Causal association between environmental variables and the excess cases of cutaneous leishmaniasis in Colombia: are we looking to the wrong side?

Our main aim was to estimate and compare the effects of six environmental variables (air temperature, soil temperature, rainfall, runoff, soil moisture, and the enhanced vegetation index) on excess cases of cutaneous leishmaniasis in Colombia. We used epidemiological data from the Colombian Public Health Surveillance System (January 2007 to December 2019). Environmental data were obtained from remote sensing sources including the National Oceanic and Atmospheric Administration, the Global Land Data Assimilation System (GLDAS), and the Moderate Resolution Imaging Spectroradiometer. Data on population were obtained from the TerriData dataset. We implemented a causal inference approach using a machine learning algorithm to estimate the causal association of the environmental variables on the monthly occurrence of excess cases of cutaneous leishmaniasis. The results showed that the largest causal association corresponded to soil moisture with a lag of 3 months, with an average increase of 8.0% (95% confidence interval [CI] 7.7-8.3%) in the occurrence of excess cases. The temperature-related variables (air temperature and soil temperature) had a positive causal effect on the excess cases of cutaneous leishmaniasis. It is noteworthy that rainfall did not have a statistically significant causal effect. This information could potentially help to monitor and control cutaneous leishmaniasis in Colombia, providing estimates of causal effects using remote sensor variables.

Pooled lagged effect of runoff on leptospirosis cases in Colombia.

Leptospirosis is a global zoonotic disease caused by spirochete bacteria of the genus Leptospira. The disease exhibits a notable incidence in tropical and developing countries, and in Colombia, environmental, economic, social, and cultural conditions favor disease transmission, directly impacting both mortality and morbidity rates. Our objective was to establish the pooled lagged effect of runoff on leptospirosis cases in Colombia. For our study, we included the top 20 Colombian municipalities with the highest number of leptospirosis cases. Monthly cases of leptospirosis, confirmed by laboratory tests and spanning from 2007 to 2022, were obtained from the National Public Health Surveillance System. Additionally, we collected monthly runoff and atmospheric and oceanic data from remote sensors. Multidimensional poverty index values for each municipality were sourced from the Terridata repository. We employed causal inference and distributed lag nonlinear models to estimate the lagged effect of runoff on leptospirosis cases. Municipality-specific estimates were combined through meta-analysis to derive a single estimate for all municipalities under study. The pooled results for the 20 municipalities suggest a lagged effect for the 0 to 2, and 0-3 months of runoff on leptospirosis when the runoff is < 120 g/m2. No effect was identified for longer lagged periods (0-1, 0 to 4, 0 to 5, and 0-6 months) or higher runoff values. Incorporation of the multidimensional poverty index into the meta-analysis of runoff contributed to the models for the lagged periods of 0-3, and 0-4 months.

The effect of El Niño and La Niña episodes on the existing niche and potential distribution of vector and host species of American Cutaneous Leishmaniasis.

Leishmaniasis is a zoonotic disease transmitted to humans by a protozoan parasite through sandfly vectors and multiple vertebrate hosts. The Pan American Health Organization reported a declining trend in cases, with Brazil, Colombia, Peru, Nicaragua, and Bolivia having the most cases in 2020. There are still knowledge gaps in transmission and the parasite-host relationship. Ecological niche modeling has been used to study host-vector relationships, disease dynamics, and the impact of climate change. Understanding these aspects can aid in early surveillance and vector control strategies. The potential distribution of five host species associated with the transmission of cutaneous leishmaniasis (CL) was modeled. Occurrence data were collected for each host species, and environmental variables were used to build the models. Climatic data from El Niño, La Niña, and Neutral episodes were used to compare the predicted distributions. Additionally, the potential distributions of four vector species were compared to identify overlaps with host species. Niche analysis was conducted to evaluate changes in vector niches across episodes and to identify host-vector pairs based on niche overlap in geographic and environmental spaces. After spatial thinning, 467 records were obtained, and 1,190 candidate models were evaluated for each species. Results showed the distribution of occurrences in the environmental space, highlighting a high risk of extrapolation beyond the calibration areas. Movement-Oriented Parity analysis revealed distinct distribution patterns under different climate conditions, with areas of environmental similarity identified. Bradypus variegatus exhibited a broad potential distribution, while Dasypus novemcinctus and Didelphis marsupialis had more restricted ranges. Sylvilagus braziliensis covered most of the Neotropics. Our study provides valuable insights into ecological niches and geographic ranges of these species, contributing to the understanding of cutaneous leishmaniasis transmission dynamics.

