Tonsils are major sites of persistence of SARS-CoV-2 in children.

In the present study, we show that SARS-CoV-2 can infect palatine tonsils, adenoids, and secretions in children without symptoms of COVID-19, with no history of recent upper airway infection. We studied 48 children undergoing tonsillectomy due to snoring/OSA or recurrent tonsillitis between October 2020 and September 2021. Nasal cytobrushes, nasal washes, and tonsillar tissue fragments obtained at surgery were tested by RT-qPCR, immunohistochemistry (IHC), flow cytometry, and neutralization assay. We detected the presence of SARS-CoV-2 in at least one specimen tested in 27% of patients. IHC revealed the presence of the viral nucleoprotein in epithelial surface and in lymphoid cells in both extrafollicular and follicular regions, in adenoids and palatine tonsils. Also, IHC for the SARS-CoV-2 non-structural protein NSP-16 indicated the presence of viral replication in 53.8% of the SARS-CoV-2-infected tissues. Flow cytometry showed that CD20+ B lymphocytes were the most infected phenotypes, followed by CD4+ lymphocytes and CD123 dendritic cells, CD8+ T lymphocytes, and CD14+ macrophages. Additionally, IF indicated that infected tonsillar tissues had increased expression of ACE2 and TMPRSS2. NGS sequencing demonstrated the presence of different SARS-CoV-2 variants in tonsils from different tissues. SARS-CoV-2 antigen detection was not restricted to tonsils but was also detected in nasal cells from the olfactory region. Palatine tonsils and adenoids are sites of prolonged RNA presence by SARS-CoV-2 in children, even without COVID-19 symptoms. IMPORTANCE This study shows that SRS-CoV-2 of different lineages can infect tonsils and adenoids in one quarter of children undergoing tonsillectomy. These findings bring advancement to the area of SARS-CoV-2 pathogenesis, by showing that tonsils may be sites of prolonged infection, even without evidence of recent COVID-19 symptoms. SARS-CoV-2 infection of B and T lymphocytes, macrophages, and dendritic cells may interfere with the mounting of immune responses in these secondary lymphoid organs. Moreover, the shedding of SARS-CoV-2 RNA in respiratory secretions from silently infected children raises concern about possible diagnostic confusion in the presence of symptoms of acute respiratory infections caused by other etiologies.

Clinical utility of PPPM and FPS-R to quantify post-tonsillectomy pain in children.

OBJECTIVES: As pain is a subjective and difficult parameter to assess in children, we aimed to evaluate the correspondence of two pain scales - parents' post-operative pain measure (PPPM) and faces pain scale-revised (FPS-R) with analgesic intake in the assessment of post-tonsillectomy pain in a pediatric population. METHODS: Children aged 4-10 years (n=174) undergoing tonsillectomy with or without adenoidectomy had their pain monitored by PPPM and FPS-R over 7 days following surgery. The amount of analgesic (acetaminophen or dipyrone) intake was also recorded each day. Linear regression and correlation analysis were performed for pain scales and Poisson regression model for analgesic administration. To evaluate influence of gender linear regression and logistic regression with random effects were performed. RESULTS: PPPM and FPS-R presented a significant positive correlation (τ=0.5; R(2)=0.36; p<0.001). PPPM and FPS-R also showed a significant correlation with analgesic use over the 7 post-operative days (p<0.0001). No influence of gender was observed in pain levels by both scales. CONCLUSIONS: Our data demonstrate that PPPM and FPS-R are equivalent pain scales to quantify post-tonsillectomy pain in children and are useful tools in post-tonsillectomy clinical research.

High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease.

Chronic tonsillar diseases are an important health problem, leading to large numbers of surgical procedures worldwide. Little is known about pathogenesis of these diseases. In order to investigate the role of respiratory viruses in chronic adenotonsillar diseases, we developed a cross-sectional study to determine the rates of viral detections of common respiratory viruses detected by TaqMan real time PCR (qPCR) in nasopharyngeal secretions, tonsillar tissues and peripheral blood from 121 children with chronic tonsillar diseases, without symptoms of acute respiratory infections. At least one respiratory virus was detected in 97.5% of patients. The viral co-infection rate was 69.5%. The most frequently detected viruses were human adenovirus in 47.1%, human enterovirus in 40.5%, human rhinovirus in 38%, human bocavirus in 29.8%, human metapneumovirus in 17.4% and human respiratory syncytial virus in 15.7%. Results of qPCR varied widely between sample sites: human adenovirus, human bocavirus and human enterovirus were predominantly detected in tissues, while human rhinovirus was more frequently detected in secretions. Rates of virus detection were remarkably high in tonsil tissues: over 85% in adenoids and close to 70% in palatine tonsils. In addition, overall virus detection rates were higher in more hypertrophic than in smaller adenoids (p = 0.05), and in the particular case of human enteroviruses, they were detected more frequently (p = 0.05) in larger palatine tonsils than in smaller ones. While persistence/latency of DNA viruses in tonsillar tissues has been documented, such is not the case of RNA viruses. Respiratory viruses are highly prevalent in adenoids and palatine tonsils of patients with chronic tonsillar diseases, and persistence of these viruses in tonsils may stimulate chronic inflammation and play a role in the pathogenesis of these diseases.

