Smriti Nayan

Smoking cessation interventions and cessation rates in the oncology population: an updated systematic review and meta-analysis.

Objectives To evaluate tobacco smoking cessation interventions and cessation rates in the oncology population through a systematic review and meta-analysis. Data Sources The literature was searched using PubMed, Google Scholar, Medline, EMBASE, and the Cochrane Library (inception to October 2012) by 3 independent review authors. Review Methods Studies were included if they were randomized controlled trials (RCTs) or prospective cohort (PCs) studies evaluating tobacco smoking cessation interventions with patients assigned to a usual care or an intervention group. The primary outcome measure was smoking cessation rates. Two authors extracted data independently for each study. When applicable, disagreements were resolved by consensus. Results The systematic review identified 10 RCTs and 3 PCs. Statistical analysis was conducted using StatsDirect software (Cheshire, UK). Pooled odds ratios (ORs) for smoking cessation interventions were calculated in 2 groups based on follow-up duration. The therapeutic interventions included counseling, nicotine replacement therapy, buproprion, and varenicline. Smoking cessation interventions had a pooled odds ratio of 1.54 (95% confidence interval [CI], 0.909-2.64) for patients in the shorter follow-up group and 1.31 (95% CI, 0.931-1.84) in the longer follow-up group. Smoking cessation interventions in the perioperative period had a pooled odds ratio of 2.31 (95% CI, 1.32-4.07). Conclusion Our systematic review and meta-analysis demonstrate that tobacco cessation interventions in the oncology population, in both the short-term and long-term follow-up groups, do not significantly affect cessation rates. The perioperative period, though, may represent an important teachable moment with regard to smoking cessation.

YouTube: a good source of information on pediatric tonsillectomy?

OBJECTIVE To investigate YouTube as a patient information source on pediatric tonsillectomy. METHODS YouTube was searched on July 31, 2012 for the search terms pediatric tonsillectomy (PT), tonsillectomy (T) and tonsil surgery (TS). Non-English videos were excluded. Two physician reviewers independently assessed the videos for characteristics, usefulness, and information source. Usefulness was assessed according to a checklist developed by the authors. Any discrepancies were resolved by consensuses. Data were analyzed with SPSS software. RESULTS One hundred fifty-six videos were included in the analysis. Forty videos were classified as very or moderately useful (25.6%). Sources of the videos were as follows: patient experience, 103 videos (66%); physician, 30 (19%); surgical technique, 14 (9%); and news report, 9 (6%). Physician sourced information was generally at least moderately useful (58%) and patient experience videos were the predominant source of videos categorized as not useful or misleading (50%). Physician sourced information (coefficient=0.61; 95% CI: .21 to 1.00, p=0.003) and PT search term (coefficient=0.26; 95% CI: 0.05 to .47, p=0.017) were the most useful videos after adjusting for mean duration, days online, number of views and page search. CONCLUSION YouTube has a large number of videos on pediatric tonsillectomy with a variety of content ranging from very useful to not useful, and misleading. Health care professionals must recognize the potential influence that these video Web sites may have on patient attitudes.

Evaluating Smoking Cessation Interventions and Cessation Rates in Cancer Patients: A Systematic Review and Meta-Analysis

Background. Tobacco smoking cessation interventions in the oncology population are an important part of comprehensive treatment plan. Objectives. To evaluate through a systematic review smoking cessation interventions and cessation rates in cancer patients. Search Strategy. The literature was searched using Medline, EMBASE, and the Cochrane Library (inception to November 2010) by three independent review authors. Selection Criteria. Studies were included if tobacco smoking cessation interventions were evaluated and patients were randomized to usual care or an intervention. The primary outcome measure was cessation rates. Data Collection and Analysis. Two authors extracted data independently for each paper, with disagreements resolved by consensus. Main Results. The systematic review found eight RCTs investigating smoking cessation interventions in the oncology patient population. Pooled relative risks were calculated from two groups of RCTs of smoking cessation interventions based on followup duration. In both groups, the pooled relative risk did not suggest a statistically significant improvement in tobacco cessation compared to usual care. Conclusions. Our review demonstrates that recent interventions in the last decade which are a combination of non-pharmacological and pharmacological approaches yield a statistically significant improvement in smoking cessation rates compared to usual care.

