Syphilitic Uveitis Hospitalizations on the rise, reveals JAMA study

A recent retrospective study by Tahreem Mir and team brought out findings that indicate a significant increase in syphilitic uveitis-related hospitalizations in the United States. The key findings of this study were published in Journal of American Medical Association – Ophthalmology.

This study was conducted by utilizing data from the the Nationwide Inpatient Sample. The research team analyzed data from a total of 444,674 patients from 2010 to 2019. There were an estimated 5,581 syphilitic uveitis-related hospitalizations during this period. The median age of individuals diagnosed was 45 years, with a significant majority (78.9%) being male. Importantly, syphilitic uveitis disproportionately affected African American individuals which constituted 32% of the total cases despite comprising only 13.6% of the population.

Moreover, the individuals belonging to the lowest median household income quartile were significantly impacted which made up 38.8% of the total cases. The national incidence reached 0.15 per 100,000 population which displayed a worrying upward trend. Yearly analysis revealed the lowest incidence in 2011 (0.08 per 100,000) and the highest in 2019 (0.23 per 100,000). The regional breakdowns mirrored this trend with all four US geographical regions experiencing an notable increase in incidence.

The study also identified 23.2% of patients with comorbid AIDS which emphasizes the complexity and severity of cases. Amidst this concerning increase, it is imperative to observe that the study primarily captured inpatient diagnoses.

The increase in syphilitic uveitis-related hospitalizations demands urgent attention from clinicians and public health officials. Also, this spike which is occurring concomitantly with a nation wide shortage of injectable penicillin G suggests a critical scenario for patients in need of treatment. The study highlights the importance of maintaining a high index of suspicion for syphilis when assessing patients with intraocular inflammation.

Source:

Mir, T. A., Kim, S. J., Fang, W., Harvey, J., & Hinkle, D. M. (2023). Rising incidence of syphilitic uveitis–related hospitalizations in the US. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2023.5386

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Ultrasound-guided ESWL may be first treatment choice for distal ureteral stones

Ultrasound-guided ESWL may be first treatment choice for distal ureteral stones suggests a new study published in the Urolithiasis.

The study aimed to analyze the factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy (ESWL) in the treatment of ureteral stones. The clinical data of 8102 patients (6083 men and 2019 women) who presented with ureteral stones were retrospectively analyzed. All the patients were treated with ultrasound-guided ESWL.

The stone-free rate (SFR) was calculated to evaluate the effect of ESWL. The characteristics of the patients and their stones, and the ESWL parameters applied were compared to identify the factors affecting the treatment outcomes. The SFR and that following one ESWL session were 94.6% (7663/8102) and 75.4% (6107/8102), respectively. Multivariate analysis showed that stone location (OR 0.656, p < 0.001), stone size (OR 1.103, p < 0.001), and degree of hydronephrosis (OR 1.952, p < 0.001) independently affected SFR; and age (OR 1.005, p = 0.022), stone location (OR 0.729, p < 0.001), stone size (OR 1.103, p < 0.001), degree of hydronephrosis (OR 1.387, p = 0.001), maximum energy level(OR 0.691, p < 0.001) independently affected SFR following one session. Ultrasound-guided ESWL is effective in all levels of ureteral stones.

Large stone size and moderate hydronephrosis are correlated with treatment failure. Ultrasound-guided ESWL may be the first choice for distal ureteral stones.

While analyzing the efficacy of ultrasound-guided ESWL for ureteral stones, researchers identified stone location, size, and the degree of hydronephrosis as independent factors influencing overall stone-free rates (SFR). Age, stone location, size, degree of hydronephrosis, and maximum energy level affected SFR after one ESWL session. Distal ureteral stones showed positive outcomes across all levels

Reference:

Liang, J., Xie, L., Gao, H. et al. Factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy in the treatment of ureteral stones: a retrospective study. Urolithiasis 52, 15 (2024). https://doi.org/10.1007/s00240-023-01512-9

Keywords:

Ultrasound-guided, ESWL, may be, first, treatment, choice, for, distal, ureteral stones,Liang, J., Xie, L., Gao, H

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Bariatric surgery may offer beneficial cardiac effects in non-HFpEF patients with obesity

Recently, there has been mounting clinical evidence supporting the metabolic and weight-loss benefits of bariatric surgery for obese patients, which leads to improved cardiac structure. However, its effectiveness in enhancing the cardiac function of heart failure patients remains controversial.

