RESUMEN
A 6-year-old intact female domestic dwarf rabbit (Oryctolagus cuniculus) was referred because of a chronic obstructive rhinitis not resolving despite antibiotic treatments. Computed tomography examination revealed 2 sub-obstructive structures of mineral density in the right nasal cavity and nasopharynx. Neoplasia and rhinolithiasis were the main differential diagnoses. A dorsal rhinostomy was performed and 1 mineralized lesion was removed. Infrared spectrophotometric and histological examinations of the lesion and nasal mucosa were consistent with a 100% calcium carbonate rhinolith with bacterial colonization and chronic lymphocytic rhinitis. Clinical signs improved during the first 4 wk following surgery. However, despite inhaled anti-inflammatory treatment, the rabbit's condition deteriorated when the rhinostomy site closed, and she died 7 wk after surgery. Rhinolith and lymphocytic rhinitis should be considered as differential diagnoses for upper respiratory tract signs in rabbits resistant to antimicrobial treatment. Key clinical message: Rhinolithiasis and chronic lymphocytic rhinitis should be included in the differential diagnoses of rabbits presenting with chronic obstructive upper respiratory tract signs characterized by purulent nasal discharge and failure of treatment despite adequate antimicrobial therapy, especially with unilateral signs. Computed tomography and rhinoscopy with biopsies are suggested to explore those possibilities.
Rhinolithiase au carbonate de calcium associée à une rhinite lymphoïde chronique chez un lapin de compagnie (Oryctolagus cuniculus)Une lapine naine domestique (Oryctolagus cuniculus) intacte, âgée de 6 ans, a été référée en raison d'une rhinite obstructive chronique non résolue malgré des traitement antibiotiques. L'examen tomodensitométrique a révélé 2 structures sous-obstructives de densité minérale dans la cavité nasale droite et le nasopharynx. La néoplasie et la rhinolithiase étaient les principaux diagnostics différentiels. Une rhinostomie dorsale a été réalisée et 1 lésion minéralisée a été retirée. Les examens par spectrophotométrie infrarouge et histologiques de la lésion et de la muqueuse nasale étaient compatibles avec un rhinolithe à 100 % en carbonate de calcium avec colonisation bactérienne et rhinite lymphocytaire chronique. Les signes cliniques se sont améliorés au cours des 4 premières semaines suivant l'intervention chirurgicale. Cependant, malgré un traitement anti-inflammatoire inhalé, l'état de la lapine s'est détérioré lors de la fermeture du site de rhinostomie et elle est décédée 7 semaines après l'opération. Le rhinolithe et la rhinite lymphocytaire doivent être envisagés comme diagnostic différentiel des signes des voies respiratoires supérieures chez les lapins résistants au traitement antimicrobien.Message clinique clé :La rhinolithiase et la rhinite lymphocytaire chronique doivent être incluses dans les diagnostics différentiels des lapins présentant des signes obstructifs chroniques des voies respiratoires supérieures caractérisés par un écoulement nasal purulent et un échec du traitement malgré un traitement antimicrobien adéquat, en particulier avec des signes unilatéraux. La tomodensitométrie et la rhinoscopie avec biopsies sont suggérées pour explorer ces possibilités.(Traduit par Dr Serge Messier).
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Carbonato de Calcio , Litiasis , Rinitis , Animales , Conejos , Femenino , Rinitis/veterinaria , Rinitis/tratamiento farmacológico , Rinitis/patología , Carbonato de Calcio/uso terapéutico , Litiasis/veterinaria , Litiasis/patología , Enfermedades Nasales/veterinaria , Enfermedades Nasales/patología , Enfermedades Nasales/tratamiento farmacológico , Diagnóstico Diferencial , Resultado FatalRESUMEN
This case report discusses a diagnosis of rhino-orbital-cerebral mucormycosis in a man aged 61 years who presented with vision loss, ophthalmoplegia, and ptosis.