Effect of environmental variables on the incidence of Visceral Leishmaniasis in Brazil and Colombia.

Visceral Leishmaniasis (VL) is the most severe of the three forms of Leishmaniasis. In the Americas, Brazil and Colombia present more than 90 % of the cases in the region. Our aim in this research was to estimate the association of the incidence rate of Visceral Leishmaniasis with the following environmental variables: the percentage of area suitable for the vector Lutzomyia longipalpis, the episodes of La Niña and El Niño, the Brazilian and Colombian biomes. Epidemiological data were obtained from the Brazilian Notifiable Diseases Information System and the Colombian National Public Health Surveillance System. Environmental data were downloaded from the NASA Giovanni web app, the Modis Sensor database, and the meteorological agencies of Australia, Japan, and the United States of America. Records of the presence of Lu. longipalpis were obtained from public databases and previous studies. As a result, the incidence per 10,000 inhabitants with LEBS for each El Niño-Southern Oscillation (ENSO) episode showed the largest values during El Niño 2015-2016, mainly in Brazil's Northeast and Central regions and the Northeast region of Colombia. Compared with the Neutral 2012-2014 episode, the episodes of El Niño 2015-2016 and La Niña 2010-2011 showed an average increase in the monthly incidence rate of VL, and the average increase was higher during El Niño 2015-2016 (aIRR = 2.304 vs.1.453) We found a positive association between the incidence rate of VL and the El Niño 2015-2016 episode and an impressive% of area suitable for the vector Lu. longipalpis in the Amazon region.An increase of 1 % in the area suitable for the vector Lu. longipalpis leads to an average rise of 0.8 % in the monthly incidence rate of VL. Our study shows a possible association between VL incidence and ENSO, with the most considerable incidence rates observed during El Niño 2015-2016 in Brazil's Northeast and Central regions and the Northeast region of Colombia. The present study is very important to better understand the Visceral Leishmaniasis transmission dynamics.

[Design and implementation of a transdisciplinary care model for patients with hereditary angioedema, in a Colombian health institution]. / Diseño e implementación de un modelo de atención transdisciplinaria para pacientes con angioedema hereditario, en una institución de salud colombiana.

OBJECTIVE: Describe the design and implementation of a transdisciplinary care model for patients with hereditary angioedema in Colombia. METHODS: Descriptive longitudinal observational study. 140 patients with hereditary angioedema were included in a transdisciplinary care model for one year. Seizure rates, hospitalizations, emergency room visits, quality of life, and pharmacological adherence were measured. RESULTS: The model was associated with reductions of 76% in seizures, 66% in hospitalizations, and 87% in emergency room visits. Pharmacological adherence increased 19% and was complete after four months. The quality of life increased significantly. CONCLUSIONS: Hereditary angioedema is an orphan disease that requires a comprehensive approach for effective care.

OBJETIVO: Describir el diseño e implementación de un modelo transdisciplinario de atención para pacientes con angioedema hereditario en Colombia. MÉTODOS: Estudio observacional longitudinal descriptivo. 140 pacientes con angioedema hereditario fueron incluidos en un modelo de atención transdisciplinario por un año. Se midieron tasas de crisis, hospitalizaciones, visitas a urgencias, calidad de vida y adherencia farmacológica. RESULTADOS: El modelo se asoció con reducciones del 76% en crisis, 66% en hospitalizaciones y 87% en visitas a urgencias. La adherencia farmacológica aumentó 19% y fue completa después de cuatro meses. La calidad de vida aumentó significativamente. CONCLUSIÓN: El angioedema hereditario es una enfermedad solitaria que requiere un abordaje integral para la atención eficaz.

Environmental and socio-economic determinants of the occurrence of malaria clusters in Colombia.