Mastoidite fúngica em paciente com sida: relato de caso / Fungal mastoiditis in aids patients: reported cases

Introdução: Mastoidite fúngica por Aspergillus fumigatus ocorre predominantemente em pacientes imunossuprimidos. O diagnóstico geralmente é difícil e a doença é potencialmente fatal. O tratamento consiste em terapia antifúngica, desbridamento cirúrgico e correção da imunossupressão. Relato do Caso: Este artigo trata-se de um relato de um caso de mastoidite fúngica em um paciente com síndrome da imunodeficiência adquirida (SIDA). O tratamento realizado foi o cirúrgico associado à terapia antifúngica. O nervo facial deste paciente não estava afetado, o que não exclui complicações potencialmente fatais da mastoidite.

Introduction: Fungal mastoidits by Aspergillus fumigates predominantly occurs in immunosuppressed patients. Diagnosis is usually hard and disease is potentially fatal. Treatment is comprised of antifungal therapy, surgical debridement and immunosuppression correction. Case Report: This article reports a case of fungal mastoiditis in a patient with acquired immunodeficiency syndrome (AIDS). The treatment performed was that of surgery associated with antifungal therapy. The patient's facial nerve was not affected, what does not exclude potentially fatal complications of mastoiditis.

Long-term evaluation in aesthetic rhinoplasty in an academic referral center.

UNLABELLED: Plastic surgery is based on improving esthetic for the patient. In most services, the surgery outcome is evaluated in a subjective manner. AIM: to objectively assess the degree of patient satisfaction one year after rhinoplasty using the Rhinoplasty Outcome Evaluation questionnaire at a referral academic center. MATERIALS AND METHODS: 69 patients operated in the otorhinolaryngology service were selected. The patients were operated upon by third year residents during the period from January to December 2007 and answered the questionnaire translated by the authors of this study. RESULTS: we obtained a mean value of 73.25% of satisfaction for primary rhinoplasty and a mean value of 72.02% of satisfaction for secondary rhinoplasty. CONCLUSION: the level of satisfaction presented by the patients was considered to be very good.

Avaliação tardia em rinoplastia estética em um centro acadêmico de referência / Long-term evaluation in aesthetic rhinoplasty in an academic referral center

A cirurgia estética tem por fundamento a melhora estética dos pacientes. O resultado das cirurgias é avaliado de modo subjetivo na maioria dos serviços. OBJETIVO: Avaliar objetivamente o grau de satisfação dos pacientes um ano após a rinoplastia, utilizando o questionário Rhinoplasty Outcome Evaluation, num centro acadêmico de referência. MATERIAIS E MÉTODOS: Foram selecionados 69 pacientes no serviço de otorrinolaringologia, operados por médicos residentes do terceiro ano no período de Janeiro a Dezembro de 2007 que responderam o questionário traduzido pelos autores do estudo. RESULTADO: Obtivemos uma média de 73,25 por cento de grau de satisfação para rinoplastia primária e 72,02 por cento para secundária. CONCLUSÃO: O grau de satisfação apresentado pelos pacientes foi considerado muito bom.

Plastic surgery is based on improving esthetic for the patient. In most services, the surgery outcome is evaluated in a subjective manner. AIM: to objectively assess the degree of patient satisfaction one year after rhinoplasty using the Rhinoplasty Outcome Evaluation questionnaire at a referral academic center. MATERIALS AND METHODS: 69 patients operated in the otorhinolaryngology service were selected. The patients were operated upon by third year residents during the period from January to December 2007 and answered the questionnaire translated by the authors of this study. RESULTS: we obtained a mean value of 73.25 percent of satisfaction for primary rhinoplasty and a mean value of 72.02 percent of satisfaction for secondary rhinoplasty. CONCLUSION: the level of satisfaction presented by the patients was considered to be very good.