Assuntos
Alérgenos/imunologia , Asma/imunologia , Síndrome de Churg-Strauss/imunologia , Imunoglobulina E/imunologia , Otorrinolaringopatias/imunologia , Adulto , Idoso , Asma/fisiopatologia , Estudos de Casos e Controles , Síndrome de Churg-Strauss/fisiopatologia , Feminino , Granulomatose com Poliangiite/imunologia , Humanos , Masculino , Análise em Microsséries , Poliangiite Microscópica/imunologia , Pessoa de Meia-Idade , Otorrinolaringopatias/fisiopatologiaRESUMO
Introduction: Due to the circumstances of the Covid-19 pandemic, the teaching during the block internship at the Department for Otorhinolaryngology was switched to digital learning. Various online courses were created and the utilisation by the students was analyzed. Material & methods: Examination videos, surgical images and videos were created and live lectures were held. In addition, patient cases of common otorhinolaryngological diseases were reconstructed on an interactive platform. A total of 16 cases were offered in weekly rotation. These cases are provided with gap texts, open and selection questions, links and videos and thematically appropriate digression offers. The time-consuming creation was carried out as a HTML 5 learning package with the authoring program Exelearning 2.5. Each case was to be evaluated separately after being worked on by the students. Results: The direct feedback and the evaluation results of the students on the internship and case presentations were consistently positive. However, on average only 50.72% of the registered students took part in the weekly video meetings. In the course of the semester, the willingness to participate decreased. In addition, the willingness to evaluate the patient cases was low. Discussion: With the case presentation tool, concrete patient examples can be well presented, especially when patient contact is not possible (especially in an ENT clinic due to violation of distance and hygienic rules). Even though the evaluations were positive in terms of content, the frequency of utilisation and also the motivation for feedback seems disappointing. This seems to be associated above all with an increasing return to everyday life after the end of the lockdown.
Assuntos
COVID-19/epidemiologia , Instrução por Computador/métodos , Educação a Distância/organização & administração , Educação Médica/organização & administração , Otorrinolaringopatias/fisiopatologia , Avaliação Educacional , Humanos , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Pandemias , SARS-CoV-2RESUMO
The endoplasmic reticulum (ER) is an important organelle for normal cellular function and homeostasis in most living things. ER stress, which impairs ER function, occurs when the ER is overwhelmed by newly introduced immature proteins or when calcium in the ER is depleted. A number of diseases are associated with ER stress, including otorhinolaryngological diseases. The relationship between ER stress and otorhinolaryngologic conditions has been the subject of investigation over the last decade. Among otologic diseases associated with ER stress are otitis media and hearing loss. In rhinologic diseases, chronic rhinosinusitis, allergic rhinitis, and obstructive sleep apnea are also significantly associated with ER stress. In this review, we provide a comprehensive overview of the relationship between ER stress and otorhinolaryngological diseases, focusing on the current state of knowledge and mechanisms that link ER stress and otorhinolaryngologic diseases.
Assuntos
Estresse do Retículo Endoplasmático/fisiologia , Otorrinolaringopatias/fisiopatologia , Animais , Perda Auditiva/etiologia , Perda Auditiva/patologia , Humanos , Inflamação/metabolismo , Inflamação/patologia , Otorrinolaringopatias/metabolismo , Biossíntese de Proteínas , Proteólise , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Rinite Alérgica/etiologia , Rinite Alérgica/patologia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/patologia , Resposta a Proteínas não DobradasRESUMO
OBJECTIVE: to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures. METHODS: We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. RESULTS: within the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%). CONCLUSION: ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.