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Infecciones Fúngicas del Ojo , Mucormicosis , Enfermedades Orbitales , Humanos , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Mucormicosis/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Masculino , Antifúngicos/uso terapéutico , Imagen por Resonancia Magnética , Enfermedades de los Senos Paranasales/microbiología , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Enfermedades Nasales/microbiología , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/tratamiento farmacológico , Femenino , Persona de Mediana Edad , Anfotericina B/uso terapéuticoAsunto(s)
Encefalopatías , Oftalmopatías , Mucormicosis , Enfermedades Nasales , Enfermedades Orbitales , Humanos , Antifúngicos/uso terapéutico , Oftalmopatías/diagnóstico por imagen , Oftalmopatías/tratamiento farmacológico , Oftalmopatías/microbiología , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Mucormicosis/diagnóstico por imagen , Mucormicosis/tratamiento farmacológico , Nariz , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Enfermedades Nasales/diagnóstico por imagen , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Nasales/microbiología , Encefalopatías/diagnóstico por imagen , Encefalopatías/tratamiento farmacológico , Encefalopatías/microbiologíaRESUMEN
Keratoacanthoma is an epithelial tumour derived from hair follicles. Clinical and histopathological features of keratoacanthoma can resemble that of squamous cell carcinoma. Different treatment alternatives have been described over the years including intralesional methotrexate injection. We present an interesting case of treatment of solitary keratoacanthoma lesion on the nose with intralesional methotrexate as non-surgical therapy.
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Queratoacantoma , Enfermedades Nasales , Humanos , Inyecciones Intralesiones , Queratoacantoma/tratamiento farmacológico , Queratoacantoma/patología , Metotrexato , Enfermedades Nasales/tratamiento farmacológicoRESUMEN
Importance: Time is a valuable resource in primary care, and physicians and patients consistently raise concerns about inadequate time during visits. However, there is little evidence on whether shorter visits translate into lower-quality care. Objective: To investigate variations in primary care visit length and quantify the association between visit length and potentially inappropriate prescribing decisions by primary care physicians. Design, Setting, and Participants: This cross-sectional study used data from electronic health record systems in primary care offices across the US to analyze adult primary care visits occurring in calendar year 2017. Analysis was conducted from March 2022 through January 2023. Main Outcomes and Measures: Regression analyses quantified the association between patient visit characteristics and visit length (measured using time stamp data) and the association between visit length and potentially inappropriate prescribing decisions, including inappropriate antibiotic prescriptions for upper respiratory tract infections, coprescribing of opioids and benzodiazepines for painful conditions, and prescriptions that were potentially inappropriate for older adults (based on the Beers criteria). All rates were estimated using physician fixed effects and were adjusted for patient and visit characteristics. Results: This study included 8â¯119â¯161 primary care visits by 4â¯360â¯445 patients (56.6% women) with 8091 primary care physicians; 7.7% of patients were Hispanic, 10.4% were non-Hispanic Black, 68.2% were non-Hispanic White, 5.5% were other race and ethnicity, and 8.3% had missing race and ethnicity. Longer visits were more complex (ie, more diagnoses recorded and/or more chronic conditions coded). After controlling for scheduled visit duration and measures of visit complexity, younger, publicly insured, Hispanic, and non-Hispanic Black patients had shorter visits. For each additional minute of visit length, the likelihood that a visit resulted in an inappropriate antibiotic prescription changed by -0.11 percentage points (95% CI, -0.14 to -0.09 percentage points) and the likelihood of opioid and benzodiazepine coprescribing changed by -0.01 percentage points (95% CI, -0.01 to -0.009 percentage points). Visit length had a positive association with potentially inappropriate prescribing among older adults (0.004 percentage points; 95% CI, 0.003-0.006 percentage points). Conclusions and Relevance: In this cross-sectional study, shorter visit length was associated with a higher likelihood of inappropriate antibiotic prescribing for patients with upper respiratory tract infections and coprescribing of opioids and benzodiazepines for patients with painful conditions. These findings suggest opportunities for additional research and operational improvements to visit scheduling and quality of prescribing decisions in primary care.