A recent study published in Obesity Surgery found bariatric surgery to have beneficial cardiac effects on non-HFpEF (heart failure and preserved ejection fraction) obese patients. However, it did not substantially improve the pooled analysis of cardiac parameters. The extent of improvement may be influenced by factors such as the patient’s baseline age and BMI and BMI loss extent. Shi-jing Lu et al. led the study.

This meta-analysis assessed BS’s effect on cardiac function by examining LVEF (left ventricular ejection fraction) and NYHA  (New York Heart Association) changes in non-HFpEF patients post-surgery.

Articles were sourced from PubMed and Embase, starting from their inception to December 9, 2022, using the Minors scale to evaluate their quality. The study included patients with non-HFpEF and severe obesity, requiring pre-operative and post-operative values of LVEF or NYHA to be reported.

Important points of consideration from the study include:

· Nine studies (146 patients) were included, with a final result showing improved cardiac functional parameters in non-HFpEF patients.

· Following the mean follow-up time of 15.8 months, the mean NYHA decreased by 0.59, and the mean LVEF increased by 7.49%.

In conclusion, bariatric surgery is associated with improved cardiac parameters in patients with non-HFpEF (heart failure and preserved ejection fraction). The extent of BS on cardiac functional improvement may relate to baseline BMI, age, and extent of BMI loss.

Bariatric surgery positively influences the cardiac function of non-HFpEF patients with obesity, they said.

PhD research initiation program of Liaoning Province, 2022-BS-358, funded the study.

Reference:

Lu, Sj et al. Evidence of Bariatric Surgery Benefits Cardiac Function in Non-HFpEF Patients with Obesity: a Meta-Analysis. OBES SURG 33, 3353–3361 (2023). https://doi.org/10.1007/s11695-023-06670-8

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Unbound bilirubin, a robust predictor of acute bilirubin encephalopathy in infants

India: Findings of the association between unbound bilirubin (UB) and acute bilirubin encephalopathy (ABE) indicate that bilirubin-induced neurological dysfunction (BIND) scoring with UB measurement may be useful for evaluating ABE in ≥ 34 weeks GA infants.

The study, published in The Journal of Pediatrics, emphasizes the importance of incorporating UB measurement into BIND scoring for a more accurate evaluation in this patient cohort.

Sanjiv B Amin, Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India, and colleagues conducted the study to compare the association of unbound bilirubin, total serum bilirubin (TSB), and bilirubin: albumin molar ratio (BAMR) with acute bilirubin encephalopathy as assessed by BIND score, in infants with significant hyperbilirubinemia (TSB ≥ 20 mg/dL or underwent exchange transfusion).

The prospective cohort study involved infants ≥ 34 weeks gestational age (GA) with significant hyperbilirubinemia during the first two postnatal weeks. Those with chromosomal disorders, craniofacial malformations, surgery, TORCH infections, or a family history of congenital deafness were excluded. Serum albumin, total serum bilirubin, and unbound bilirubin were measured at hospital admission using the bromocresol green, colorimetric, and modified peroxidase method, respectively.

Infants were assessed on admission for ABE using a standardized neurological examination. They were assigned a BIND score by trained physicians. Infants with a total BIND score of 0 were deemed normal and those with a score ≥ 1 were deemed to have ABE.

The study led to the following findings:

  • A total of 151 infants were studied, among whom 37 had ABE. Of these,
  • 19 had mild ABE [BIND score 1 to 3] and 18 had moderate to severe ABE [BIND score 4-9].
  • On logistic regression, UB, but not TSB or BAMR, was associated with ABE (adjusted OR:1.64).
  • On ordered logistic regression, UB, but not TSB or BAMR, was associated with the severity of ABE (adjusted OR:1.76).

“Unbound bilirubin levels, but not bilirubin: albumin molar ratio or total serum bilirubin, have emerged as a robust predictor of acute bilirubin encephalopathy occurrence and severity in infants ≥ 34 weeks GA,” the researchers wrote.

“This emphasizes the importance of UB measurement incorporation into bilirubin-induced neurological dysfunction scoring for a more accurate evaluation in this patient cohort,” they concluded.