Assuntos
Infecções por Coronavirus/fisiopatologia , Transtornos do Olfato/fisiopatologia , Faringite/fisiopatologia , Pneumonia Viral/fisiopatologia , Tonsila Faríngea , Betacoronavirus , COVID-19 , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Eritema/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Mialgia/fisiopatologia , Obstrução Nasal/fisiopatologia , Otorrinolaringopatias/fisiopatologia , Tonsila Palatina , Pandemias , Infecções Respiratórias/fisiopatologia , SARS-CoV-2RESUMO
Introduction: The RAVE trial has revolutionized induction treatment of anti-neutrophil cytoplasmic antibodies (ANCA)-Associated Vasculitis (AAV)by demonstrating the non-inferiority of rituximab (RTX) compared with cyclophosphamide.Objectives: We studied AAV patients' characteristics, RTX prescription practices and efficacy in AAV induction treatment in four Belgian university hospitals. The patient population, selected according to the Belgian reimbursement criteria, was relatively homogeneous and comparable to the one of RAVE trial.Methods: 57 patients, receiving RTX as AAV induction therapyfrom May 2014 to June 2017 were enrolled in an observational retrospective multicenter trial involving four Belgian university hospitals. We focused on the type of AAV, ANCA specificity, prescriber's specialty, used reimbursement criteria, organ involvements, severity of the flares and finally RTX efficacy in AAV induction treatment by considering the RAVE primary (complete remission without prednisone) and secondary (complete remission with prednisone <10 mg) outcomes at 6, 12, 18 and 24 months.Results: 66.7% of the patients reached complete remission with prednisone <10 mg at 6 months, 55.3% at 12 months, 40% at 18 months and 25% at 24 months. The rates of complete remission without steroids were very low at 6, 12, 18 and 24 months. The rates of relapses were high between 18 and 24 months. Conclusions: Our results confirm those of RAVE regarding complete remission rates with prednisone <10 mg/day, in a 'real-life' cohort of patients selected according to data of RAVE trial. The high prevalence of relapses - especially after 18 months - underlines the need to optimize maintenance treatment after an induction treatment with RTX..
Assuntos
Granulomatose com Poliangiite/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Poliangiite Microscópica/tratamento farmacológico , Rituximab/uso terapêutico , Adulto , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Bélgica , Estudos de Coortes , Feminino , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/imunologia , Granulomatose com Poliangiite/fisiopatologia , Hospitais Universitários , Humanos , Nefropatias/tratamento farmacológico , Nefropatias/imunologia , Nefropatias/fisiopatologia , Pneumopatias/tratamento farmacológico , Pneumopatias/imunologia , Pneumopatias/fisiopatologia , Masculino , Poliangiite Microscópica/imunologia , Poliangiite Microscópica/fisiopatologia , Pessoa de Meia-Idade , Mieloblastina/imunologia , Otorrinolaringopatias/tratamento farmacológico , Otorrinolaringopatias/imunologia , Otorrinolaringopatias/fisiopatologia , Peroxidase/imunologia , Padrões de Prática Médica , Prednisona/uso terapêutico , Indução de Remissão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Foregut cystic developmental malformations (FCDM) are a type of rare cystic lesion. The occurrence of FCDM is exceedingly uncommon in the intraoral location. We report three cases of FCDM with intraoral location who presented at Chacha Nehru Bal Chikitsalaya, New Delhi, India, in 2016, 2017 and 2018 with symptoms of respiratory distress and feeding difficulties. Two patients were male and one was female with an age range of 29 days to eight years. The clinical differential diagnosis included mucocele, ranula, dermoid, lymphangioma, teratoma, thyroglossal duct cyst, etc. All patients were treated with simple surgical excision and diagnosed, based on histopathology, with FCDM. These should be considered as differential diagnosis of head and neck midline cystic mass lesions. This case report aimed to discuss differential diagnosis and appropriate terminology for these cystic masses as there is varied and ambiguous nomenclature.