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Enfermedades Nasales , Infecciones del Sistema Respiratorio , Humanos , Femenino , Anciano , Masculino , Prescripción Inadecuada , Estudios Transversales , Pautas de la Práctica en Medicina , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Benzodiazepinas/uso terapéutico , Analgésicos Opioides/uso terapéutico , Enfermedades Nasales/tratamiento farmacológico , Antibacterianos/uso terapéutico , Atención Primaria de SaludRESUMEN
Purpose: Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19-associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM. Methods: This case-control study included all COVID-19-associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients. Results: The study included 69 patients with COVID-19-associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19-associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03-1.78), blood glucose (OR = 1.008, 95% CI: 1.003-1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02-1.17) were associated with increased odds of developing COVID-19-associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30-9.02) and blood glucose (OR = 1.02, 95% CI: 1.005-1.03) (P = 0.02) had a higher probability of developing COVID-19-associated ROCM than patients with established DM. Conclusion: Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19-induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19-associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.
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COVID-19 , Diabetes Mellitus , Mucormicosis , Enfermedades Nasales , Enfermedades Orbitales , Antifúngicos/uso terapéutico , Glucemia , COVID-19/epidemiología , Estudios de Casos y Controles , Diabetes Mellitus/epidemiología , Hemoglobina Glucada , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Mucormicosis/diagnóstico , Mucormicosis/epidemiología , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Orbitales/tratamiento farmacológico , Factores de RiesgoRESUMEN
INTRODUCTION: Inappropriate antibiotic (ab)use contributes to antimicrobial resistance. Upper respiratory tract infection (URTI) is the most common reason for antibiotic prescription in an outpatient department (OPD). Several factors influence the high and unjustified antibiotic use in a common ailment. MATERIALS AND METHODS: A clinical audit was performed to assess antibiotic prescription rate (APR) for URTI in the pediatric OPD against the available benchmark. The prescription pattern was assessed, and interventions were formulated to improve prescription behavior. Data of all children attending OPD and fulfilling the criteria for URTI group were collected from the online hospital management system and analyzed. Interventions, in the form of discussions, presentations, posters, and guidelines (Indian Ministry of Health Guidelines for URTI) regarding etiology of URTI, and indications for antibiotic prescription were implemented. Data were monitored and feedback to consultants was given. RESULTS: The baseline APR was 14.7%. There was wide variation in APR (4.1%-53.1%) among consultants. Three consultants had a rate of 53.1%, 29.7%, and 28.6%, which was very high. Postintervention, the average APR decreased to 8.7%, a reduction of 40.8%. There was a reduction in APR among consultants with high APR as well. There was reduction in the use of azithromycin, a drug recommended for patients with penicillin allergy, from 21.2% to 14.4% (32.1% reduction). Amoxycillin plus clavulanic acid combination and amoxicillin alone continued to be the most prescribed antibiotics. CONCLUSION: Interventions through clinical audit were useful in reducing APR. The APR of 8.7% achieved in this study postintervention can be used as a benchmark by other institutions to assess APR in children with URTI.
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Enfermedades Nasales , Infecciones del Sistema Respiratorio , Amoxicilina , Antibacterianos/uso terapéutico , Niño , Auditoría Clínica , Humanos , Enfermedades Nasales/tratamiento farmacológico , Pacientes Ambulatorios , Pautas de la Práctica en Medicina , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Atención Terciaria de SaludRESUMEN
OBJECTIVE: To observe the effect of topical application of recombinant human basic fibroblast growth factor (bFGF) in patients with nasal vestibulitis. METHODS: One hundred patients with nasal vestibulitis were randomly divided into two groups. Local application of bFGF + conventional medication was administered in the treatment group, while conventional medication was conducted in the control group. The healing of the nasal vestibular mucosa was observed. RESULTS: The mucosal healing time was 18.3 ± 4.8 days in the treatment group and 36.2 ± 6.2 days in the control group. The data comparison revealed that the difference between groups was statistically significant (P < 0.01). The total effective rate was 98.0% in the treatment group and 90.0% in the control group, and the difference was not statistically significant between the two groups (P > 0.05). CONCLUSION: Topical application of bFGF in patients with nasal vestibulitis could promote the growth of nasal mucosa, shorten the healing time of mucosal erosion, enhance the clinical treatment effect, and save a lot of treatment time for patients.
