration of HNSCC. Ceramide levels and effect of irradiation on tumor and normal cells were studied. Setting: University medical center Patients: Sixteen patients were enrolled in this study with different stage of cancers (stages I through IV) as graded by the American Joint Committee on Cancer staging system. Main Outcome Measure: Expression of SPK. Results: Higher levels of SPK expression were detected in all primary tumors and metastatic lymph nodes than were found in normal mucosa. Patients with advanced disease (stage III/IV) showed higher SPK expression than those with earlier disease stage (I or II). Four HNSCC cell lines showed high expression of SPK; SPK siRNA specifically blocked the expression of SPK and thus increased the ceramide levels. Blocking of SPK resulted in inhibition of cell growth, migration, invasion, and irradiation-induced apoptosis in a dose-dependent manner. Conclusions: To our knowledge, these data are the first to demonstrate the higher expression of SPK in HNSCC than in normal mucosa. The radiation dose needed to cure HNSCC may be reduced by blocking SPK expression, which will improve quality of life for patients with HNSCC.