Assuntos
Otorrinolaringopatias/congênito , Cisto Tireoglosso/congênito , Criança , Pré-Escolar , Diagnóstico por Imagem , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Humanos , Índia , Lactente , Masculino , Otorrinolaringopatias/fisiopatologia , Otorrinolaringopatias/cirurgia , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/fisiopatologia , Cisto Tireoglosso/fisiopatologia , Cisto Tireoglosso/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: PANDAS are known as the spectrum of autoimmune pathologies related to a previous or current infection by group A beta-hemolytic streptococcus (SBEGA), dealing with several neuropsychiatric manifestations that mainly affect pediatric age. The main features consist of behavioral disease or movement disease characterized by acute-onset, presenting especially through infant period or adolescence. Specific manifestations, occurring during the progression of the disease, are the presence of otorhinolaryngologic symptoms (ENT) and orofacial movement disorders associated with temporomandibular joint pain. PATIENTS AND METHODS: We enrolled 130 children (5-15 years) with a clinical diagnosis of PANDAS between 2012 and 2018. Participants were assessed using ENT specific parameters, PSG to examine respiratory disorders and conventional audiological evaluation. Descriptive and comparative statistical analyses were performed with a control group of 51 healthy patients. RESULTS: The prevalence of ENT symptoms associated was significantly detected in 88 patients of 130 in Group A (relative frequency (%) 67.6; p=0.041) and in 51 patients of 130 in the control Group B (relative frequency (%) 39.2; p=0.063). In relation to prevalence of SDB, 54 subjects have presented nocturnal respiratory obstructive symptoms from mild to severe (relative frequency (%) 61.3; p=0.033) vs. 20 patients of Group B (relative frequency (%) 39.2; p=0.055). The obstructive severity average type was correlated to the consensual adenotonsillar development (size 3-4), (relative frequency (%) 45.4; p=0.047). The audiological deficits found were mostly of transmissive type with OME correlated and linked to the presence of occasional episodes of AOM. The four PANDAS patients who presented orobuccal dystonia (relative frequency (%) 4.54; p=0.091) achieved an improvement of the algic symptoms through the exercises of self-rehabilitation. CONCLUSIONS: Findings from our study show that respiratory diseases, characterizing a group of patients with pandas, are the direct consequences of the malformed or hypertrophic condition and suggesting in these conditions surgical therapy as an approaching tool.
Assuntos
Doenças Autoimunes/complicações , Doenças Autoimunes/reabilitação , Discinesias/fisiopatologia , Transtornos dos Movimentos/etiologia , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/reabilitação , Infecções Estreptocócicas/microbiologia , Adolescente , Doenças Autoimunes/diagnóstico , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Pneumopatias Obstrutivas/epidemiologia , Pneumopatias Obstrutivas/fisiopatologia , Masculino , Transtornos dos Movimentos/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/fisiopatologia , Dor/etiologia , Prevalência , Índice de Gravidade de Doença , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/reabilitação , Streptococcus pyogenes/isolamento & purificação , Articulação Temporomandibular/patologiaRESUMO
Introduction: Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis characterized by a necrositing granulomatous inflammation of the upper and lower respiratory tracts and focal/proliferative glomerulonephritis. In more than 70% of the cases, the presenting symptoms are head and neck manifestations that are often misdiagnosed as infectious or allergic in etiology. Objective: The present study provides an analysis of head and neckmanifestations in a series of patients diagnosed with GPA. It also evaluates their medical and surgical treatment and provides a review of the relevant literature. Methods: A retrospective analysis of 19 patients diagnosed with GPA at a public tertiary care hospital between 2006 and 2017 was performed. Results: A total of 19 patients were included in the present study, and 16 of them presented head and neck manifestations. Sinonasal symptoms were the most common, affecting 56% of the patients, followed by laryngotracheal (31.25%) and ear (25%) symptoms. In 7 patients, sinonasal symptoms were the first manifestation of the disease (43.75%). Four patients underwent surgery at some stage of the disease. Conclusions: Head and neck involvement is common in GPA and may stand for the first or the onlymanifestation of the disease. The otolaryngologists play a central role in the diagnosis and long-term treatment of these patients, and they have to keep this pathology in mind when treating patients with ENT symptoms that do not respond as expected to the treatment (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Otorrinolaringopatias/fisiopatologia , Granulomatose com Poliangiite/fisiopatologia , Otorrinolaringopatias/cirurgia , Otorrinolaringopatias/diagnóstico por imagem , Espanha , Vasculite , Granulomatose com Poliangiite/cirurgia , Granulomatose com Poliangiite/diagnóstico por imagem , Estudos Retrospectivos , Anticorpos Anticitoplasma de Neutrófilos , EndoscopiaRESUMO
The microbiome is defined as the total of cellular microorganisms of baczerial, viral or e. g., parasite origin living on the surface of a body. Within the anatomical areas of otorhinolaryngology, a significant divergence and variance can be demonstrated. For ear, nose, throat, larynx and cutis different interactions of microbiome and common factors like age, diet and live style factors (e. g., smoking) have been detected in recent years. Besides, new insights hint at a passible pathognomic role of the microbiome towards diseases in the ENT area. This review article resumes the present findings of this rapidly devloping scientific area.