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Factor 2 de Crecimiento de Fibroblastos , Enfermedades Nasales , Factor 2 de Crecimiento de Fibroblastos/uso terapéutico , Humanos , Cavidad Nasal , Mucosa Nasal , Enfermedades Nasales/tratamiento farmacológico , Cicatrización de HeridasAsunto(s)
Antifúngicos/uso terapéutico , COVID-19/complicaciones , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Mucorales/efectos de los fármacos , Mucormicosis/tratamiento farmacológico , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Orbitales/tratamiento farmacológico , Antifúngicos/efectos adversos , COVID-19/inmunología , COVID-19/virología , Infecciones Fúngicas del Sistema Nervioso Central/inmunología , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Infecciones Fúngicas del Ojo/inmunología , Infecciones Fúngicas del Ojo/microbiología , Interacciones Huésped-Patógeno , Humanos , Mucorales/inmunología , Mucorales/patogenicidad , Mucormicosis/inmunología , Mucormicosis/microbiología , Enfermedades Nasales/inmunología , Enfermedades Nasales/microbiología , Enfermedades Orbitales/inmunología , Enfermedades Orbitales/microbiología , Factores de Riesgo , SARS-CoV-2/inmunología , SARS-CoV-2/patogenicidad , Resultado del TratamientoRESUMEN
BACKGROUND: Relapsing polychondritis (RPC) is a complex immune-mediated systemic disease affecting cartilaginous tissue and proteoglycan-rich organs. The most common and earliest clinical features are intermittent inflammation involving the auricular and nasal regions, although all cartilage types can be potentially affected. The life-threatening effects of rpc involve the tracheobronchial tree and cardiac connective components. Rpc is difficult to identify among other autoimmune comorbidities; diagnosis is usually delayed and based on nonspecific clinical symptoms with limited laboratory aid and investigations. Medications can vary, from steroids, immunosuppressants, and biologics, including anti-tnf alpha antagonist drugs. METHOD: Information on updated etiology, clinical symptoms, diagnosis, and treatment of rpc has been obtained via extensive research of electronic literature published between 1976 and 2019 using PubMed and medline databases. English was the language of use. Search inputs included 'relapsing polychondritis,' 'polychondritis,' 'relapsing polychondritis symptoms,' and 'treatment of relapsing polychondritis.' Published articles in English that outlined and reported rpc's clinical manifestations and treatment ultimately met the inclusion criteria. Articles that failed to report the above and reported on other cartilaginous diseases met the exclusion criteria. RESULT: Utilizing an extensive overview of work undertaken in critical areas of RPC research, this review intends to further explore and educate the approach to this disease in all dimensions from pathophysiology, diagnosis, and management. CONCLUSION: RPC is a rare multi-systemic autoimmune disease and possibly fatal. The management remains empiric and is identified based on the severity of the disease per case. The optimal way to advance is to continue sharing data on RPC from reference centers; furthermore, clinical trials in randomized control groups must provide evidence-based treatment and management. Acquiring such information will refine the current knowledge of RPC, which will improve not only treatment but also diagnostic methods, including imaging and biological markers.