This study identifies the environmental and socio-economic determinants of clusters of high malaria incidence in Colombia during the period of 2008-2019. The malaria cases were obtained from the National System of Surveillance in Public Health, with 798,897 cases reported in the 986 Colombian municipalities evaluated during the study period. Spatial autocorrelation of incidence was examined with global and local indices. Clusters were identified in the Amazon, Pacific, and Uraba-Bajo Cauca-Alto Sinú regions. The factors associated with a municipality belonging to a high-incidence cluster were identified using a logistic regression model with mixed effects and showed a positive association for the variables (forest coverage and minimum multi-year average rainfall). An inverse relationship was observed for aqueduct coverage and the odds of belonging to a cluster. A 1% increase in forest coverage was associated with a 4.2% increase in the odds of belonging to a malaria cluster. The association with minimum multi-year average rainfall was positive (OR = 1.0011; 95% CI 1.0005-1.0027). A 1% increase in aqueduct coverage was associated with a 4.3% decrease in the odds of belonging to malaria cluster. The identification of malaria cluster determinants in Colombia could help guide surveillance and disease control policies.

The frequency of complications in a cohort of patients diagnosed with hemophilia A and hemophilia B receiving prophylactic treatment in Colombia: A retrospective noninterventional study.

INTRODUCTION: Hemophilia A and B are disorders associated with the deficit of coagulation factors VIII and IX. OBJECTIVE: Was to determine the incidence of complications in a cohort of patients diagnosed with moderate and severe hemophilia A or B under treatment in a specialized institution. METHODS: A retrospective study of a cohort of patients with replacement therapy for hemophilia A or B, evaluating treatment and complications between January/2012 and July/2019. Sociodemographic, clinical and disease management-related variables were extracted from the medical records. Time to inhibitor development and rate associated with bleeding and hospitalizations were evaluated. RESULTS: A total of 159 male patients were identified with hemophilia A (n = 140; 88.1%) and B (n = 19; 11.9%) with a mean follow-up of 5.9±2.3 years. The mean age was 23.6±16.1 years, hemophilia was reported as severe in 125 patients in hemophilia A (89.3%) and 13 patients in hemophilia B (68.4%). Primary prophylaxis was registered in 17.0% of patients, 44.7% secondary, and 38.3% tertiary, with recombinant factors (n = 84; 52.8%) followed by plasma derived factors (n = 75; 47.2%). The incidence of inhibitor development was 0.3 per 100 patients/year, with mean time to event of 509 days. The incidence of bleeding was 192 per 100 patients/year, especially at the joint (n = 99; 62.3%) and muscle (n = 25; 15.7%) level. The incidence of hospitalization was 3.7 per 100 patients/year. CONCLUSIONS: The most common complication was joint bleeding which was expected in this type of patients. Low proportion of patients developed factor inhibitors during the follow up.

A database of common vampire bat reports.

The common vampire bat (Desmodus rotundus) is a sanguivorous (i.e., blood-eating) bat species distributed in the Americas from northern Mexico southwards to central Chile and Argentina. Desmodus rotundus is one of only three mammal species known to feed exclusively on blood, mainly from domestic mammals, although large wildlife and occasionally humans can also serve as a food source. Blood feeding makes D. rotundus an effective transmissor of pathogens to its prey. Consequently, this species is a common target of culling efforts by various individuals and organizations. Nevertheless, little is known about the historical distribution of D. rotundus. Detailed occurrence data are critical for the accurate assessment of past and current distributions of D. rotundus as part of ecological, biogeographical, and epidemiological research. This article presents a dataset of D. rotundus historical occurrence reports, including >39,000 locality reports across the Americas to facilitate the development of spatiotemporal studies of the species. Data are available at https://doi.org/10.6084/m9.figshare.15025296 .

Potential distribution of four vectors of American Cutaneous Leishmaniasis: The effect of El Niño and La Niña episodes from the perspective of the ecological niche.

The potential distribution of four American Cutaneous Leishmaniasis vectors under average conditions during Neutral (in between episodes), El Niño, and La Niña episodes from 2000 to 2018 were constructed through ecological niche modeling. The potential distribution in El Niño and La Niña were compared with the Neutral distribution. The four vector species (Lutzomyia gomezi, Lutzomyia ovallesi, Lutzomyia panamensis, and Lutzomyia trapidoi) decreased the potential distribution with the occurrence of El Niño and La Niña episodes. During El Niño, the reduction was concentrated over the dry ecosystems, while with the occurrence of La Niña, the potential distribution decreased over most of the Neotropic, leaving areas of climatic suitability concentrated in the Andean and Amazon areas, along with some scattered patches. We found evidence that the occurrence of the climatic anomalies has an effect on the potential distribution of this vector species.

Effect of El Niño Southern Oscillation cycle on the potential distribution of cutaneous leishmaniasis vector species in Colombia.

