Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study.

BACKGROUND: Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. METHODS: Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. RESULTS: 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. CONCLUSION: Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.

Achieving the best method to classify Eosinophilic Chronic Rhinosinusitis: a systematic review.

BACKGROUND: Chronic Rhinosinusitis is currently classified into eosinophilic and non-eosinophilic, according to the histologic quantification of the number of eosinophils in nasal mucosa biopsy. There is a lack of unanimous histopathologic criteria and methodology for this classification and no consensus regarding a cut-off point for Eosinophils per High power field. METHODOLOGY: A systematic electronic search was performed on BVS, PUBMED, PUBMED PMC, SCOPUS, WEB OF SCIENCE, EMBASE, COCHRANE and PROQUEST databases looking for studies that reported a cut point for classification of Eosinophilic Chronic Rhinosinusitis (eCRS), and data concerning methodology of classification was extracted. RESULTS: We identified 142 studies that reported 29 different cut-off values for classification of eCRS, and different methods of histologic analysis. Out of these studies 13 reported their own methodology to establish the cut-off point, and used different reference standards as polyp recurrence, asthma and allergy, immunocytochemistry, quality of life index, standard deviation of the control population and cluster analysis. CONCLUSIONS: Further studies are needed to determine a precise cut-off point, especially international multicentered cluster analysis. Moreover, methodologic standardization of biopsy and analysis is needed to certify comparable results. Multiple biopsy sites, densest cellular infiltration area examination and oral steroids restriction at least four weeks before sampling are advisable.

An open multicenter study of the use of gatifloxacin for the treatment of non-complicated acute bacterial rhinosinusitis in adults.

The bacteriological and clinical efficacy and the safety of gatifloxacin for the treatment of non-complicated acute rhinosinusitis was evaluated in 49 adult patients in an open-label multicenter study in Brazil. Patients under age 18, or with associated systemic diseases, were excluded. Diagnosis was based on symptoms, otorhinolaryngological examination, and X-rays of the sinus. At the first visit, all patients were treated with a single daily dose of 400 mg gatifloxacin for 10 days. Middle nasal meatus secretion was collected and sent for culture before and after treatment. Patients were all reevaluated at days 3 to 5; days + 1 to + 5 and 18 to 25 days + 7 to + 14 . Ninety three percent of the patients were considered clinically cured at the end of the treatment. The most frequent bacteria isolated were Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, and at the end of the treatment, presumed bacteriological eradication was observed in almost all patients. Adverse effects were observed in 19 of the cases, mostly mild and self limiting, including diarrhea, abdominal pain, nausea and vomiting. Treatment had to be interrupted in two cases. Gatifloxacin was found to be efficacious and safe for the treatment of acute rhinosinusitis in adults.

An open multicenter study of the use of gatifloxacin for the treatment of non-complicated acute bacterial rhinosinusitis in adults

The bacteriological and clinical efficacy and the safety of gatifloxacin for the treatment of non-complicated acute rhinosinusitis was evaluated in 49 adult patients in an open-label multicenter study in Brazil. Patients under age 18, or with associated systemic diseases, were excluded. Diagnosis was based on symptoms, otorhinolaryngological examination, and X-rays of the sinus. At the first visit, all patients were treated with a single daily dose of 400 mg gatifloxacin for 10 days. Middle nasal meatus secretion was collected and sent for culture before and after treatment. Patients were all reevaluated at days 3 to 5; days + 1 to + 5 and 18 to 25 days + 7 to + 14 . Ninety three percent of the patients were considered clinically cured at the end of the treatment. The most frequent bacteria isolated were Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, and at the end of the treatment, presumed bacteriological eradication was observed in almost all patients. Adverse effects were observed in 19 of the cases, mostly mild and self limiting, including diarrhea, abdominal pain, nausea and vomiting. Treatment had to be interrupted in two cases. Gatifloxacin was found to be efficacious and safe for the treatment of acute rhinosinusitis in adults.

The EBV action in tonsils and adenoids.