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Productos Biológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Policondritis Recurrente/diagnóstico , Policondritis Recurrente/tratamiento farmacológico , Policondritis Recurrente/fisiopatología , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Enfermedades del Oído/tratamiento farmacológico , Enfermedades del Oído/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Nasales/fisiopatología , Policondritis Recurrente/etiología , Prevalencia , Evaluación de Síntomas , Resultado del TratamientoRESUMEN
Since the onset of COVID-19 pandemic, parallel opportunistic infections have also been emerging as another disease spectrum. Among all these opportunistic infection, mucormycosis has become a matter of concern with its rapid increase of cases with rapid spread as compared to pre-COVID-19 era. Cases have been reported in post-COVID-19-related immune suppression along with the presence of comorbidity which adds on the deadly outcome. There is no systematic review addressing the issue of COVID-19-associated mucormycosis. This is the first systematic review of published studies of mucormycosis associated with COVID-19. The aim was to analyze the real scenario of the disease statement including all the published studies from first November 2019 to 30th June to analyze the contemporary epidemiology, clinical manifestations, risk factor, prognosis, and treatment outcome of COVID-19 associated rhino-orbito-cerebral-mucormycosis. A comprehensive literature search was done in following databases, namely, PubMed, Google Scholar, Scopus, and EMBASE using keywords mucormycosis, rhino orbital cerebral mucormycosis, COVID-19, and SARS-CoV-2 (from November 01, 2019 to June 30, 2021). Our study shows that, while corticosteroids have proved to be lifesaving in severe to critical COVID-19 patients, its indiscriminate use has come with its price of rhino-orbito-cerebral mucormycosis epidemic, especially in India especially in patients with preexisting diabetes mellitus with higher mortality. Corticosteroid use should be monitored and all COVID-19 patients should be closely evaluated/monitored for sequelae of immunosuppression following treatment.
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COVID-19/virología , Coinfección , Meningitis Fúngica/microbiología , Mucormicosis/microbiología , Enfermedades Nasales/microbiología , Infecciones Oportunistas/microbiología , Enfermedades Orbitales/microbiología , SARS-CoV-2/patogenicidad , Antifúngicos/uso terapéutico , COVID-19/inmunología , COVID-19/mortalidad , Interacciones Huésped-Patógeno , Humanos , Meningitis Fúngica/tratamiento farmacológico , Meningitis Fúngica/inmunología , Meningitis Fúngica/mortalidad , Mucormicosis/tratamiento farmacológico , Mucormicosis/inmunología , Mucormicosis/mortalidad , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Nasales/inmunología , Enfermedades Nasales/mortalidad , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/mortalidad , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/inmunología , Enfermedades Orbitales/mortalidad , Pronóstico , Medición de Riesgo , Factores de Riesgo , SARS-CoV-2/inmunologíaRESUMEN
Coronavirus disease-associated mucormycosis (CAM) is an established clinical entity in India. In the past 4 months, there has been a sharp upsurge in the number of CAM cases in most parts of the country. Early diagnosis can be lifesaving. Magnetic resonance imaging (MRI) imaging remains the corner stone of management in patients with ROCM. This review discussed the utility of MRI imaging in ROCM with an emphasis on the ideal MRI protocol in a suspected case of ROCM, the pathways of spread of infection, the classic diagnostic features, MRI for staging of the disease, MRI for prognostication, MRI for follow up, and imaging features of common differentials in ROCM. The pit falls of MRI imaging and a comparison of CT and MRI imaging in ROCM are discussed. The clinical interpretation of areas of contrast uptake and those of necrosis and its relevance to treatment are discussed. This review aims to familiarize every member of the multidisciplinary team involved in managing these patients to be able to interpret the findings on MRI in ROCM.