Local anomalies in rainfall and temperature induced by El Niño and La Niña episodes could change the structure of the vector community. We aimed to estimate the effect of the El Niño-La Niña cycle in the potential distribution of cutaneous leishmaniasis (CL) vector species in Colombia and to compare the richness of the vectors with the occurrence of CL in the state of Norte de Santander. The potential distributions of four species were modeled using a MaxEnt algorithm for the following episodes: La Niña 2010-2011, Neutral 2012-2015 and El Niño 2015-2016. The relationship between the potential richness of the vectors and the occurrence of CL in Norte de Santander was evaluated with a log-binomial regression model. During the El Niño 2015-2016 episode, Lutzomyia ovallesi and Lutzomyia panamensis increased their distribution into environmentally suitable areas, and three vector species (Lutzomyia gomezi, Lutzomyia ovallesi and Lutzomyia panamensis) showed increases in the range of their altitudinal distribution. During the La Niña 2010-2011 episode, a reduction was observed in the area suitable for occupation by Lutzomyia gomezi and Lutzomyia spinicrassa. During the El Niño 2015-2016 episode, the occurrence of at least one CL case was related to a higher percentage of rural localities showing a richness of vectors = 4. The anomalies in rainfall and temperature induced by the episodes produced changes in the potential distribution of CL vectors in Colombia. In Norte de Santander, during Neutral 2012-2015 and El Niño 2015-2016 episodes, a higher probability of at least one CL case was related to a higher percentage of areas with a greater richness of vectors. The results help clarify the effect of the El Niño-La Niña cycle in the dynamics of CL in Colombia and emphasize the need to monitor climate variability to improve the prediction of new cases.

Factors Involved in the Development of Inhibitory Antibodies in Patients with Hemophilia in Colombia: A Case-Control Study.

BACKGROUND: The appearance of inhibitory antibodies against antihemophilic factors is one of the most serious complications related to hemophilia. OBJECTIVE: The objective of this study was to identify variables and factors related to the development of inhibitory antibodies in a group of patients undergoing antihemophilic therapy in Colombia. METHODS: A case-control study in patients with hemophilia treated in Specialized Healthcare Provider Institutions (IPS-E) in 21 cities of Colombia of any age and with a diagnosis of inhibitory antibodies against factor VIII or IX during 2016. Four controls per case paired by age and type of hemophilia were used. Sociodemographic, clinical, and pharmacological variables were identified and analyzed. RESULTS: Seventeen patients with inhibitory antibodies and 68 controls with hemophilia were identified. The mean age was 28.3 ± 17.8 years. A total of 94.1% had hemophilia A, and 88.2% of the cases and 50.0% of the controls had severe hemophilia; 47.1% of the cases and 54.4% of the controls were receiving prophylaxis with coagulation factors. Multivariate analysis showed that having severe hemophilia (OR:17.0, 95%CI:1.32-219.60) and lack of knowledge of the coagulation factor with which the patient was treated before entering the care program in the IPS-E (OR:8.9, 95%CI:1.82-43.75) were significantly associated with a higher probability of developing inhibitory antibodies. CONCLUSION AND RELEVANCE: Coagulation factors associated with the development of inhibitory antibodies were severe hemophilia and lack of knowledge of the type of factor used prior to entering the follow-up cohort.

Environmental and socioeconomic determinants of leptospirosis incidence in Colombia.

Human leptospirosis is an infection that most often affects tropical countries. Since 2007, Colombia requires the notification of disease cases, enabling the observation of an increase in cases in recent years. The objectives of this article were to analyze environmental and socioeconomic variables and to evaluate their relationship with human leptospirosis cases. This is an ecological study on human leptospirosis cases aggregated by municipality and reported between 2007 and 2016. Spatial aggregation assessment was made using the Getis-Ord Gi method, and negative binomial regression was used to evaluate the relationship between environmental and socioeconomic variables with human leptospirosis. During the study period, 9,928 cases of human leptospirosis were reported, and 58.9% of municipalities reported at least one case. Four hotspots of human leptospirosis, including 18 municipalities, were identified. The results of the negative binomial model confirmed the importance of the effects of education, poverty and some climatic variables on the decadal incidence rate of human leptospirosis. Our results confirm the importance of socioeconomic determinants such as social marginality associated with violence and education, as well as ecological variables such as rainfall, height above sea level and forest coverage on the incidence rate of human leptospirosis at municipal scale.