Assuntos
Microbiota , Otorrinolaringopatias , Orelha/microbiologia , Feminino , Humanos , Masculino , Nariz/microbiologia , Otolaringologia/tendências , Otorrinolaringopatias/fisiopatologia , Otorrinolaringopatias/terapia , Faringe/microbiologiaRESUMO
OBJECTIVES: Granulomatosis with polyangiitis is a rare autoimmune disease of the group of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Involvement of the ear, nose and throat (ENT)-region is only described in a few case series and case reports. The objective of this study is to systematically characterise the ENT-involvement in a large series of GPA patients. METHODS: GPA patients examined in the Department of Otorhinolayngology of the Christian-Albrechts-University of Kiel between 1990 and 2012 were included. Diagnosis was based on histological, serological and clinical parameters. GPA patients were examined in a standardised way based on the Ear Nose and Throat Activity Score (ENTAS) or its precursor. Medical history, ENT examination, diagnostic findings (ear, nose) and cranial radiology were documented cumulatively. RESULTS: A total of 230 GPA patients were included in this study. Over 95% of them showed ENT-involvement. 59% of the patients showed nasal obstructions, 57% a loss of smell. A hearing loss was diagnosed in 23% of the patients, 50% involvement in MR or CT scans and 15% showed laryngeal involvement. CONCLUSIONS: The data of the largest monocentric study presented here demonstrate a frequent ENT-involvement in GPA patients. Rhinological and ontological manifestations are most common.
Assuntos
Granulomatose com Poliangiite/fisiopatologia , Otorrinolaringopatias/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Tontura/etiologia , Tontura/fisiopatologia , Disfonia/etiologia , Disfonia/fisiopatologia , Dor de Orelha/etiologia , Dor de Orelha/fisiopatologia , Epistaxe/epidemiologia , Epistaxe/fisiopatologia , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico por imagem , Perda Auditiva/etiologia , Perda Auditiva/fisiopatologia , Testes Auditivos , Humanos , Laringoscopia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Otorrinolaringopatias/diagnóstico por imagem , Otorrinolaringopatias/etiologia , Otoscopia , Rinite/etiologia , Rinite/fisiopatologia , Rinomanometria , Zumbido/etiologia , Zumbido/fisiopatologia , Adulto JovemRESUMO
Objectives: There are few data on clinical profiles of ANCA-associated vasculitis (AAV) in different ethnic populations. The aim of this study was to examine the differences in the ANCA type and clinical features of AAV between populations using the Diagnostic and Classification Criteria in Vasculitis Study (DCVAS) dataset. Methods: The DCVAS is an international, multicentre, observational study recruiting in 133 sites. Eight ethnic categories were analysed: Northern European, Caucasian American, Southern European, Middle Eastern/Turkish, Chinese, Japanese, Indian subcontinent and other. ANCA type was categorized as myeloperoxidase (MPO), PR3 and ANCA negative. Organ system involvement was recorded using a standard dataset. Differences were analysed by chi-squared tests using a Bonferroni correction and logistic regression (adjusting for age and sex). Northern European was the reference population. Results: Data from 1217 patients with AAV were available and the 967 (79.5%) patients recruited by rheumatology departments were analysed to reduce confounding by recruitment specialty. There were differences in ANCA type between ethnic categories (P < 0.001): MPO-ANCA was more common than PR3-ANCA in Japanese, Chinese and Southern Europeans; PR3-ANCA was more common in the other groups. Compared with Northern Europeans, Japanese had a nearly 60-fold increased chance of having MPO-ANCA (vs PR3-ANCA) [odds ratio (OR) 59.2 (95% CI 8.0, 440.7), P < 0.001] and Chinese had a nearly 7-times increased chance [OR 6.8 (95% CI 2.6, 17.8), P < 0.001]. Ophthalmologic and otorhinolaryngologic involvement were less common in Japanese and Chinese populations than Northern Europeans; otherwise, there were few differences in organ involvement between ethnic groups. Conclusion: This study confirms the previously observed differential occurrence of MPO-AAV and PR3-AAV between different ethnic groups.
Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Oftalmopatias/fisiopatologia , Nefropatias/fisiopatologia , Otorrinolaringopatias/fisiopatologia , Dermatopatias/fisiopatologia , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/etnologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Árabes , Povo Asiático , China/epidemiologia , Europa (Continente)/epidemiologia , Oftalmopatias/etiologia , Feminino , Doenças Urogenitais Femininas/etiologia , Doenças Urogenitais Femininas/fisiopatologia , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Índia/epidemiologia , Japão/epidemiologia , Nefropatias/etiologia , Masculino , Doenças Urogenitais Masculinas/etiologia , Doenças Urogenitais Masculinas/fisiopatologia , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Mieloblastina/imunologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Razão de Chances , Otorrinolaringopatias/etiologia , Peroxidase/imunologia , Doenças Respiratórias/etiologia , Doenças Respiratórias/fisiopatologia , Dermatopatias/etiologia , Turquia/epidemiologia , Estados Unidos/epidemiologia , População BrancaRESUMO
Context ⢠Oxidative stress and tissue-damaging, oxygen (O2)-related, free-radical formation is inherent in human metabolism, and the tissues of the ear, nose, and throat (ENT) have an increased exposure to injury from those substances. Because glutathione (GSH) is a major component in an antioxidant defense against oxidative damage in ENT tissues, a review of the impact of lowered GSH and oxidative stress in conditions associated with the upper respiratory tract is warranted. Objective ⢠The review intended to summarize the role that oxidative stress and GSH play. Design ⢠The research team performed a literature review from 1980 to the present that was based on the following keywords: oxidative stress, oxidation, antioxidant, and GSH in common ENT conditions. The review found the following conditions: (1) rhinitis, (2) allergic rhinitis, (3) chronic rhinosinusitis (CRS), (4) CRS with polyps, (5) otitis media with effusion, (6) chronic otitis media (COM), (7) COM and cholesteatoma, (8) tympanic membrane sclerosis, (9) tonsillitis, (10) Meniere's disease, (11) laryngeal conditions, and (12) chronic cough. Results ⢠ENT conditions have been found to be associated with oxidative stress and with low GSH. A limited number of the reviewed studies discussed antioxidant use or repletion of GSH. Although only a few reports support the use of GSH or antioxidants as adjuncts in the management of ENT conditions, no reports of side effects were found related to their use. Conclusions ⢠Many ENT conditions are associated with oxidative stress and decreased GSH, both locally in the affected tissues and systemically. The oxidative stress of those conditions may be related to depletion of GSH, which is increased by the higher levels of O2 in the upper respiratory tract. A small number of studies have reported clinical benefits from the use of an antioxidant or GSH support. The findings of benefits and the lack of reports of side effects suggest that the clinical use of antioxidants and support with GSH in ENT conditions may be considered as adjuncts to conventional management and that more research is warranted.