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Mucormicosis , Enfermedades Nasales , Enfermedades Orbitales , Antifúngicos/uso terapéutico , Humanos , India , Imagen por Resonancia Magnética , Mucormicosis/diagnóstico por imagen , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/tratamiento farmacológicoRESUMEN
OBJECTIVES: Sarcoidosis is a multisystemic inflammatory disease with extrathoracic manifestations, most commonly affecting the young and middle-aged, female and Black populations. Diagnosis usually requires evidence of non-caseating granulomata and, when treated, prognosis is usually favourable. We aim to establish the incidence, clinical features and optimal treatment of ENT manifestations of this disease. DESIGN: We performed a PubMed literature review to determine the evidence base supporting this. RESULTS: ENT manifestations are present in 5%-15% of patients with sarcoidosis, often as a presenting feature, and require vigilance for swift recognition and coordinated additional treatment specific to the organ. Laryngeal sarcoidosis presents with difficulty in breathing, dysphonia and cough, and may be treated by speech and language therapy (SLT) or intralesional injection, dilatation or tissue reduction. Nasal disease presents with crusting, rhinitis, nasal obstruction and anosmia, usually without sinus involvement. It is treated by topical nasal or intralesional treatments but may also require endoscopic sinus surgery, laser treatment or even nasal reconstruction. Otological disease is uncommon but includes audiovestibular symptoms, both sensorineural and conductive hearing loss, and skin lesions. CONCLUSIONS: The consequences of ENT manifestations of sarcoidosis can be uncomfortable, disabling and even life-threatening. Effective management strategies require good diagnostic skills and use of specific therapies combined with established treatments such as corticosteroids. Comparisons of treatment outcomes are needed to establish best practice in this area.
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Enfermedades del Oído/patología , Enfermedades de la Laringe/patología , Enfermedades Nasales/patología , Sarcoidosis/patología , Diagnóstico Diferencial , Enfermedades del Oído/diagnóstico , Enfermedades del Oído/tratamiento farmacológico , Humanos , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/tratamiento farmacológico , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/tratamiento farmacológico , Sarcoidosis/diagnóstico , Sarcoidosis/tratamiento farmacológicoRESUMEN
BACKGROUND: Conidiobolomycosis is a rare tropical rhinofacial fungal infection which has not been well characterised. The available evidence in its management is sparse due to lack of clinical studies and the limited data on antifungal susceptibility patterns. OBJECTIVE: To analyse the clinical manifestations, antifungal treatment and outcomes of patients with conidiobolomycosis and to determine antifungal susceptibility profiles of the isolates. PATIENTS/METHODS: Retrospective analysis of data of all patients with a diagnosis of conidiobolomycosis confirmed by histopathology and culture at a tertiary care hospital from 2012 to 2019 was done. RESULTS: There were 22 patients, 21 males and one female, with a mean age of 37.1 years. Most common presenting symptom was nasal obstruction, found in 20 (90.90%) patients. Patients who presented within 12 months had a better cure rate (85%) compared to those who presented late (67%). Among the 19 patients who had a follow-up, good outcome was seen in 15 of the 17 (88.24%) patients who were on itraconazole or potassium iodide containing regimen. Of the six patients who received additional trimethoprim-sulphamethoxazole (co-trimoxazole), 67% showed good outcome with two patients showing complete cure and two patients still on treatment with significant improvement. High minimum inhibitory concentration (MIC) values were noted for azoles and amphotericin B, whereas co-trimoxazole showed lowest MIC ranges. CONCLUSION: Itraconazole and potassium iodide are reasonable first-line options for the treatment of conidiobolomycosis. Good clinical response to KI and comparatively lower MIC of co-trimoxazole are promising. Further studies are required for developing clinical breakpoints that can predict therapeutic outcomes.