The Proportion of Malignancy in Incidental Thyroid Lesions on 18-FDG PET Study: A Systematic Review and Meta-analysis.

Objective To evaluate through a systematic review and meta-analysis the malignancy rates of thyroid incidentalomas identified in adults by 18-fluorodeoxyglucose positron emission tomography, computed tomography (18-FDG PET-CT) imaging studies. Data Sources The literature search was conducted using OVID Medline, EMBASE, the Cochrane Library, Google Scholar, Pubmed, and reference list review (inception to April 2013) by 2 independent review authors. Review Methods Studies with adults undergoing 18-FDG PET scan identifying a thyroid incidentaloma with definitive histological or cytological results reported were included. Results Thirty-one studies with a total of 197,296 PET studies and 3659 focal thyroid incidentalomas were identified with 1341 having definitive cytopathology or histopathology. The pooled proportion of malignancy was calculated as 19.8% (95% confidence interval [CI], 15.3%-24.7%) with 15.4% (95% CI, 11.4%-20.0%) of the total cases being papillary thyroid cancer. Distant metastases represented 1.1% (95% CI, 0.6%-1.8%) of the total cases. Conclusions Our systematic review and meta-analysis suggests that the incidence of malignancy is high in thyroid incidentalomas identified through 18-FDG PET imaging studies. Thyroid incidentalomas identified through 18-FDG PET require thorough investigation.

Treatment of Aspirin Exacerbated Respiratory Disease with a Low Salicylate Diet A Pilot Crossover Study

Objective Aspirin exacerbated respiratory disease (AERD) is comprised of aspirin/acetylsalicylic acid (ASA) sensitivity, bronchial asthma, and nasal polyposis. Treatment of this condition is challenging and may include topical/systemic steroids, endoscopic sinus surgery, and/or aspirin desensitization. Study Design A prospective crossover pilot study (n = 10) was conducted in which patients were randomized into either of 2 groups with 6 weeks of regular diet (R) or 6 weeks of a low salicylate diet (LS). Setting The study was conducted in a tertiary otolaryngology clinic. Subjects Patients with AERD were enrolled in the study. Methods Subjective (Sino-nasal Outcome Test-22 [SNOT-22], Nasal Sinus Symptom Scale [NSSS], and the Asthma Control Questionnaire-7 [ACQ-7]) and objective outcome instruments (Peri-Operative Sinus Evaluation [POSE] and Lund-Kennedy Endoscopic Score [LKES]) were used to evaluate patients at baseline, 6 weeks (at crossover), and 12 weeks. Results Wilcoxon rank sum tests demonstrated that patients on the low salicylate diet had improved scores compared to their regular diet when evaluated by 4 of the 5 outcome measures (SNOT-22 pLS = 0.0059, NSSS pLS = 0.0195, LKES pLS = 0.0039, POSE pLS = 0.005). Conclusion Results of the pilot study indicate that implementation of a low salicylate diet improves the nasal symptoms and nasal endoscopy findings of individuals with AERD. Further research is required to support these findings.

Cervical esophageal duplication cyst: case report and review of the literature ☆

Cervical esophageal duplication cysts are rare congenital anomalies that can be successfully managed surgically. These anomalies are rare causes of upper airway obstruction. We present here a case of a cervical esophageal duplication cyst in an infant, along with a review of the literature concerning this anomaly.

A novel treatment adjunct for aspirin exacerbated respiratory disease: the low-salicylate diet: a multicenter randomized control crossover trial

Aspirin‐exacerbated respiratory disease (AERD) is a clinical triad consisting of aspirin/acetylsalicylic acid (ASA) sensitivity, bronchial asthma, and nasal polyposis. Although respiratory reactions following ingestion of ASA and other nonsteroidal anti‐inflammatory drugs (NSAIDs) are considered a hallmark of the condition, respiratory inflammation persists despite patients’ avoidance of NSAIDs. Treatment of this condition remains challenging and includes both medical and surgical options.