Assuntos
Glutationa , Otorrinolaringopatias , Estresse Oxidativo/fisiologia , Glutationa/análise , Glutationa/metabolismo , Glutationa/fisiologia , Humanos , Otorrinolaringopatias/metabolismo , Otorrinolaringopatias/fisiopatologiaRESUMO
OBJECTIVE: To examine the relationship of antineutrophil cytoplasmic antibody (ANCA) type and ANCA-associated vasculitis (AAV) diagnosis with demographic features, disease manifestations, and clinical outcomes. We focused on patients who account for the differences between ANCA type and disease type classifications: anti-myeloperoxidase (MPO)-ANCA-positive and ANCA-negative patients with granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: We performed a pooled analysis of the Wegener's Granulomatosis Etanercept Trial and the Rituximab in ANCA-Associated Vasculitis trial comparing patients with MPO-ANCA-positive GPA and patients with ANCA-negative GPA to patients with proteinase 3 (PR3)-ANCA-positive GPA and patients with MPO-ANCA-positive microscopic polyangiitis (MPA). RESULTS: Of the 365 patients analyzed, 273 (75%) had PR3-ANCA-positive GPA, 33 (9%) had MPO-ANCA-positive GPA, 15 (4%) had ANCA-negative GPA, and 44 (12%) had MPO-ANCA-positive MPA. MPO-ANCA-positive GPA patients were younger at diagnosis compared to MPO-ANCA-positive MPA patients (53 versus 61 years; P = 0.02). Their disease manifestations and rates of relapse were similar to those of PR3-ANCA-positive GPA patients. Relapse was more frequent in MPO-ANCA-positive GPA patients than in patients with MPO-ANCA-positive MPA at trial entry as well as at 12 and 18 months. ANCA-negative patients with GPA had lower Birmingham Vasculitis Activity Score for Wegener's Granulomatosis scores at trial entry than PR3-ANCA-positive patients with GPA (4.5 versus 7.7; P < 0.01), primarily because of a lower prevalence of renal involvement. CONCLUSION: We were unable to demonstrate important clinical differences between MPO-ANCA-positive and PR3-ANCA-positive patients with GPA. The risk of relapse was associated more closely with disease type than with ANCA type in this patient cohort. These findings deserve consideration in the assessment of relapse risk in patients with AAV.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Granulomatose com Poliangiite/imunologia , Peroxidase/imunologia , Antirreumáticos/uso terapêutico , Etanercepte/uso terapêutico , Oftalmopatias/etiologia , Oftalmopatias/imunologia , Oftalmopatias/fisiopatologia , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/fisiopatologia , Humanos , Nefropatias/etiologia , Nefropatias/imunologia , Nefropatias/fisiopatologia , Pneumopatias/etiologia , Pneumopatias/imunologia , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mieloblastina/imunologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/imunologia , Doenças do Sistema Nervoso/fisiopatologia , Otorrinolaringopatias/etiologia , Otorrinolaringopatias/imunologia , Otorrinolaringopatias/fisiopatologia , Recidiva , Rituximab/uso terapêutico , Índice de Gravidade de DoençaRESUMO
The authors describe various clinical forms of streptococcal infections, the pathogenetic mechanisms underlying these conditions, and peculiarities of their clinical picture. Also considered are the modern methods employed for laboratory diagnostics of streptococcal infections. The probability of the risk of development of post-streptococcal diseases in the children is evaluated. Measures for the prevention of these conditions are proposed.
Assuntos
Otorrinolaringopatias , Infecções Estreptocócicas , Streptococcus pyogenes , Criança , Gerenciamento Clínico , Diagnóstico Precoce , Humanos , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/microbiologia , Otorrinolaringopatias/fisiopatologia , Otorrinolaringopatias/terapia , Fatores de Risco , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/fisiopatologia , Infecções Estreptocócicas/terapia , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/fisiologiaRESUMO
Radiation therapy is a cornerstone of head and neck cancer management. Technological improvements in recent years in radiation therapy, with intensity-modulated techniques, reinforce even more its role. However, both local and locoregional relapses are still observed. Understanding biological mechanisms of treatment resistance is a topic of major interest. From the cancer cell itself, its ability to repair and proliferate, its microenvironment and oxygenation conditions, migratory and invasive capacity, to biological parameters related to the patient, there are many mechanisms involving radiosensitivity and/or radioresistance of head and neck cancer. The present study explores the main biological mechanisms involved in radiation resistance of head and neck cancer, and describes promising therapeutic approaches.