Beyond type 2 asthma biomarkers: risk stratification for NSAID-exacerbated respiratory disease.

Introduction: Type 2 (T2) asthma is often associated with chronic rhinosinusitis with nasal polyposis (CRSwNP). Additionally, nonsteroidal anti-inflammatory drug (NSAID) intolerance leads to NSAID-exacerbated respiratory disease (N-ERD). Previous transcriptomic data in non-CRSwNP T2 asthma patients showed differentially expressed genes. We focused on ALOX15, CLC, CYSLTR2, HRH4 and SMPD3 to investigate their role in T2 asthma. Methods: The study included 100 healthy controls and 103 T2 asthma patients, divided into patients with asthma (n=54), patients with asthma and CRSwNP (n=29) and patients with N-ERD (n=20). Quantitative PCR analysis was performed on blood-derived RNA samples first to validate the five differentially expressed genes. The data were further analysed to find potential associations and biomarkers. Results: Patients, regardless of stratification, exhibited significantly higher gene expression than healthy controls. The patterns of association revealed that ALOX15 was exclusively present in the non-comorbidity group, SMPD3 and CLC in the comorbidity groups, and HRH4 in all patient groups. ALOX15, CYSLTR2 and SMPD3 expression showed potential as biomarkers to confirm the diagnosis of T2 asthma using peripheral blood eosinophils as the initial criterion. Peripheral blood eosinophils combined with gene expression, especially SMPD3, may improve the diagnosis. CLC and CYSLTR2 expression play a specific role in discriminating N-ERD. Discussion: We validated the transcriptomic data of five differentially expressed genes in T2 asthma. Different patterns of association were identified in patient stratification, suggesting that different molecular mechanisms underlie the spectrum of T2 asthma. Potential biomarkers were also found and used to design an algorithm with practical diagnostic utility for T2 asthma, including risk stratification for N-ERD.

The Role of the Gut and Airway Microbiota in Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review.

In recent years, there has been growing interest in understanding the potential role of microbiota dysbiosis or alterations in the composition and function of human microbiota in the development of chronic rhinosinusitis with nasal polyposis (CRSwNP). This systematic review evaluated the literature on CRSwNP and host microbiota for the last ten years, including mainly nasal bacteria, viruses, and fungi, following the PRISMA guidelines and using the major scientific publication databases. Seventy original papers, mainly from Asia and Europe, met the inclusion criteria, providing a comprehensive overview of the microbiota composition in CRSwNP patients and its implications for inflammatory processes in nasal polyps. This review also explores the potential impact of microbiota-modulating therapies for the CRSwNP treatment. Despite variability in study populations and methodologies, findings suggest that fluctuations in specific taxa abundance and reduced bacterial diversity can be accepted as critical factors influencing the onset or severity of CRSwNP. These microbiota alterations appear to be implicated in triggering cell-mediated immune responses, cytokine cascade changes, and defects in the epithelial barrier. Although further human studies are required, microbiota-modulating strategies could become integral to future combined CRSwNP treatments, complementing current therapies that mainly target inflammatory mediators and potentially improving patient outcomes.

PTGDR2 Expression in Peripheral Blood as a Potential Biomarker in Adult Patients with Asthma.

BACKGROUND: Precision medicine is a promising strategy to identify biomarkers, stratify asthmatic patients according to different endotypes, and match them with the appropriate therapy. This proof-of-concept study aimed to investigate whether gene expression in peripheral blood could provide a valuable noninvasive approach for the molecular phenotyping of asthma. METHODS: We performed whole-transcriptome RNA sequencing on peripheral blood of 30 non-atopic non-asthmatic controls and 30 asthmatic patients. A quantitative PCR (qPCR) validation study of PTGDR2 that encodes for CRTH2 receptor, expressed in cells involved in T2 inflammation, was developed in a cohort of 361 independent subjects: 94 non-asthmatic non-atopic controls, 187 asthmatic patients [including 82 with chronic rhinosinusitis with nasal polyposis (CRSwNP) and 24 with aspirin-exacerbated respiratory disease (AERD)], 52 with allergic rhinitis, and 28 with CRSwNP without asthma. RESULTS: PTGDR2 was one of the most differentially overexpressed genes in asthmatic patients' peripheral blood (p-value 2.64 × 106). These results were confirmed by qPCR in the validation study, where PTGDR2 transcripts were significantly upregulated in asthmatic patients (p < 0.001). This upregulation was mainly detected in some subgroups such as allergic asthma, asthma with CRSwNP, AERD, eosinophilic asthma, and severe persistent asthma. PTGDR2 expression was detected in different blood cell types, and its correlation with eosinophil counts showed differences in some groups of asthmatic patients. CONCLUSIONS: We found that PTGDR2 expression levels could identify asthma patients, introduce a minimally invasive biomarker for adult asthma molecular phenotyping, and add additional information to blood eosinophils. Although further studies are required, analyzing PTGDR2 expression levels in peripheral blood of asthmatics might assist in selecting patients for treatment with specific antagonists.