The bacteria involved in tonsil disease have been well studied, but we cannot say the same for the viruses. The method to detect virus make this approach difficult to study. Epstein-Barr Virus (EBV) infection usually occurs in early childhood and can persist in palatine and pharyngeal tonsil lymphocytes. EBV has been closely associated with the undifferentiated form of nasopharyngeal carcinoma (NPC) in its effect. Nevertheless, the presence of EBV in non-neoplastic lymphoid tissue of the nasopharynx and tonsil has rarely been investigated. Our objective was to study the frequency of EBV in tonsils and adenoids and to define the correlation between EBV and adenoid hyperplasia. In this study, we looked for EBV in adenoid and tonsil tissue of 165 patients (2 and 15 years old ) by in situ hybridization (ISH) for EBER 1/2 RNA. Resection of the adenoids was done for relief of upper respiratory tract obstruction, and the tonsils were resected because of recurrent tonsillitis and/or hyperplasia with upper airway obstruction. We divided the adenoid samples in two groups: one group 12-24 months old (average 18 months old) and the second group, 25 months to 15 years old. Tonsils were obtained from 85 patients, 3-13 years old (mean age 5.6 years) who underwent surgery due to recurrent tonsillitis or hyperplasia. EBV was demonstrated in lymphoid cells of 11 (34.3%) out of 32 adenoids for the first group and 36 (72%) out of 48 children of the second group. EBV was found in the respiratory epithelial cells of adenoid in one case. Children under 24 months of age can be infected by EBV, and this virus might be responsible for obstructive hyperplasia. Tonsils are less affected by EBV than the adenoids, suggesting that the EBV is more attracted to the adenoid tissue than the tonsillar tissue.

Panorama global da bacteriologia das amígdalas palatinas de crianças / Children palatine tonsils bacteriology: a comprehensive view

A microbiologia das amígdalas continua sendo assunto de muita discussäo. Este trabalho investiga a flora amigdaliana abrangendo-a em praticamente todas as situaçöes patogênicas e também normais. Foram colhidos swabs da superfície de amígdalas de 132 crianças normais (sem AR) em meses quentes (Q> (61 crianças) e frios (F) (71 crianças), de 64 crianças na fase aguda de amigdalite (AA) e de 76 com amigdalite recorrente (com AR, fora da fase aguda). Neste último grupo ainda foi realizado o estudo do core (interior) das amígdalas. Imediatamente após a coleta, o material era introduzido em meio específico e a cultura era realizada no máximo em 8 horas, seguindo padröes da microbiologia clínica. Como resultados, obtivemos uma alta prevalência de Streptococcus viridans nos três grupos. Entre o grupo Q e F foi notado que realmente existem diferenças sazonais, sendo Streptococcus viridans, Neisseria sp e enterobactérias mais freqüentes no grupo F. Comparando-se o grupo com AR e o sem AR vimos que Neisseria sp e enterobactérias säo mais freqüentes no sem AR. No grupo AA, Neisseria sp foi mais freqüente que no grupo normal (sem AR). Este trabalho é importante, pois traz a microbiologia das amígdaIas estudada de forma ampla, melhorando assim a interpretaçäo dos swabs e direcionando a um correto tratamento das afecçöes amigdalianas

Eosinophilic angiocentric fibrosis of the nasal cavity.

Eosinophilic angiocentric fibrosis (EAF) is a rare condition of unknown etiology that causes stenosis of the upper respiratory tract. We report one case in which immunohistochemical studies were performed that involved the mucosa of the lateral nasal wall and septum of a 54-year-old woman. The lesion showed areas with vascular proliferation, small-vessel vasculitis, and dense inflammatory infiltrate consisting of T lymphocytes, macrophages, polyclonal plasma cells, and numerous eosinophils and neutrophils. Other areas were hypocellular and fibrotic, and in those, the collagen bundles showed perivascular onion-skin whorling. The clinical and histologic similarities between our case and those previously described, in addition to the immunohistochemical findings, support the hypothesis that eosinophilic angiocentric fibrosis is a chronic inflammatory condition with a peculiar and striking stromal response.

Comparative bacteriology of the surface of normal and pathological palatine tonsils in children.

There are only few studies on the normal bacteriology of tonsils. The purpose of this study was to acquire knowledge about the normal microflora: patients without recurrent tonsillitis (RT) and without tonsil hypertrophy (TH) and to compare these results with the pathological microflora: patients who have recurrent tonsillitis and/or tonsillar hypertrophy. We did 132 cultures of tonsil surface obtained from normal children and 96 cultures from pathological surfaces during the summer and in the winter. Comparing normal and pathological groups, we found Neisseria spp and Enterobacteria spp more frequently in the normal group. There are differences in the surface microflora of tonsils from normal persons and from individuals with tonsillitis.