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Hipóxia Celular , Neoplasias de Cabeça e Pescoço/radioterapia , Otorrinolaringopatias/radioterapia , Tolerância a Radiação/fisiologia , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/fisiopatologia , Movimento Celular , Proliferação de Células , Reparo do DNA , Fracionamento da Dose de Radiação , Transição Epitelial-Mesenquimal , Receptores ErbB/fisiologia , Neoplasias de Cabeça e Pescoço/etiologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/fisiopatologia , Humanos , Nanopartículas/uso terapêutico , Invasividade Neoplásica , Recidiva Local de Neoplasia , Células-Tronco Neoplásicas/fisiologia , Otorrinolaringopatias/etiologia , Otorrinolaringopatias/patologia , Otorrinolaringopatias/fisiopatologia , Terapia com Prótons/métodos , Radiossensibilizantes/uso terapêutico , Fatores de Risco , Microambiente TumoralRESUMO
We conducted the first survey of otorhinolaryngological (ORL) screening at educational institutions, from kindergarten to high school, in Niigata Prefecture. The survey results showed that ORL screening is not performed in 62.1% of kindergartens and nursery schools, and that screening was conducted by non-ENT doctors in 23.9% of them. At elementary school entry health check-ups, ORL screening was performed by otorhinolaryngologists in only 4.2% of children overall. ORL screening was conducted in students in all grades by 51.7% of all elementary schools and 31.6% of all junior high schools. Audiometry was performed in students in all grades by over 80% of elementary schools and junior high schools. With regard to high schools, ORL screening was performed in students in all grades at only three schools among 105 high school; ORL screening and audiometry were conducted primarily in the first-year students. In addition to the above results, the survey revealed that no ORL screening whatsoever was performed during a period of 9 years at an elementary school and a junior high school in a certain municipality; as a result of discussion with the relevant municipality, it was decided that screening will be conducted starting at 2016. From the viewpoint of reinforcing the structure of conducting ORL screening in infants in whom ORL findings are identified at a high frequency, we requested that Niigata City conduct ORL screening at private kindergartens in Niigata City where the ORL screening rate is low. We consider this survey to have been productive, as it identified meaningful new facts and measures that could be devised to address the relevant issues. It is our aim to become more proactively than ever involved in school health including health check-ups.
Assuntos
Programas de Rastreamento , Otorrinolaringopatias/diagnóstico , Criança , Humanos , Japão , Otorrinolaringopatias/fisiopatologia , Instituições Acadêmicas , Estudantes , Inquéritos e QuestionáriosRESUMO
The organs of the ear, nose and throat (ENT) contain air- or gas-filled cavities, which make them sensitive to pressure changes. There is a specific pathophysiology involved when these structures are exposed to non-acoustic press ure changes, which are usually not traumatic in normals. The concepts of pathophysiology, diagnosis and treatment of these traumas in an emergency setting are reviewed.
Assuntos
Barotrauma/fisiopatologia , Traumatismos por Explosões/fisiopatologia , Emergências , Otorrinolaringopatias/fisiopatologia , Barotrauma/diagnóstico , Barotrauma/terapia , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/terapia , Humanos , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapiaRESUMO
Introducción: Los niños con síndrome de Down (SD) tienen mayor riesgo de desarrollar enfermedad otorrinolaringológica (ORL). Recomendaciones internacionales sugieren realizar tamizaje auditivo precoz y control periódico por especialista. Nuestro objetivo fue caracterizar la enfermedad ORL en niños con SD y proponer una recomendación adaptada a nuestra realidad. Pacientes y método: Estudio transversal, descriptivo, en niños de 6 meses a 15 años con SD. Los datos se obtuvieron por medio de entrevista a los padres y revisión de fichas clínicas. Resultados: Se analizaron 134 pacientes, con una edad promedio de 44,5 meses. El 78,8% de ellos presentaba enfermedad ORL, siendo la más frecuente la rinitis alérgica y otitis con efusión. El tamizaje auditivo estaba alterado en un 25% de ellos, el 50% de los mayores de 3 años con estudio de sueño tenían apnea obstructiva del sueño. Los niños de mayor edad tuvieron estadísticamente mayor frecuencia de enfermedad ORL. Conclusiones: Esta serie muestra una alta frecuencia de enfermedad ORL en niños con SD, lo que refuerza la necesidad de realizar tamizaje auditivo, sospechar e identificar las apneas obstructivas del sueño y derivación rutinaria al especialista para optimización de las condiciones auditivas que permitan el mejor desarrollo del niño con SD.
