There has been concern regarding the applicability of the Carolyn’s Window Approach (CWA) to Asian patients because the nasal corridors in Asians are typically narrower externally with lower radix height compared to Western noses. This study evaluated the success rates and frontal sinus patency outcomes of the CWA in a cohort of Asian patients. Patients (≥ 18 years) who underwent frontal sinus surgery via CWA were consecutively enrolled. Patients were followed at 3 and 6 months after surgery. Anthropometric data on nasal appearance were obtained from CT scans. The outcomes were the success rate and the patency of the frontal sinus, determined by the ability to endoscopically visualize the frontal sinus at 3 and 6 months postoperatively. A total of 51 frontal sinuses (41 patients) were included. The ratios of nasal length to tip projection, dorsal height, and radix height were 2.00:0.82:0.49:0.24. All frontal sinus surgeries were successfully performed via the CWA using a 0° endoscope, with visualization of the sinus achieved in all cases. At the 3-month postoperative follow-up, 48 frontal sinuses (94.1
BACKGROUNDPreclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.König) Link ex Dietr.(Phlai). However, its clinical effect on allergic rhinitis (AR) is not evident.OBJECTIVEWe sought to assess the efficacy and safety of Phlai for treating AR.METHODSA phase 3, randomized, double-blind, placebo-controlled study was conducted. Patients with AR were randomized into three groups and received Phlai 100 mg or Phlai 200 mg or placebo once a day for four weeks. The primary outcome was a change in the reflective total five symptom score (rT5SS). The secondary outcomes were the change in the instantaneous total five symptom score (iT5SS), the reflective individual symptom scores (rhinorrhea, nasal congestion, sneezing, itchy nose, itchy eyes), Rhinoconjunctivitis Quality of Life-36 Questionnaire (RCQ-36) score, peak nasal inspiratory flow (PNIF), and adverse events.RESULTSTwo hundred and sixty-two patients were enrolled. Compared with placebo, Phlai 100 mg improved rT5SS [adjusted mean difference (aMD) -0.62; 95%CI -1.22, -0.03; p = 0.039], rhinorrhea (aMD -0.19; 95%CI -0.37, 0.002; p = 0.048), itchy nose (aMD -0.24; 95%CI -0.43, -0.05; p = 0.011), and itchy eyes (aMD -0.19; 95%CI -0.36, -0.02; p = 0.033) at week 4. Nasal obstruction, sneezing, iT5SS, overall RCQ-36 score, PNIF did not reach statistical significance. Phlai 200 mg did not bring additional benefits compared to 100 mg. Adverse events were similar among groups.CONCLUSIONSPhlai was safe. At four weeks, there were small improvements in rT5SS, together with the individual symptoms of rhinorrhea, itchy nose, and itchy eyes.
INTRODUCTION:Survival alone may not fully reflect the quality of emergency and critical care. Neurological outcomes provide an important measure of recovery among critically ill patients treated in the emergency department (ED). OBJECTIVE:To identify patient- and emergency care system-related factors associated with neurological outcomes following ED admission. METHODS:This prospective cohort study was conducted across seven tertiary hospitals in six central provinces of Thailand between December 2023 and May 2024. Critically ill adult patients (≥18 years) admitted to the ED were enrolled. A favorable neurological outcome was defined as a Cerebral Performance Category (CPC) score of 1 or 2. Data were analyzed using a population-averaged Generalized Estimating Equation (GEE) model to account for repeated outcome measurements. RESULTS:Among 442 critically ill adult patients admitted to the ED, the mean age was 66.8 ± 15.0 years, 230 (52.0%) were female, and 254 (57.7%) were classified as Emergency Severity Index (ESI) level 2. At 30 days, 393 patients (96.4%) achieved favorable neurological outcomes. Increasing age (OR 0.95; 95% CI: 0.92-0.97), and a high risk of pre-cardiac arrest signs (OR 0.15; 95% CI 0.03-0.83) were associated with lower odds of favorable neurological outcomes. In contrast, higher emergency nursing competency (OR 2.78; 95% CI: 1.11-6.96) and adherence to clinical practice guidelines for early warning signs monitoring patients' status (OR 2.76; 95% CI: 1.10-6.94) were independently associated with higher odds of favorable neurological outcomes. CONCLUSION:Both patient characteristics and emergency care system factors were associated with neurological outcomes following ED admission. Enhancing emergency nursing competency and adherence to clinical practice guidelines may improve neurological recovery among critically ill patients.
OBJECTIVES:Access to the frontal sinus after receiving angled Draf 2a frontal sinusotomy remains challenging, while adequate postoperative irrigation is essential in managing chronic inflammatory sinus disease. This study compared frontal sinus irrigation distribution between the angled Draf 2a and Carolyn's window approaches, a modification of Draf 2a which removes the nasofrontal beak by drilling to permit direct 0° endoscopic access. METHODS:Fresh human cadaver heads underwent sequential dissection with angled Draf 2a followed by Carolyn's window approach. Each cavity was irrigated using a 250 mL high-pressure squeeze bottle filled with 1/1000 10% fluorescein-labeled water in the Frankfort horizontal position. Fluid irrigation was recorded using an endoscope placed within the frontal sinus. Blinded grading of fluid distribution was performed using a 0-4 scale: 0 (nasal cavity only), 1 (frontal recess), 2 (medial half), 3 (lateral half), and 4 (complete lavage). Scores were compared between two surgical approaches. RESULTS:Eight cadaveric specimens (16 frontal sinuses) were evaluated. Compared with angled Draf 2a frontal sinusotomy, Carolyn's window approach achieved a greater distribution: grade 1 (50.0% vs. 0%), grade 2 (31.3% vs. 0%), grade 3 (6.3% vs. 43.8%), and grade 4 (12.5% vs. 56.3%). The median (IQR) distribution grade following angled Draf 2a frontal sinusotomy was 1.5 (1, 2), and 4 (3, 4) for the Carolyn's window approach (p < 0.01). CONCLUSION:Carolyn's window significantly enhances frontal sinus irrigation compared to angled Draf 2a by improving access and distribution. This technique is robust for enhancing postoperative topical therapy in chronic frontal sinus disease. LEVEL OF EVIDENCE:N/A.