Reference:

Amin SB, Saluja S, Kler N. Unbound Bilirubin and Acute Bilirubin Encephalopathy in Infants Born Late Preterm and Term with Significant Hyperbilirubinemia. J Pediatr. 2023 Dec 20:113880. doi: 10.1016/j.jpeds.2023.113880. Epub ahead of print. PMID: 38135027.

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Low to moderate-intensity exercise may prevent metabolic conditions and atherosclerosis in young people

USA: Compared to no exercise, exercising at low to moderate exercise intensity for 1 h sufficiently attenuated a fat meal-induced postprandial hypertriglyceridemia (PHTG), a recent study published in the Journal of Exercise Science & Fitness has shown. Moderate exercise intensity was also effective in mitigating insulin resistance.

“An acute bout of exercise at 40 %, 60 %, and 70 % VO2 max 12 h before intake of a fat-meal had similar effects on PHTG attenuation,” the researchers reported. “Also, there was an improvement in insulin sensitivity among all exercise trials, leading to decreased insulin response to fat-rich meal.”

The randomized controlled trial found that compared to no exercise, low-intensity exercise on a treadmill for 1 hour significantly lowered serum triglyceride levels following a fat-rich meal that was ingested 12 hours post-exercise

Cardiovascular disease (CVD) is the foremost cause of death worldwide. Postprandial hypertriglyceridemia is a condition characterized by elevated triglyceride levels after a meal. It is a common lipid abnormality linked to an increased CVD risk.

Previous studies showed that exercising at 40-70% intensities not only attenuates PHTG but also lowers insulin response among physically inactive people with metabolic syndrome. However, there is a need to elucidate the effects of different exercise intensities on insulin resistance and PHTG in healthy individuals (non-hyperlipidemic). Therefore, John Q. Zhang, Department of Kinesiology, The University of Texas at San Antonio, USA, and colleagues aimed to investigate the effects of different exercise intensities on insulin resistance and postprandial lipemia (PHTG) in healthy individuals.

The study included 10 adult males (age = 34 ± 2.8 y, fasting plasma TG = 1.36 ± 0.18 mmol/l, body mass = 72.9 ± 2.4 kg, VO2max = 43.7 ± 3.0 ml/kg/min, fasting Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) = 1.7 ± 0.3, and fasting glucose = 5.2 ± 0.2 mmol/l) with normal fasting triglyceride (TG) concentrations.

Each participant performed a control trial (Ctr, no exercise), and three exercise trials at 40 % (40%T), 60 % (60%T), and 70 % (70%T) of their VO2 max. In the exercise trials, participants jogged on a treadmill for one hour at a designated intensity. Each participant consumed a fat-rich meal 12 hours after exercise. Blood samples were taken at 0 h (before the meal), and 2 h, 4 h, 6 h, 8 h, and 24 h after the meal. After the meal, they analyzed the plasma TG, HOMA2-IR, and area score under the TG concentration curve over an 8 period (TG tAUC).

The study led to the following findings:

  • At 2 h, 4 h, and 6 h after the meal, TG in all exercise trials was lower than Ctr but did not differ.
  • All the exercise trials were lower in TG tAUC scores than Ctr, but differences were not observed among the exercise trials.
  • Compared to Ctr, a significant difference in HOMA2-IR in both 60 % T and 70 % T was observed, but not in 40 % T.

“These findings indicate that exercising at low to moderate intensity may be sufficient in preventing metabolic conditions and atherosclerosis among young, healthy, and recreationally active individuals,” the researchers wrote.

“These results may provide exercise-oriented health promotion measures for communities with healthy and at-risk individuals,” they concluded.

Reference:

Ji, L. L., Fretwell, V. S., Escamilla, A., Yao, W., Zhang, T., He, M., & Zhang, J. Q. (2023). An acute exercise at low to moderate intensity attenuated postprandial lipemia and insulin responses. Journal of Exercise Science & Fitness, 22(1), 14-22. https://doi.org/10.1016/j.jesf.2023.10.006

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Hormone Therapy may lower risk of Allergic Rhinitis in Perimenopausal Women

In a recent study conducted between May 2020 and March 2021 at Shijitan Hospital, researchers explored the complex connections between hormone therapy (HT), obesity, and allergic rhinitis (AR) in perimenopausal women. The study found that HT was found to reduce the risk of AR in perimenopausal women and intriguingly an association was also found between HT, BMI, and AR as lean women on HT exhibited a higher risk for AR compared to overweight women on HT.

