Correctly performed nasal swabs.

BACKGROUND: As the incidence of new cases of coronavirus disease increased exponentially, the use of viral swabs to collect nasopharyngeal specimens are increasing drastically. Therefore, healthcare workers military staff and uneducated nonprofessional's were ordered to make this swabs. Subsequently case reports reported about basal skull perforation, cerebrospinal fluid fistula and injury due to an incorrect technique. METHODS: Search of the literature. RESULTS: Only in 44% of the videos (Youtube) nasal swabs were correctly performed. Due to an false technique biological sampling resulted in false-negative COVID-19 tests. CONCLUSION: Although professional societies started to report about this unacceptable situation, no publication reported about this health endangerment. In this time of overwhelming information and diversity of opinions, it is necessary to report about this in the hope, all media and TV reports will follow this article to show correctly performed nasal swabs to reduce false-negative COVID-19 tests and injury.

Influence of Surgical Trauma in the Nasal Cavity on the Expression of p53 Protein in the Hippocampus of Rats.

The aim of the study was to determine the role of the stress effect of septoplasty modeling on p53 protein expression in the hippocampus of rats under conditions of sensory olfactory deprivation. Simulation of septoplasty was carried out on 30 sexually mature male rats. A quantitative assessment of the apoptosis of neurons in the pyramidal layer of the hippocampus in the subfields CA1, CA2, CA3, and dentate gyrus (DG) on days 2, 4, and 6 after surgery was carried out. Histological sections were stained by the immunohistochemical method with antibodies to the p53 protein. An increase in the number of p53-positive neurons was noted in all subfields; the maximum increase in the number of apoptotic neurons was noted on day 4 after surgery. The stress effect of modeling septoplasty in rats, accompanied by sensory deprivation of the peripheral part of the olfactory analyzer, provoked the expression of p53 and the initiation of apoptosis mechanisms in various subfields of the hippocampus.

The Effect of Surgical Trauma in the Nasal Cavity on the Behavior in the Open Field and the Autonomic Nervous System of Rats.

In this article, the effect of surgical damage to the nasal mucosa in rats under the action of general anesthesia was investigated. The motor activity and heart rate variability (HRV) of rats were studied before and 2 days after the surgery. After surgical exposure, motor activity decreased, the time of fading and grooming increased, VLF increased, and HF decreased. Surgical trauma of the nasal septum in rats at the early postoperative stage promotes a pronounced stress response in the form of a sharp shift in the balance of the autonomic nervous system towards the sympathetic level and causes a decrease in exploratory activity, an anxiety, and a depressive-like state in rats.

[The injuries to the nose and paranasal sinuses in the children resulting from shooting an air rifle]. / Povrezhdeniia nosa i okolonosovykh pazukh u detei pri strel'be iz pnevmaticheskogo oruzhiia.

This article reports two clinical cases of the successful treatment of the gunshot wounds in the nasal cavity and paranasal sinuses of the children resulting from the careless use of the pneumatic weapons. Despite the fact that the shots were fired from a close distance, the intracranial structures and the eyeballs remained unaffected. The bullets were localized in the nasal septum of one child and in the frontal recess of the other as is typical of the injuries inflicted to the nose and paranasal sinuses by the shots from the air rifles. Multi-slice spiral computed tomography (MSCT) is known to have a number of important advantages over the roentgenological examination for determining the location of the bullets. Bullets for pneumatic rifles are manufactured in the form of the balls either from lead or copper-coated steel; therefore, they are a priory can not be removed with the use of a magnet.

Nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates-a randomised trial.