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Antifúngicos/uso terapéutico , Conidiobolus/efectos de los fármacos , Enfermedades Raras/microbiología , Cigomicosis/tratamiento farmacológico , Cigomicosis/microbiología , Adulto , Manejo de la Enfermedad , Cara/microbiología , Cara/patología , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Nasales/microbiología , Enfermedades Raras/tratamiento farmacológico , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Intranasal sprays (INSs) are commonly used medications for the treatment of many rhinologic conditions. Despite their popularity, an analysis of a nationwide reporting database and comparison to the available literature has never been performed. METHODS: The Food and Drug Administration Adverse Event Reporting System (FAERS) database was accessed to obtain adverse event (AE) records from 2014 to 2019 for varying INSs, including: 10 corticosteroids, 1 alpha adrenergic, and 3 antihistamines. The Proportional Reporting Ratios (PRR) and Reporting Odds Ratios (ROR) were calculated for dyspnea, anosmia, ageusia/dysgeusia, epistaxis, and headache. A PRR ≥ 2 or ROR ≥ 1 was considered significant. RESULTS: Corticosteroids had 98 864 total reported AEs to the database, followed by antihistamines (7011) and alpha adrenergics (2071). In total, dyspnea was reported 5843 times, followed by headache (4230), epistaxis (1205), ageusia/dysgeusia (920), and anosmia (312). Overall, PRR and ROR values for dyspnea ranged from 0.51 to 4.25 and 0.51 to 4.49; for dysgeusia/ageusia from 0.56 to 6.09 and 0.56 to 6.12; and for epistaxis from 1.03 to 27.24 and 1.03 to 30.76, respectively. All medications which listed anosmia within the top AEs had PRR and ROR values exceeding 2 and 1, respectively. The PRR for headache exceeded 2 for 1 medication and the ROR exceeded 1 in 7 medications. CONCLUSION: The AEs of dyspnea, anosmia, ageusia/dysgeusia, epistaxis, and headache are reported within the FAERS database for commonly prescribed INSs. When compared against the existing scientific literature, the clinical significance of this reporting tool from the FDA for these classes of medications remains unvalidated.
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Corticoesteroides , Agonistas alfa-Adrenérgicos , Sistemas de Registro de Reacción Adversa a Medicamentos/estadística & datos numéricos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Antagonistas de los Receptores Histamínicos , Rociadores Nasales , Enfermedades Nasales/tratamiento farmacológico , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Agonistas alfa-Adrenérgicos/administración & dosificación , Agonistas alfa-Adrenérgicos/efectos adversos , Estudios Transversales , Bases de Datos Factuales/estadística & datos numéricos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/clasificación , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Antagonistas de los Receptores Histamínicos/administración & dosificación , Antagonistas de los Receptores Histamínicos/efectos adversos , Humanos , Estados Unidos , United States Food and Drug AdministrationAsunto(s)
Congresos como Asunto , Tos/tratamiento farmacológico , Antagonistas del Receptor Purinérgico P2X/uso terapéutico , Asma/complicaciones , Asma/tratamiento farmacológico , Bronquitis/complicaciones , Bronquitis/tratamiento farmacológico , Enfermedad Crónica/tratamiento farmacológico , Tos/etiología , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Enfermedades Nasales/complicaciones , Enfermedades Nasales/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , TelecomunicacionesRESUMEN
BACKGROUND: In the specialty of Otolaryngology - Head and Neck Surgery, intranasal corticosteroids are the mainstay treatment for inflammatory processes within the nasal cavity. All too often, physician prescribing patterns are based on previous training, personal experience, and interactions with industry. The purpose of this commentary is to review the nuances of each intranasal corticosteroid. COMMENTARY: There are nine intranasal corticosteroids approved for use in Canada. Each are discussed in detail, including their indication, bioavailability, effects on intranasal environment, and factors around patient adherence. Off-label use of budesonide irrigations is also discussed and cost information is presented in reference format for all available intranasal corticosteroids. CONCLUSION: Although the efficacy of each intranasal corticosteroid has been shown to be similar, prescribing should be tailored based on bioavailability, intranasal environment, and factors that impact patient adherence such as dosing, cost and tolerability.
Asunto(s)
Corticoesteroides/administración & dosificación , Enfermedades Nasales/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Administración Intranasal , Corticoesteroides/economía , Canadá , Humanos , Uso Fuera de lo Indicado , Pautas de la Práctica en Medicina/economía , Irrigación TerapéuticaRESUMEN
BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19-associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. "R-metafor package" was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041-0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212-4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205-0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.