Cocamidopropyl Betaine Surfactant 0.075% Solution in Physiological Serum for Hygiene Process of COVID-19 Intubated Patients.

When using ventilators in the management of the coronavirus disease 2019 patient, dense and abundant mucous secretions are formed, obstructing the endotracheal tube and making its aspiration difficult. This situation is worsened if in order to minimize the risk of infection of the medical personnel, the humidifier is disconnected. This circumstance forces the tube to be removed, cleaned, or changed, increasing the workload of the intensive care unit staff. Other therapies tested until now, like mesna, acetylcysteine, or hypertonic saline solution, are valid alternatives, although they have not shown great efficacy for this specific procedure in the past. The sanitary emergency forced the collaboration between a pharmacist and an otorhinolaryngologist to develop the cocamidopropyl betaine surfactant formula, after several tests with different concentrations of the surfactant. The objective of this compounding formula was to resolve a mechanical problem and avoid reintubation due to obstruction of the ventilator tube. The cocamidopropyl betaine surfactant solution 0.075% in saline 0.9% (physiological serum) solution demonstrated to be a well-tolerated formula, using inexpensive materials, was simple to prepare, and was easy to use in clinical practice.

Radiation-induced leiomyosarcoma of the posterior neck region.

INTRODUCTION: Leiomyosarcomas are mesenchymal malignant tumours that appear in smooth muscle cells. Their most frequent locations are the uterus and gastrointestinal tract. Their occurrence in head and neck is considered exceptional. We present a patient with a posterior neck region leiomyosarcoma who had received radiation for a nasopharyngeal carcinoma 20 years earlier. The incidence ratio of these tumours in radiated patients (therefore considered radiation-induced) ranges from 0,035 to 0,2%. Radiation-induced sarcomas are difficult to diagnose due to the induration and fibrosis in the radiated area and the non-specific symptoms that they present. Their prognosis is very poor.

[Complications of endoscopic sinus surgery in a residency training program]. / Complicaciones de la cirugía endoscópica nasosinusal en un programa de entrenamiento de residentes.

INTRODUCTION: Endoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. METHODS: Descriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. RESULTS: Of the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade i, 19 (9.8%) cases; grade ii, 55 (28.6%); and grade iii, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21(10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. CONCLUSIONS: Endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.

[Phobic orthostatic insecurity]. / Inseguridad fóbica ortostática.

BACKGROUND AND OBJECTIVES: The authors attempt to expand knowledge about a subjective balance disorder they have called phobic orthostatic insecurity, a condition representing the second cause of medical visits (22.3 %) to their ENT and neuro-otology clinic, and attempt to identify relationships with similar conditions described in psychiatry (agoraphobia, somatoform vertigo, and space-phobia) and in neurology (phobic postural vertigo). They also propose a simple diagnostic method and present their therapies and results. PATIENTS AND METHOD: A total of 151 patients with an indefinite symptomatology of "dizziness" "vertigo" or "insecurity" were evaluated (from 1999 to 2005) by means of a full medical history and an appropriate neurological examination, pharmacological treatments with anxiolytics-antidepressives, a measurement of the degree of depression with the Beck test (a kind of psychiatric benchmark) and with a specific standardized test. RESULTS: Three symptoms and one exploratory condition, among others, were found in all 151 patients studied; these constitute the four bases for a positive diagnosis. This is confirmed if the treatment achieves total remission (this occurred in 69.53 % of all patients) or a sub-total remission (24.49 %), according to valuation scale for insecurity in all situations. CONCLUSIONS: The statistical analysis showed a symptomatic concordance within the group analyzed, a syndromic equivalence between patients and satisfactory results with the antidepressive treatments (94 %), thus confirming the diagnostic and aetiopathogenic hypotheses for the disorder and, later, providing a logical method for diagnosis. The authors propose to assimilate this diagnostic protocol (and therapeutic when no specialist psychotherapy teams are available) to most of the psychogenic insecurity syndromes described.