The objective of this study was to compare the efficacy and safety of continuous positive airway pressure (CPAP) delivered using nasal masks with binasal prongs. We randomly allocated 72 neonates between 26 and 32 weeks gestation to receive bubble CPAP by either nasal mask (n = 37) or short binasal prongs (n = 35). Primary outcome was mean FiO2 requirement at 6, 12 and 24 h of CPAP initiation and the area under curve (AUC) of FiO2 against time during the first 24 h (FiO2 AUC0-24). Secondary outcomes were the incidence of CPAP failure and nasal trauma. FiO2 requirement at 6, 12 and 24 h (mean (SD); 25 (5.8) vs. 27.9 (8); 23.8 (4.5) vs. 25.4 (6.8) and 22.6 (6.8) vs. 22.7 (3.3)) as well as FiO2 AUC0-24 (584.0 (117.8) vs. 610.6 (123.6)) were similar between the groups. There was no difference in the incidence of CPAP failure (14 vs. 20%; relative risk 0.67; 95% confidence interval 0.24-1.93). Incidence of severe nasal trauma was lower with the use of nasal masks (0 vs. 31%; p < .001). CONCLUSIONS: Nasal masks appear to be as efficacious as binasal prongs in providing CPAP. Masks are associated with lower risk of severe nasal trauma. TRIAL REGISTRATION: CTRI2012/08/002868 What is Known? • Binasal prongs are better than single nasal and nasopharyngeal prongs for delivering continuous positive airway pressure (CPAP) in preventing need for re-intubation. • It is unclear if they are superior to newer generation nasal masks in preterm neonates requiring CPAP. What is New? • Oxygen requirement during the first 24 h of CPAP delivery is comparable with use of nasal masks and binasal prongs. • Use of nasal masks is, however, associated with significantly lower risk of severe grades of nasal injury.

Nonfatal Cervical-Neck Lesion With a Wooden Foreign Body: Diagnosis and Management.

Penetrating cervical lesions caused by a foreign body are rare events. The neck is a complex and delicate body region, given the important vascular structures it holds. The most frequent fatal complications often involve vascular injuries, and as a consequence, the mortality rate increases by approximately 50%. Civilian patients are mainly victims of violence or motor vehicle accidents and rural accidents involving neck are not very common. When a cervical lesion is because of a wooden foreign body, infectious risk increases for its organic peculiarity. The authors report a rural nonfatal cervical lesion in a civilian, and its management.

Primary incisor intruded through the nasal cavity: a case report.

Intrusive luxation may cause complications for the primary tooth and generate adverse sequelae in the permanent successor. Although intrusion is prevalent in the primary dentition, full intrusion is a rare event that requires specialized treatment and a multidisciplinary approach. This article describes the case of a 1-year-old girl who presented with traumatic displacement of the maxillary left central incisor into the nasal cavity. The parents sought treatment 1 month after the child sustained the injury, and the impacted tooth was removed through her left nostril under general anesthesia. Four-year clinical and radiographic follow-up revealed no adverse sequelae.

Computed tomography image guidance for more accurate repair of anterior table frontal sinus fractures.

BACKGROUND: Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging. METHODS: Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded. RESULTS: Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%). CONCLUSIONS: A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.

Efficacy of N-Acetylcysteine on Wound Healing of Nasal Mucosa.

Postoperative nasal mucosa healing is a highly complex and organized process, and the success rates of endoscopic sinus surgery and septoplasty surgeries are closely associated with the postoperative wound healing processes. In this experimental study, the authors' aim was to use histopathologic examination to investigate the effects of N-Acetylcysteine (NAC) on the wound healing of rat nasal mucosa after mechanical trauma. Twenty-one Sprague-Dawley rats were randomly divided into 3 groups: the nontreated group (N = 7), the control saline group (N = 7), and the NAC group (N = 7). No treatment was given to the nontreated group for 15 days. The control saline group received intraperitoneal injection of saline (2.5  mL/kg, intraperitoneal) for 15 days and the NAC group was intraperitoneally injected with NAC at a dose of 300  mg/kg/day for 15 days. At the beginning of the study, unilateral mechanical nasal trauma was induced with an interdental brush inserted through the right nostril in all rats. Samples were stained using hematoxylin and eosin solution, and were examined by a pathologist using a light microscope. The severity of inflammation was milder in the NAC group compared with that in the nontreated and saline groups (P < 0.05). The subepithelial thickness index was lower in the experimental group (P < 0.05). Goblet cell loss was reduced in the experimental group compared with the nontreated and saline groups (P < 0.05). NAC decreases inflammation and goblet cell loss. Therefore, NAC has potential beneficial effects on the wound healing of nasal mucosa in rats.