Squeeze Bottle versus Saline Spray after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Pilot Multicentre Trial:

Background There is a need for controlled trials to guide the perioperative management of patients undergoing endoscopic sinus surgery (ESS). The authors performed a pilot multicenter trial to compare two types of saline delivery devices in this population. Methods Patients were randomized to high volume saline irrigation with a squeeze bottle and low volume saline spray after ESS in patients with chronic rhinosinusitis (CRS). Surgeons were blinded to treatment, and one-month postoperative scores for sinonasal outcomes [Sinonasal Outcome Test-22 (SNOT-22)] scale, nasal and sinus symptom score (NSS), and perioperative sinus endoscopy (POSE) scale were compared with preoperative scores. Results Nine centers provided data for 86 patients. All three outcomes measures improved significantly for both groups. Saline spray: SNOT-22 48.8 versus. 23.7, treatment effect 25.1 (95% confidence interval [CI], 17.9-32.2), POSE 21.1 versus. 8.4, treatment effect 12.7 (95% CI, 9.2-16.1), and NSS 8.2 versus 5.0, treatment effect 3.1 (95% CI, 1.4-4.9) pre- and postoperatively, respectively (all p < 0.0001). Squeeze bottle: SNOT-22 49.5 versus 23.6, treatment effect 25.9 (95% CI, 20.3-31.6), POSE 18.6 versus 9.2, treatment effect 9.3, (95% CI 6.7-12.0), and NSS 9.0 versus 5.7, treatment effect 3.3 (95% CI, 2.3-4.3) pre- and postoperatively, respectively (all p < 0.0001). Analysis of variance did not identify a difference between the two treatment groups. Subgroup analysis based on preoperative disease severity did not change the nonassociation of saline bottle with outcome measures. Post hoc sample size calculation determined that 176 patients is required to detect an 8.9-point difference in SNOT-22 scores. Conclusion In this pilot multicenter trial examining patients with chronic rhinosinusitis undergoing ESS, both squeeze bottle and saline spray showed significant improvement in SNOT-22, POSE, and NSS scores at one-month postoperatively. Because the study was nonpowered, we cannot rule out a potential difference between the two treatment groups.

Humoral Primary Immunodeficiencies in Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) may be the primary presenting symptom for primary immunodeficiencies (PID). PID can affect the humoral or the cellular immune system. This paper provides an overview of PID which affect the humoral immune system, with details around the diagnostic criteria, the epidemiology, the subtypes, the clinical manifestations, underlying molecular mechanisms, methods to screen for PID and the management of CRS in the context of PID. A high clinical suspicion of PID is required when assessing patients with CRS who are refractory to maximal medical therapy.

Dietary modifications for refractory chronic rhinosinusitis? Manipulating diet for the modulation of inflammation.

Background An endotype of chronic rhinosinusitis (CRS) refractory to medical and surgical management is characterized by persistent T-helper 1/T-helper 17 inflammation of the sinus mucosa, which potentially facilitates colonization with dysbiotic microbial flora. Dietary interventions that target reduction of systemic inflammation are increasingly recommended as adjuncts to ongoing medical therapy in chronic disorders with a strong inflammatory component, such as cardiac disease, diabetes, and metabolic syndrome. Inflammation-reducing dietary modifications may thus be of benefit in patients with refractory CRS (RCRS). Objective To identify nonpharmacologic approaches that implicate modification of dietary factors, potentially reducing systemic level of inflammation in RCRS. Methods A systematic review of the literature was undertaken to identify dietary strategies for reducing inflammation in metabolic syndrome, diabetes, and cardiac disease. Mechanistic-based strategies for reducing systemic inflammation were identified and categorized to identify potential therapeutic avenues, which would be applicable to RCRS. Results Principal mechanisms for altering inflammation at the systemic level via dietary manipulation center around (1) increased consumption of foods with anti-inflammatory properties, and (2) modulation of the gut microbiome to reduce short-chain fatty acid secretion by dysbiotic gut flora. Recommended dietary modifications to reduce systemic markers of inflammation or to improve RCRS include alteration of macronutrient intake, alterations in consumption of meat and fats, consumption of prebiotics and probiotics, and a low-salicylate diet in the context of aspirin-exacerbated respiratory disease. Conclusion Dietary modifications may offer a potential nonpharmacologic means of reducing inflammation in patients with RCRS and hence may represent a complementary adjunct to existing medical therapies. Additional prospective studies are required to further validate the concept of dietary modifications in patients with RCRS to support the findings.