Adult subjects undergoing PKT do not experience less postoperative pain in comparison to MCT.

Allergic fungal sinusitis (AFS) is a condition that has an allergic basis caused by exposure to fungi in the sinonasal tract leading to chronic inflammation. Despite standard treatment modalities, which typically include surgery and medical management of allergies, patients still have a high rate of recurrence. Subcutaneous immunotherapy (SCIT) has been used as adjuvant treatment for AFS. Evidence exists to support the use of sublingual immunotherapy (SLIT) as a safe and efficacious method of treating allergies, but no studies have assessed the utility of SLIT in the management of allergic fungal sinusitis. A record review of cases of AFS that are currently or previously treated with sublingual immunotherapy from 2007 to 2011 was performed. Parameters of interest included serum IgE levels, changes in symptoms, Lund-McKay scores, decreased sensitization to fungal allergens associated with AFS, and serum IgE levels. Ten patients with diagnosed AFS were treated with SLIT. No adverse effects related to the use of SLIT therapy were identified. Decreases in subjective complaints, exam findings, Lund-McKay scores, and serum IgE levels were observed. Thus, sublingual immunotherapy appears to be a safe adjunct to the management of AFS that may improve patient outcomes.

PatientAt our monthly meeting on maternal morbidity we discussed a 31 year old woman at 35 weeks' gestation. She was admitted to the labour and delivery ward because of elevated blood pressure (155/90 mm Hg). Laboratory tests showed increased levels of aspartate aminotransferase and alanine aminotransferase in addition to proteinuria. Her platelet count was 68 000. She received no corticosteroids antepartum or post partum for HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome, and both she and her infant did well.In recent months we had cared for other women with HELLP syndrome who were given corticosteroids on the recommendation of our obstetrical consultants (none were present at the meeting). This experience raised the issue of whether such patients benefit from corticosteroids. The family physicians, obstetricians, and nurse midwives at the meeting were unable to reach consensus on this topic, and those with opinions were unaware of supporting evidence. As our question remained unanswered, we decided to assess current evidence. In doing so we framed the question: "Among patients with HELLP syndrome, does the administration of corticosteroids improve maternal morbidity in terms of both laboratory and clinical parameters?" SearchWe searched Medline from 1966 to February 2004 using the key words "HELLP syndrome" (all subheadings) AND "corticosteroids" (which mapped to "adrenal cortex hormones"). Our search produced 36 citations. We reviewed the titles to determine which articles might answer our question. When the study objective was not clear from the title, we read the abstract. Although we found no systematic reviews of randomised controlled trials in the Cochrane Library, there is a protocol for a systematic review.

Among patients with SCD, the prevalence of CM-I is elevated. This association is especially marked in patients with posterior SCD. This finding suggests a relationship between CM-I and SCD, particularly with posterior SCD.

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