Maxillofacial Fractures: Midface and Internal Orbit-Part I: Classification and Assessment.

Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all physicians treating facial trauma patients to understand the basic principles of injuries to the midface. Thus, this article aims to describe the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern.

Avoiding and correcting complications in perinasal trauma.

Injuries to the nose and perinasal region are common. Although the nasal fractures are commonly recognized and properly addressed, injuries to adjacent structures such as the orbit, medial canthus, and midface skeleton can be missed or misdiagnosed, leading to improper primary treatment and subsequent secondary deformities. In this discussion, three common injuries will be discussed, including nasomaxillary fractures, limited naso-orbital-ethmoid fractures, and severe central facial injuries with naso-orbital-ethmoid fractures. For instructional purposes, a case example of inadequate primary diagnosis and subsequent delayed or secondary management will be followed by a case example of proper initial diagnosis and proper primary management.

Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation. / Alternância de máscara nasal com pronga nasal reduz a incidência de lesão nasal moderada a grave em prematuros em uso de ventilação não invasiva.

OBJECTIVE: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. METHODS: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. RESULTS: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). CONCLUSION: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

OBJETIVO: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. MÉTODOS: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. RESULTADOS: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01).O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). CONCLUSÃO: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

Role of reactive oxygen and nitrogen species in olfactory epithelial injury by the sulfur mustard analogue 2-chloroethyl ethyl sulfide.

The inhalation of sulfur mustard (SM) causes substantial deposition in the nasal region. However, specific injury has not been characterized. 2-chloroethyl ethyl sulfide (CEES) is an SM analogue used to model injury and screen potential therapeutics. After the inhalation of CEES, damage to the olfactory epithelium (OE) was extensive. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive cells were present by 4 hours, and maximal at 18-72 hours. Cleaved caspase 3 immunohistochemistry (IHC) was maximal at 18 hours after the inhalation of 5% CEES. Olfactory marker protein (OMP)-positive olfactory neurons were markedly decreased at 18 hours. IHC-positive cells for 3-nitrotyrosine (3-NT) within epithelium were elevated by 8 hours, waning by 18 hours, and absent by 72 hours. AEOL 10150, a catalytic manganoporphyrin antioxidant, administered both subcutaneously (5 mg/kg) and intranasally (50 µM, "combined treatment"), decreased OE injury. CEES-induced increases in markers of cell death were decreased by combined treatment involving AEOL 10150. CEES-induced changes in OMP and 3-NT immunostaining were markedly improved by combined treatment involving AEOL 10150. The selective inducible nitric oxide synthase inhibitor 1400W (5 mg/kg, subcutaneous), administered 1 hour after inhalation and thereafter every 4 hours (five doses), also reduced OE damage with improved OMP and 3-NT staining. Taken together, these data indicate that reactive oxygen and nitrogen species are important mediators in CEES-induced nasal injury.

Conservative management of transnasal intracranial injury.

The purpose of this study was to explore the conservative management for an unusual case of transnasal intracranial injury. A 3-year-old female child presenting with transnasal injuries after a domestic accident whereby she apparently fell while holding a large pair of scissors, which then penetrated her left nasal cavity, piercing her nasal cavity, ethmoid sinus, and skull base. The scissors were removed from her nasal cavity. The patient had scant cerebrospinal rhinorrhea and no other additional neurologic deficits noted at the time, as well as no long-term developmental deficits. This report highlights the occurrence of this rare condition. The role of radiologic studies such as computed tomographic scans and plain films in diagnosis and management of this case is affirmed. The strategy of minimally invasive treatment of this injury can be a reasonable treatment option.

[Preparation and clinical application of polyvinyl alcohol/drug-loaded chitosan microsphere composite wound dressing].

