Is generative pre-trained transformer artificial intelligence (Chat-GPT) a reliable tool for guidelines synthesis? A preliminary evaluation for biologic CRSwNP therapy.

INTRODUCTION: Biologic therapies for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) have emerged as an auspicious treatment alternative. However, the ideal patient population, dosage, and treatment duration are yet to be well-defined. Moreover, biologic therapy has disadvantages, such as high costs and limited access. The proposal of a novel Artificial Intelligence (AI) algorithm offers an intriguing solution for optimizing decision-making protocols. METHODS: The AI algorithm was initially programmed to conduct a systematic literature review searching for the current primary guidelines on biologics' clinical efficacy and safety in treating CRSwNP. The review included a total of 12 studies: 6 systematic reviews, 4 expert consensus guidelines, and 2 surveys. Simultaneously, two independent human researchers conducted a literature search to compare the results. Subsequently, the AI was tasked to critically analyze the identified papers, highlighting strengths and weaknesses, thereby creating a decision-making algorithm and pyramid flow chart. RESULTS: The studies evaluated various biologics, including monoclonal antibodies targeting Interleukin-5 (IL-5), IL-4, IL-13, and Immunoglobulin E (IgE), assessing their effectiveness in different patient populations, such as those with comorbid asthma or refractory CRSwNP. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, demonstrated significant improvement in nasal symptoms and quality of life in patients with CRSwNP in several randomized controlled trials and systematic reviews. Similarly, mepolizumab and reslizumab, which target IL-5, have also shown efficacy in reducing nasal polyp burden and improving symptoms in patients with CRSwNP, particularly those with comorbid asthma. However, additional studies are required to confirm the long-term efficacy and safety of these biologics in treating CRSwNP. CONCLUSIONS: Biologic therapies have surfaced as a promising treatment option for patients with severe or refractory CRSwNP; however, the optimal patient population, dosage, and treatment duration are yet to be defined. The application of AI in decision-making protocols and the creation of therapeutic algorithms for biologic drug selection, could offer fascinating future prospects in the management of CRSwNP.

Chronic rhinosinusitis with nasal polyposis: the role of personalized and integrated medicine.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common disorder. From a clinical and immunopathological point of view, different phenotypes and endotypes have been identified. As asthma is frequent comorbidity, biological agents for treating CRSwNP associated with asthma may be an attractive strategy. Biological agents have several mechanisms, such as antagonizing IgE, interleukin (IL) 4, IL-5, and IL-13. However, a workup is mandatory, mainly concerning pheno-endotyping. In this regard, clinical cytological grading (CCG) has been proposed as a useful tool to manage patients with CRSwNP as it allows us to define clinical and immunopathological phenotypes able to identify the ideal candidate for biologics. In particular, the mixed cellular pattern, such as eosinophils and mast cells, could be sensitive to anti-IL-4 agents. There is still a need for well-established indications, criteria of responsiveness, duration, and safety. Moreover, personalized medicine could be opportunely integrated and/or alternated with intranasal corticosteroids to prevent relevant adverse events.

The microbiology and the efficacy of antibiotic-based medical treatment of chronic rhinosinusitis in Singapore.

BACKGROUND: Medical therapy including appropriate antibiotic treatment is advocated for the management of chronic rhinosinusitis (CRS), with sinus surgery reserved for treatment failures. This study investigates the microbiology of CRS and their response to culture-directed antibiotic treatment. METHODS: Sinus aspirates of mucopus from 172 consecutive CRS patients, with (n=89) and without (n=83) previous antibiotic treatment, were obtained for bacterial culture at their first visit. Medical treatment which included initial empirical and subsequent culture-directed antibiotics was instituted. Endoscopic sinus surgery (FESS) was performed for patients with persistent CRS and/or complications of CRS. A follow-up of 12 months was scheduled for all patients. RESULTS: One hundred and twenty (69.8%) patients were treated successfully by with antibiotic-based medical therapy. Thirty-eight patients (22.1%) did not respond to medical treatment and eventually underwent FESS. The incidence of CRS with nasal polyps (CRSwNP) was higher in FESS group (n=13, 34.2%) than patients with medical treatment only (n=9, 6.7%). Staphylococcus aureus was the most common pathogen (n=43, 25%) and amongst patients with no prior antibiotic treatment, the incidence was higher in patients with CRSwNP (n=8, 53 %) than CRS without NP (CRSwoNP) (n=20, 27%). The rate of sensitivity of the cultured microbes to amoxicillin with clavulanate and cephalosporins was 78% and 70%, respectively. CONCLUSION: The microbiology of CRS in Singapore is described. Staphylococcus aureus appears to be the most common bacterial isolates in both CRS with and without nasal polyps. Medical treatment with CRS using culture-directed antibiotics is effective in the majority of patients, especially in patients without nasal polyps.

Use of complementary and alternative medicine by patients attending a rhinology outpatient clinic.

BACKGROUND: There are 50,000 practitioners of complementary and alternative medicine (CAM) within the United Kingdom. The current U.K. prevalence of CAM use is reported to be 25% and is rising. The national expenditure on CAM is an estimated pound1.6 billion. The aim of this study was to explore the pattern of CAM use in patients attending a rhinology outpatient clinic in Aberdeen. METHODS: Questionnaires were provided to 100 patients over a 2-month period. The questionnaire consisted of demographic sections and whether they had ever used CAM from a list of 49 herbal and nonherbal alternative therapies. Subjects were also asked why they used CAM, where they learned of CAM, whether they found it efficacious, and whether their general practitioner was aware they were using it. RESULTS: One hundred subjects completed questionnaires. Patients attending the clinic were suffering from the most common rhinological complaints including rhinosinusitis and nasal polyps. Sixty-five percent of patients had ever used CAM. Women were statistically significantly more likely to use CAM than men (p = 0.012). Patients who were employed were more likely to use CAM, but there was no significant difference in CAM usage depending on marital status, social class, and age. Only 6% of patients felt CAM use was definitely ineffective. Only 43% of users of CAM had informed their doctor about its use. CONCLUSION: CAM usage is growing in popularity. All health care professionals should be aware of this and of the potential for adverse drug reactions occurring. The dangers of noncompliance with conventional medications should be emphasized to CAM users.

[Allergological study of subjects with chronic rhinitis]. / Studio allergologico in soggetti affetti da rinite cronica.

The following parameters were considered in an allergological study of 362 subjects with chronic rhinitis unaccompanied by bronchial asthma: sex, age at onset, residence, familial allergy, personal history, season in which distrubances occurred, nasal polyps, concomitance of conjunctivitis, appear of chronic bronchitis, skin tests for dusts, vegetable fibres, skin derivatives, pollens and moulds. A positive allergometric response was noted in 60.77% and familial allergy in 30.93%. Skin manifestations were observed in 20.99%. Conjunctivitis was present in 55.24%, most of whom were skin-positive; nasal polyps were present in 4.69%, most of whom were skin-negative. 1.65% had chronic bronchitis. 79.54% of the skin-positive subjects were sensitive to pollens, 47.72% to "inhalants" (28.18% to household dust), and 30% to moulds.