The study results were published in the journal Allergy, Asthma and Clinical Immunology.

Also Read: Breakthrough Treatment for Allergic Rhinitis: Intratonsillar Injection Shows Promising Results in Clinical Trial

Mounting evidence indicates that both hormone therapy (HT) and obesity play a role in the development of allergic rhinitis (AR). As it is crucial to explore the connections and interplay between HT, body mass index (BMI), and AR specifically in perimenopausal women researchers from China conducted a study to investigate the association and interactions between HT, BMI, and AR in perimenopausal women.

A cross-sectional survey conducted between May 2020 and March 2021 involved patients from the Allergy and Gynecology Departments of Shijitan Hospital. Participants completed a detailed questionnaire, and BMI tertile-stratified analyses were performed. Logistic analyses were employed to assess relationships between HT, BMI, and AR.

Findings:

  • Out of 950 participants, 393 were undergoing HT.
  • HT was associated with elevated risks for AR, asthma, and their respective symptoms.
  • In lean women, HT usage significantly correlated with increased risks for AR, the duration of AR, hay fever, and accompanying symptoms (including canker sores, diarrhea, and stomachache) compared to normal or heavier-weight counterparts.

The study brought to light an interaction effect between HT and BMI concerning AR. Lean women on HT exhibited a higher risk for AR compared to overweight women on HT. The relationship dynamics revealed an intricate interplay, with the course of AR, hay fever, and accompanying symptoms showing statistically significant interactions.

Also Read: Omalizumab may improve outcomes among patients with chronic rhinosinusitis with nasal polyps independent of allergic status

Contrary to previous assumptions, hormone therapy was found to reduce the risk of AR in perimenopausal women. However, the heightened risk in lean women on HT suggests a nuanced relationship that warrants further exploration. The findings not only contribute to a better understanding of the intricate connections between HT, BMI, and AR but also point towards potential shared pathways between hormone therapy and obesity in influencing allergic rhinitis.

Further reading: Liu J, Ma T, Wang X, Bai W, Wang X. Associations between HT, BMI, and allergic rhinitis in perimenopausal women. Allergy Asthma Clin Immunol. 2023;19(1):107. Published 2023 Dec 19. doi:10.1186/s13223-023-00839-7

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Waist Circumference Linked to Female Infertility: Study Reveals Impact Beyond BMI

In a groundbreaking study utilizing data from the National Health and Nutrition Examination Survey (NHANES), researchers have unveiled a significant association between waist circumference (WC) and female infertility among women of childbearing age in the United States. The findings suggest that beyond BMI, waist circumference may play a significant role in female infertility, and engagement in moderate recreational activities could potentially mitigate the risk associated with abdominal obesity.

The study results were published in the journal PLOS One.

Also Read: Women’s risk of infertility increases by 3% for every Kg of weight gained

Obesity carries noteworthy consequences for fertility and reproductive health. Nevertheless, the evidence connecting abdominal obesity to female infertility has been both limited and inconclusive. Hence, researchers aimed to elucidate the possible correlation between waist circumference (WC) and infertility in women of childbearing age in the United States, utilizing data from the National Health and Nutrition Examination Survey.

The cross-sectional study involved 3239 female participants aged 18–45 years. Employing weighted multivariable logistic regression and smoothed curve fitting, the researchers sought to disentangle the influence of waist circumference from other factors, including BMI and potential confounders.

Findings:

  • The results revealed a positive and independent association between waist circumference and female infertility.
  • Even after adjusting for BMI and other confounding variables, every 1cm increase in waist circumference was associated with a 3% rise in the risk of infertility (OR = 1.03, 95% CI: 1.01–1.06).
  • Stratifying WC into quintiles highlighted a striking 2.64 times higher risk of infertility in women in the highest quintile compared to those in the lowest quintile (OR = 2.64, 95% CI: 1.31–5.30).
  • The relationship between WC and infertility was further nuanced by activity levels.
  • Smooth curve fitting revealed a non-linear, dose-dependent association.
  • Intriguingly, an inverted U-shaped relationship emerged in participants engaged in moderate recreational activities, with a turning point at 113.5 cm.
  • For those with deficient recreational activities, a J-shaped relationship was observed, with a turning point at 103 cm.