Histopathological comparison between tonsil and adenoid responses to allergy.

In a previous study of adenoid tissue from allergic and non-allergic patients, we concluded that in allergic children edema of the "chorium" was present in 80.4% and that treatment with antihistamine drugs may reduce this edema. The purpose of the present study was to compare the histopathology of the palatine tonsil and adenoid from allergic patients. Tissue samples were obtained from 153 patients (56 tonsils and 97 adenoids from allergic children). We analysed the intensity of the edema and its cellular components in the chorium of palatine tonsils and adenoids. The frequently seen edema in the adenoids was significantly different from that in the tonsils. The squamous epithelium of the tonsils was thicker and bad stronger intercellular junctions than the columnar epithelium of the adenoids. This fact probably makes difficult the contact of the antigen with the chorium.

Abscesso retrofaríngeo: dificuldades no diagnóstico / Retropharyngeal abscess: difficults in diagnosis

Os autores apresentam dois casos de abcesso retrofaringeo em criança, apontando suas dificuldades para o diagnóstico e alertando para importância de se ter em mente esta patologia, principalmente nos casos de toxemia com rigidez cervical e torcicolo, evitando-se, assim, com um tratamento adequadoas complicaçöes graves que podem ocorrer

[Antral choanal polyp--cause of nasal obstruction in children: report of 12 cases]. / Pólipo antro-coanal--causa de obstrução nasal na infância: uma série de 12 casos.

Nasal obstruction is a common pediatric clinical complaint that involves a great number of pathologies (allergic rhinopathy,adenoid hypertrophy, septal deformities, infectious sinusitis, tumours, choanal atresia, nasal foreign bodies, etc.). Not only the history, and a through physical examination but also, the subsidiary exams are of great value in the etiologic diagnostic. Antro-choanal polyp (Killian's polyp) must be remembered in the differential diagnosis of nasal obstruction, when a sinus roentgenogram with unilateral maxillary opacification is seen. Clinically, the lesion often protrudes into the nasopharynx and in some cases it may even be seen extending into the oropharynx. The surgical procedure usually employed is a unilateral Caldwell-Luc antrostomy, with oropharyngeal remotion. We present 12 pediatric patients with antral-choanal polyps,and discuss history, radiology, nasal/nasopharyngeal endoscopic evaluation, considerations about the origin and surgical treatment of choice.

[Nasal rhinosporidiosis in children]. / Rinosporidiose nasal na infância.

Rhinosporidiosis is a rare fungal disease resulting from infection by Rhinosporidium seeberi. There seems to be a relationship between the disease and agriculture, suggesting that Rhinosporidium lives in soil, and many authors agree that water is a necessary medium of transmission. The sites of infection are the nose (most common), eye, nasopharynx, penile urethra and external ear. Nasal cases generally present obstruction, epistaxis, watery or mucopurulent discharge, presence of tumoral pedunculated polypoid mass, generally with septal implantation. Histological examination presents characteristic sporangia in large numbers and in the submucosa a granulomatous host response. The treatment is by surgical excision (recurrence occurs in 10% of cases), and medical treatment used diaminodiphenylsulfone or Amphotericin B to avoid recurrent cases. We present a case of Rhinosporidiosis in a 10 years-old child, female, with 3 months history of nasal obstruction, epistaxis and presence of nasal mass in left nasal cavity that was submitted to surgical excision.

Button battery as a foreign body in the nasal cavities. Special aspects.

Alkaline batteries as foreign bodies in the nasal cavities are dangerous because they can cause liquefaction necrosis with subsequent severe local tissue destruction. Batteries found in the nasal cavities should be removed immediately to prevent sequelae such as septal perforations or nasal meatus stenosis. Due to the common use of these batteries (e.g. watches, electronic toys and games, calculators) physicians and the general public should be more aware of this type of foreign body and the peculiarities in their management. We present five cases of button battery foreign bodies in the nasal cavities and review 12 cases described in the literature and discuss the special aspects of these foreign bodies.