Vólvulo gástrico, abordaje por laparotomía y laparoscopia. Revisión de la literatura a raíz de dos casos / Gastric volvulus, laparotomy and laparoscopic approach. Literature review pertaining two cases

El vólvulo gástrico es una condición potencialmente mortal, consistente en la rotación anormal del estómago sobre un eje sostenido por dos partes fijas. Produce síntomas inespecíficos, lo cual, junto con su baja incidencia, hace difícil el diagnóstico. Se hizo una revisión bibliográfica y se presentan dos pacientes con diagnóstico de vólvulo gástrico. En ambos, la presentación clínica fue aguda, pero con diferentes manifestaciones. El abordaje quirúrgico, en uno, fue mediante técnica abierta y, en el otro, mediante laparoscopia (gastrectomía vertical); esta última, con menor morbimortalidad y repercusión en las funciones fisiológicas y anatómicas del paciente. La vía laparoscópica permite abordajes mínimamente invasivos, poco reportada en la literatura, la cual puede ser una opción adecuada para el abordaje en estos pacientes.

Gastric volvulus is a life-threatening pathology characterized by the abnormal rotation of the stomach on an axis formed by two fixed parts, which causes nonspecific symptoms. Together, the low incidence and clinical presentation, makes it a challenging diagnosis. The aim of this article is to review the literature and to present two patients with acute gastric volvulus with different clinical presentation. The first was treated by an open technique and the second one by laparoscopic technique (vertical gastrectomy) which resulted in a lower morbidity and mortality with less impact on the physiological and anatomical functions. Few cases have been reported in the literature and it may be considered an appropriate option for the approach on these patients

Environmental and socioeconomic determinants of leptospirosis incidence in Colombia / Determinantes ambientales y socioeconómicos asociados con incidentes en casos de leptospirosis en Colombia / Determinantes ambientais e socioeconômicos associados a casos incidentes de leptospirose na Colômbia

Human leptospirosis is an infection that most often affects tropical countries. Since 2007, Colombia requires the notification of disease cases, enabling the observation of an increase in cases in recent years. The objectives of this article were to analyze environmental and socioeconomic variables and to evaluate their relationship with human leptospirosis cases. This is an ecological study on human leptospirosis cases aggregated by municipality and reported between 2007 and 2016. Spatial aggregation assessment was made using the Getis-Ord Gi method, and negative binomial regression was used to evaluate the relationship between environmental and socioeconomic variables with human leptospirosis. During the study period, 9,928 cases of human leptospirosis were reported, and 58.9% of municipalities reported at least one case. Four hotspots of human leptospirosis, including 18 municipalities, were identified. The results of the negative binomial model confirmed the importance of the effects of education, poverty and some climatic variables on the decadal incidence rate of human leptospirosis. Our results confirm the importance of socioeconomic determinants such as social marginality associated with violence and education, as well as ecological variables such as rainfall, height above sea level and forest coverage on the incidence rate of human leptospirosis at municipal scale.

La leptospirosis humana es una infección que afecta a la mayoría de países tropicales. Desde 2007, la notificación de esta enfermedad es obligatoria en Colombia, reflejando un aumento de casos observado durante los últimos años. Los objetivos fueron analizar las variables ambientales y socioeconómicas y evaluar su relación con los casos de leptospirosis. Se llevó a cabo un estudio ecológico de casos de leptospirosis humana agregados por municipio, registrados entre 2007 y 2016. La evaluación de la agregación espacial fue desarrollada mediante el Getis-Ord Gi method, y se implementó una regresión negativa binomial para evaluar la relación entre las variables ambientales y socioeconómicas con la leptospirosis humana. Durante el periodo de estudio, se registraron 9.928 casos de leptospirosis humana, y un 58,9% de los municipios informaron de al menos un caso de leptospirosis. Se identificaron cuatro epicentros de leptospirosis humana, incluyendo 18 municipios. Los resultados del modelo binomial negativo confirmaron la importancia de los efectos de la educación, pobreza y algunas variables climáticas en la tasa de incidencia de leptospirosis humana por decenios. Nuestros resultados confirmaron la importancia de determinantes socioeconómicos tales como: marginalidad social, asociada con la violencia y educación, así como variables ecológicas como: precipitaciones, altura sobre el nivel del mar y superficie forestal en la tasa de incidencia de la leptospirosis humana dentro una escala municipal.