The study’s conclusions emphasize the significance of waist circumference as an independent predictor of female infertility, irrespective of BMI. This challenges conventional notions that solely focusing on overall obesity metrics suffices in understanding reproductive health implications.

Also Read: Are intracavernosal injections of platelet-rich plasma effective against erectile dysfunction?

Moreover, the findings shed light on the potential protective role of moderate recreational activities. Women engaging in such activities exhibited a lower risk of infertility associated with abdominal obesity. This underscores the importance of not only addressing weight-related factors but also considering lifestyle and physical activity in the context of reproductive health.

Further reading: Association between waist circumference and female infertility in the United States. https://doi.org/10.1371/journal.pone.0295360

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Aspirin tied to reduced risk of mortality, sepsis, and shock among IBD patients

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder affecting the gastrointestinal tract, including Crohn’s disease (CD) and ulcerative colitis (UC). IBD affects over 1 million people in the US and is linked to increased short- and long-term mortality. CD and UC are influenced by microbial, genetic, immune, and environmental factors.

In a study published in the International Journal of Colorectal Disease, Humzah Iqbal et al. and colleagues found that aspirin usage in IBD patients is associated with a reduced risk of mortality, sepsis, and shock. Aspirin may offer protective effects in IBD patients.

IBD can increase the mortality risk. Aspirin is an anti-inflammatory drug used for primary prevention of cardiovascular events. However, the impact of aspirin use on significant outcomes in IBD remains unclear.

The NIS (National Inpatient Sample) 2016-2020 was used to identify adult IBD patients, with data collected on demographics, hospital characteristics, and comorbidities. The study analyzed in-hospital mortality, sepsis, shock, ICU admission, and surgery needs using multivariate logistic regression.

The study could be summarised as follows:

  • The study included 1,524,820 IBD hospitalizations.
  • 137,430 patients were long-term aspirin users.
  • In the aspirin group, 34% of patients were aged > 65 years, 56% were female, 78% were White, and 36% had Medicare insurance.
  • Aspirin users had a lower incidence of in-hospital mortality (1.6% vs 1.4%), sepsis (2.5% vs 2.9%), shock (2.9% vs 3.4%), ICU admission (2.6% vs 2.9%), and surgery need (2.1% vs 4.2%).
  • After adjusting for confounders, aspirin was associated with a reduction in mortality having adjusted odds ratio of 0.49.

They said, Our study used an extensive NIS database to assess the outcomes of patients hospitalized with IBD taking aspirin. Previous literature has shown that White patients are more likely to be taking long-term aspirin even when controlling for cardiovascular risk factors. These findings suggest that the study sample is representative of the population taking aspirin. The study also found lower odds of surgical intervention in patients with long-term aspirin use, which may be due to the effect of aspirin on the disease activity among IBD patients. The incidence of surgical intervention in the study was 4%.

Reference:

Iqbal H et al. The impact of aspirin use on outcomes in patients with inflammatory bowel disease: Insights from a national database. Int J Colorectal Dis. 2023 Dec 20;39(1):6

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Telepsychiatry fails to replace in-person counselling: Study

India: A recent study published in Consortium Psychiatricum showed that patients reported moderate or even low satisfaction with sessions of a telepsychiatry service, however, the doctor’s attitude to the online service was positive. 

Researchers from Dr. Ram Manohar Lohia Institute of Medical Sciences, working in collaboration with their colleges from Era’s Lucknow Medical College & Hospital, as well as the Institute of Human Behaviour and Allied Sciences in New Delhi have found out why the patients did not like the “remote” treatment. 

Because of the lockdown during the pandemic, mentally ill patients could not get in-person psychiatric counseling on a regular basis. To solve this problem, a telepsychiatry service was created in India that helped patients to talk with their doctors while safely staying at home.

In the era of rapid distribution and implementation of digital technologies, telepsychiatry can potentially become an easier, more convenient and cost-effective way for patients to get psychiatric care. But how effective are virtual doctor-patient conversations?

The researchers surveyed 100 subjects to find the answer to this question. All subjects were followed up by psychiatrists for various disorders such as major depression, bipolar and anxiety disorders, obsessive-compulsive disorder or tension headaches accompanied by mild psychiatric symptoms. The patients had been coming for in-person consultations with a psychiatrist for two years before the pandemic, and during the lockdown, they were offered free psychiatric counselling using video conferencing via a special hospital mobile app.