In order to prepare and apply the polyvinyl alcohol/drug-loaded chitosan microspheres composite wound dressing, we first prepared chitosan microspheres by emulsion cross-linking method, and then added chitosan microspheres into the reactants during the acetalization of polyvinyl alcohol and formaldehyde. We further studied the morphology, water absorption, swelling degree, mechanical properties and in vitro release of the sponge with different amount of chitosan microspheres. The results showed that polyvinyl alcohol/drug-loaded chitosan composite sponge has porous structure with connectionism. Increasing the amount of chitosan microspheres would make the apertures smaller, so that the water absorption and the swelling of sponge decreased, but the tensile strength and compressive strength increased. With the increase of the amount of chitosan microspheres, the drug absorption of cefradine and the release rate increase, and the release time become longer. With the results of toxicity grade of 0 to 1, this type of composite sponge is non-toxic and meets the requirement of biocompatibility. The observation of rabbit nasal cavity after surgical operation suggested that polyvinyl acetal sponge modified with the chitosan has antiphlogistic, hemostatic and non-adherent characteristic, and can promote the healing and recovering of the nasalmucosa. After using this composite material, best growing surroundings for patients' granulation tissue were provided. Exposed bone and tendon were covered well with granulation tissue.

[Diagnostic endoscopy of the nasal cavity and nasopharynx in premature newborn infants].

Disturbed nasal breathing in the children always was a topical socio-medical problem and has remained such up to now. The objective of the present investigation was to estimate the potential of modern endoscopic techniques for diagnostics of disturbed nasal breathing in the premature infants and to develop therapeutic measures aimed at the prevention of destructive changes in the nose during therapy with the use of continuous positive airway pressure (CPAP). The study included 43 children ranging in the age from 1 month to 2 years (24 boys and 19 girls). All the newborn babies were transferred to the department of resuscitation and intensive therapy for the urgent treatment including respiratory support with the use of the CPAP technique. The endoscopic surveillance made it possible to exactly determine the causes responsible for the disturbances of nasal breathing in the children who survived the critical conditions, to estimate the anatomical and functional conditions of the nasopharyngeal structures, and to develop therapeutic and preventive measures to protect the nose from further destructive changes.

Acute intranasal intoxication with mercuric chloride taken accidently instead of cocaine - A case report.

CONTEXT: Mercuric chloride (mercury (II) chloride) belongs to inorganic mercury compounds characterized by good water solubility and associated high toxicity. The paper describes an unusual case of intranasal intoxication with corrosive sublimate confused with cocaine by a young male. CASE REPORT: Intranasal administration of corrosive sublimate caused severe local symptoms of chemical burn within the nasal cavity. From the 2nd day the patient developed symptoms of renal dysfunction with transient polyuria and serum retention of nitrogen metabolites. The patient was undergoing chelation therapy with DMPS, N-acetylcysteine and d-penicyllamine. Four procedures of haemodialysis were performed with simultaneous DMPS and N-acetylcysteine treatment. The urine mercury level on the first day of hospitalization was 1989 µg/L, and after 26 days of treatment returned to the physiological level. During treatment renal function was normalized, the patient was discharged in general good condition. DISCUSSION: Mercuric chloride is readily absorbed from the nasal cavity. Its administration may cause intoxication manifested by both chemical burn at the exposure site and systemic symptoms, particularly renal impairment. Even in case of renal dysfunction the use of DMPS seems safe, if haemodialysis is performed at the same time. Simultaneous haemodialysis and chelation therapy may accelerate elimination of mercury from the organism.

Presentation and management of nasal foreign bodies in a Chinese metro area.

ABSTRACT: Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.

Using a modified nasotracheal tube to prevent nasal ala pressure sore during prolonged nasotracheal intubation.

Nasotracheal tube induced nasal ala pressure sores or necrosis during prolonged nasotracheal intubation have been reported, and it is a serious but preventable complication. Here we introduce a modified nasotracheal tube to prevent this complication. This modified nasotracheal tube is composed of two parts, an oral endotracheal tube and a proximal part of a preformed nasotracheal tube, which are linked by a connector. The use of this modified nasotracheal tube can prevent nasal ala pressure sores during prolonged nasotracheal intubation.

[Transnasal wounds of the base of the skull encountered in the practical work of the otorhinolaryngologist].

The authors describe rare clinical observations of patients suffering transnasal injuries to the base of the skull. Based on their own experience, they propose practical recommendations for the management of such cases.