A leptospirose humana é uma infecção que majoritariamente afeta países tropicais. Desde 2007, a notificação da doença é compulsória na Colômbia, o que levou a um aumento do número de casos nos últimos anos. Os objetivos foram analisar variáveis ambientais e socioeconômicas e avaliar sua relação com casos de leptospirose humana. Foi feito um estudo ecológico de casos de leptospirose humana notificados entre 2007 e 2016 agregados por município. Uma análise de agregação espacial foi desenvolvida por meio do método Getis-Ord Gi e regressão binomial negativa foi implementada para avaliar a relação entre variáveis ambientais e socioeconômicas e leptospirose humana. Durante o período do estudo, 9.928 casos de leptospirose humana foram notificados e 58,9% de municípios notificaram ao menos um caso de leptospirose. Quatro hotspots incluindo 18 municípios foram identificados. Os resultados do modelo binomial negativo confirmaram a importância dos efeitos de educação, pobreza e algumas variáveis climáticas na taxa de incidência decenal de leptospirose humana. Nossos resultados confirmam a importância de determinantes socioeconômicos tais como marginalidade social associada a violência e educação, bem como as variáveis ecológicas, tais como precipitação, altitude acima do nível do mar e cobertura florestal sobre a incidência de leptospirose humana no nível municipal.

Guía de práctica clínica para el tratamiento de la rinosinusitis crónica: versión completa / Clinical practice guideline for the treatment of chronic rhinosinusitis: full version

La rinosinusitis (RS) se define como la inflamación de la nariz y los senos paranasales con dos o más síntomas como bloqueo/obstrucción/congestión o secreción nasal (goteo nasal anterior/posterior) más dolor/presión facial y/o reducción o pérdida del sentido del olfato. Adicional, se tienen en cuenta los hallazgos objetivos como la presencia de pólipos nasales y/o descarga mucopurulenta en meato medio y/o edema u obstrucción de la mucosa en el meato medio en la endoscopia nasal. Se pueden considerar o no, los cambios tomográficos como cambios mucosos en el complejo osteomeatal y la mucosa de los senos paranasales. Se reconoce que los síntomas tienen alta sensibilidad, pero baja especificidad, de ahí la necesidad de hallazgos objetivos.

Rhinosinusitis (RS) is defined as inflammation of the nose and sinuses with two or more symptoms such as blockage/obstruction/congestion or nasal discharge. with two or more symptoms such as nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior runny nose) plus facial pain/pressure and/or reduction or loss of the sense of smell. sense of smell. In addition, objective findings such as the presence of nasal polyps and/or nasal presence of nasal polyps and/or mucopurulent discharge from the middle meatus and/or edema or mucosal obstruction or mucosal obstruction in the middle meatus on nasal endoscopy. Tomographic changes may or may not tomographic changes may or may not be considered as mucosal changes in the osteomeatal complex and mucosal osteomeatal complex and the mucosa of the paranasal sinuses. It is recognized that the symptoms symptoms have high sensitivity but low specificity, hence the need for objective findings. findings.

Guía de práctica clínica para el tratamiento de la rinosinusitis crónica: versión corta para profesionales de la salud. Colombia-2023 / Clinical practice guideline for the management of chronic rhinosinusitis: short version for health care professionals. Colombia-2023

La rinosinusitis (RS) se define como la inflamación de la nariz y los senos paranasales con dos o más síntomas como bloqueo/obstrucción/congestión o secreción nasal (goteo nasal anterior/posterior) más dolor/presión facial y/o reducción o pérdida del sentido del olfato. Adicional, se tienen en cuenta los hallazgos objetivos como la presencia de pólipos nasales y/o descarga mucopurulenta en meato medio y/o edema u obstrucción de la mucosa en el meato medio en la endoscopia nasal.

Rhinosinusitis (RS) is defined as inflammation of the nose and sinuses with two or more symptoms such as blockage/obstruction/congestion or nasal discharge with two or more symptoms such as nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior runny nose) plus facial pain/pressure and/or reduced or lost sense of smell sense of smell. Additionally, objective findings such as the presence of nasal polyps and/or nasal presence of nasal polyps and/or mucopurulent discharge in the middle meatus and/or edema or mucous or mucosal obstruction in the middle meatus on nasal endoscopy.