The study subjects got two 15- to 20-minute consultations with a two-week interval. After the second consultation, they were asked to complete the Client Satisfaction Questionnaire-8 (CSQ-8) in a Google form for easier interaction. Then the researchers conducted the statistical data analysis to evaluate the degree of patients’ satisfaction.

The lowest degree of satisfaction was associated with the question “Has the provided medical care helped you overcome your issues more effectively?” over the past two weeks – 61% of patients said no. The next question was “How would you assess the quality of provided care?” 55% of respondents reported poor quality of the provided care. When answering the question “In general, to what extent are you satisfied with the care you have received?”, about 53% of patients reported being dissatisfied or partially satisfied with the care they had been provided.

At the same time, despite admitting the low effectiveness of two virtual sessions, many patients were ready to use the service again (72%) or recommend it to a friend (67%). More than half of respondents said they had received the care they had wanted but to a lesser extent or of poorer quality.

Patients’ demographic characteristics did not significantly affect their responses; however, people living in cities tended to be more satisfied with the remote treatment (most likely due to the fact that they were used to online communication), and so did patients from low-income communities who could not probably afford to get paid psychiatric care.

The doctors suggested that cultural differences of patients from Central Asia and misinterpretation of the patients’ emotions on the screen played a role in the patients’ negative impression of the sessions.

Patients who are satisfied with the process and the outcome of treatment are more adherent to therapy and more likely to have better prognosis. This shows the importance of surveys evaluating patients’ satisfaction: they reveal weaknesses and disadvantages of provided medical care and therefore help healthcare decision-makers develop more effective mental health programs. In this case, too, the feedback from patients regarding the telepsychiatry service may be used to develop guidelines for practice.

According to one of the authors of the study, Dr. Abdul Q Jilani, in the coming decades, online consultations may rise exponentially as it avoid the inconvenience travelling barriers and indirect medical expenses, especially for the follow-up of stable patients.

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Isotretinoin as adjuvant to rhinoplasty increases cosmesis and patient satisfaction

Use of Isotretinoin as an adjuvant to rhinoplasty may increase cosmetic and patient satisfaction suggests a new study published in the International Journal of Dermatology. 

Isotretinoin has been used in the treatment of acne for decades through the reduction of sebaceous secretion. There are reports in the literature that isotretinoin may be associated with decreased skin thickness, especially in patients with thick nasal skin for whom rhinoplasty can be more challenging. The objective of this study was to quantify, through ultrasonography, the effect of the use of oral isotretinoin in patients undergoing rhinoplasty, pre- and postoperatively.

Twenty-four patients participated in this randomized, single-blind controlled pilot clinical trial. The intervention group used oral isotretinoin (20 mg/day) for 2 months before rhinoplasty and for 4 months after. Both groups underwent rhinoplasty in the same plastic surgery department and were submitted to high-frequency (22 MHz) ultrasound evaluation of the epidermis and dermis on the nasal dorsum, nasal tip, and left nose wing at the beginning of the study and 6 months after rhinoplasty, with the aim of assessing changes in skin thickness.

Results

Six months after rhinoplasty, a statistically significant reduction was observed in the thickness of the epidermis and dermis of the nasal dorsum and left nose wing, as well as of the epidermis of the nasal tip, but only in the intervention group. The results of the satisfaction questionnaire were better after rhinoplasty in both groups, with no statistical difference between them regarding the specific questions; however, the intervention group had significantly higher satisfaction scores than the control group.

Isotretinoin was effective in reducing the thickness of the skin covering the nose of the evaluated sites.

Reference:

Silveira, C.S.C., Azulay-Abulafia, L., Barcaui, E.O., Silva, M.M.M. and Roxo, A.C.W. (2023), Analysis of the use of isotretinoin as an adjuvant in rhinoplasty. Int J Dermatol. https://doi.org/10.1111/ijd.16924

Keywords:

Use, Isotretinoin, adjuvant, rhinoplasty, may, increase, cosmetic, patient, satisfaction, Silveira, C.S.C., Azulay-Abulafia, L., Barcaui, E.O., Silva, M.M.M. and Roxo, A.C.W.

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