Browsing by Author "Maul, Ximena"

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    A Clinical Decision Analysis for Use of Antibiotic Prophylaxis for Nonabsorbable Nasal Packing
    (2021) Maul, Ximena; Dincer, Berkay C.; Wu, Arthur W.; Thamboo, Andrew, V; Higgins, Thomas S.; Scangas, George A.; Oliveira, Kristin; Ho, Allen S.; Mallen-St Clair, Jon; Walgama, Evan
    Objective Nonabsorbable nasal packing is often placed for the treatment of epistaxis or after sinonasal or skull base surgery. Antibiotics are often prescribed to prevent toxic shock syndrome (TSS), a rare, potentially fatal occurrence. However, the risk of TSS must be balanced against the major risk of antibiotic use, specifically Clostridium difficile colitis (CDC). The purpose of this study is to evaluate in terms of cost-effectiveness whether antibiotics should be prescribed when nasal packing is placed. Study Design A clinical decision analysis was performed using a Markov model to evaluate whether antibiotics should be given. Setting Patients with nonabsorbable nasal packing placed. Methods Utility scores, probabilities, and costs were obtained from the literature. We assess the cost-effectiveness of antibiotic use when the risk of community-acquired CDC is balanced against the risk of TSS from nasal packing. Sensitivity analysis was performed for assumptions used in the model. Results The incremental cost-effectiveness ratio for antibiotic use was 334,493 US dollars (USD)/quality-adjusted life year (QALY). Probabilistic sensitivity analysis showed that not prescribing antibiotics was cost-effective in 98.0% of iterations at a willingness to pay of 50,000 USD/QALY. Sensitivity analysis showed that when the risk of CDC from antibiotics was greater than 910/100,000 or when the incidence of TSS after nasal packing was less than 49/100,000 cases, the decision to withhold antibiotics was cost-effective. Conclusions Routine antibiotic prophylaxis in the setting of nasal packing is not cost-effective and should be reconsidered. Even if antibiotics are assumed to prevent TSS, the risk of complications from antibiotic use is of greater consequence.
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    The European lactase persistence genotype determines the lactase persistence state and correlates with gastrointestinal symptoms in the Hispanic and Amerindian Chilean population: a case-control and population-based study
    (BMJ PUBLISHING GROUP, 2011) Morales, Eugenia; Azocar, Lorena; Maul, Ximena; Perez, Claudio; Chianale, Jose; Francisco Miquel, Juan
    Background: The lactase persistent (LP) or lactase nonpersistent (LNP) state in European adults is genetically determined by a single nucleotide polymorphism (SNP) located 13.9 kb upstream of the lactase (LCT) gene, known as LCT C>T-13910 (rs4988235). The LNP condition leads to an inability to digest the milk sugar lactose leading to gastrointestinal symptoms and can affect nutrient and calcium intake in certain populations.
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    The Inferior Turbinate: Role in Normal Respiration and Airway Obstruction
    (2021) Thamboo, Andrew; Ayoub, Noel; Maul, Ximena; Nayak, Jayakar
    Purpose of Review The understanding of the inferior turbinate (IT) function, role in nasal obstruction, and its management for symptomatic relief has evolved. We aim to provide a comprehensive review of the anatomy, contribution to nasal function and response of the IT to sinonasal disease. Recent Findings Techniques to study the nasal physiology are expanding; these include the computational flow dynamics that has allowed a better understanding of the function and role of the inferior turbinate in normal respiration and airway obstruction. The IT function includes warming, moisturizing, and filtering the air prior to the entrance to the lower airways. More sophisticated techniques have been developed to study the nasal physiology, though not widely used in clinical practice.