Introduction: The children with Down syndrome (DS) are at increased risk of ear-nose-throat (ENT) disorders. International recommendations suggest early hearing screening and periodic specialist evaluation. Our goal was to characterize ENT disorders in children with DS, and propose recommendations for the Chilean population. Patients and method: Cross-sectional, descriptive study, of children with DS, between 6 months and 15 years of age. The data was obtained by a health interview to the parents and review of medical records. Results: We analyzed 134 patients with an average age of 44.5 months. The 78.8% had ENT disorders, the most frequent ENT disorders was allergic rhinitis and otitis media with effusion. Hearing screening was abnormal in a quarter of the patients, 50% of children over 3 years of age had obstructive sleep apnea diagnosed by polysomnogram. Older children had a statistically higher frequency of ENT disorders. Conclusions: This series shows a high rate of ENT disorders in children with DS, which supports recommendations for hearing screening, high suspicion of obstructive sleep apnea and routine referral to an ENT specialist for prevention and aggressive therapy in order to reduce hearing loss and improve development of the child with DS.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Otorrinolaringopatias/epidemiologia , Otite Média com Derrame/epidemiologia , Síndrome de Down/complicações , Rinite Alérgica/epidemiologia , Otorrinolaringopatias/etiologia , Otorrinolaringopatias/fisiopatologia , Chile , Estudos Transversais , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/epidemiologia , Perda Auditiva/epidemiologia , Testes AuditivosRESUMO
Noonan syndrome is an autosomal dominant disorder with associated anomalies that include short stature, congenital heart defects, developmental delay, and characteristic facial features among other abnormalities. Articulation deficiency and language delay are often present and require speech therapy. Otitis media and hearing loss have been reported to be common in these patients. We performed a retrospective chart review of pediatric patients who were diagnosed with Noonan syndrome at our tertiary care center from January 1979 through December 2009. We found 19 such patients. Of these, 8 had received single-specialty care at our hospital; it is not known if they had received otolaryngologic care from an outside provider. These 8 patients were not included in our study. The remaining 11 patients-6 boys and 5 girls, aged 1 to 19 years (mean: 9.2)-had all received multidisciplinary care at our institution; 9 of them had received care from an otolaryngologist at our center. Of this group, 7 had history of feeding difficulty, 6 had experienced speech delay that required speech therapy, 6 had undergone placement of a pressure equalization tube, 4 had undergone adenoidectomy with or without tonsillectomy, and 1 had been treated with endoscopic sinus surgery. Although this study is limited by our small number of patients, our results suggest that early otolaryngologist involvement must be considered in the care of children with Noonan syndrome because many have evidence of eustachian tube dysfunction, hearing loss, and speech delay.
Assuntos
Síndrome de Noonan/diagnóstico , Otorrinolaringopatias/diagnóstico , Adenoidectomia , Adolescente , Transtornos da Coagulação Sanguínea/diagnóstico , Criança , Pré-Escolar , Tuba Auditiva/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Perda Auditiva Condutiva/diagnóstico , Humanos , Lactente , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/terapia , Masculino , Síndrome de Noonan/genética , Otorrinolaringopatias/genética , Otorrinolaringopatias/fisiopatologia , Otorrinolaringopatias/terapia , Estudos Retrospectivos , Tonsilectomia , Adulto JovemRESUMO
INTRODUCTION: The children with Down syndrome (DS) are at increased risk of ear-nose-throat (ENT) disorders. International recommendations suggest early hearing screening and periodic specialist evaluation. Our goal was to characterize ENT disorders in children with DS, and propose recommendations for the Chilean population. PATIENTS AND METHOD: Cross-sectional, descriptive study, of children with DS, between 6 months and 15 years of age. The data was obtained by a health interview to the parents and review of medical records. RESULTS: We analyzed 134 patients with an average age of 44.5 months. The 78.8% had ENT disorders, the most frequent ENT disorders was allergic rhinitis and otitis media with effusion. Hearing screening was abnormal in a quarter of the patients, 50% of children over 3 years of age had obstructive sleep apnea diagnosed by polysomnogram. Older children had a statistically higher frequency of ENT disorders. CONCLUSIONS: This series shows a high rate of ENT disorders in children with DS, which supports recommendations for hearing screening, high suspicion of obstructive sleep apnea and routine referral to an ENT specialist for prevention and aggressive therapy in order to reduce hearing loss and improve development of the child with DS.