Rinite alérgica na visão do paciente / Allergic rhinitis from a patient's perspective

Os sintomas nasais têm impacto na vida dos pacientes com rinite alérgica. A maioria das pessoas alérgicas relata impacto negativo dos sintomas de alergia no trabalho e no desempenho escolar. Dentre todos os sintomas de alergia, o mais incômodo é a obstrução nasal, embora outros sintomas também tenham impacto na qualidade de vida dos pacientes, especialmente no sono. Os anti-histamínicos orais e corticosteroides nasais são as medicações mais frequentemente utilizadas para o tratamento de rinite, seguidos por descongestionantes orais ou intranasais. Os pacientes alérgicos frequentemente compram medicações sem prescrição médica nas farmácias, e nem sempre estão satisfeitos com o tratamento que lhes é oferecido. Os médicos devem trabalhar mais na comunicação com os pacientes alérgicos para atender às suas necessidades, abordando medo de efeitos colaterais, preocupações quanto aos sintomas de alergia e como estes interferem na qualidade de vida. Desse modo, a educação do paciente baseada em melhor comunicação pode facilitar o controle da rinite alérgica.

Nasal symptoms have an impact on the daily lives of patients with allergic rhinitis. Most allergic individuals report a negative impact of allergy symptoms on work and school performance. Among all allergy symptoms, the most bothersome is nasal congestion, although other symptoms also have an impact on patients' quality of life, especially on their sleep. Oral antihistamines and intranasal corticosteroids are the most frequently used medications for rhinitis, followed by oral or intranasal decongestants. Allergic patients frequently purchase different over-the-counter medications and sometimes are not satisfied with proposed treatments. Physicians should improve the communication with allergic patients to meet their needs, addressing fear of side effects, concerns about allergy symptoms and how they impact quality of life. Thus, educating patients through better communication may improve the control of allergic rhinitis.

Intoxicación grave con nafazolina: puesta al día a partir de un error terapéutico / Severe poisoning with naphazoline: update from a therapeutic error

La nafazolina es un fármaco utilizado como descongestivo, generalmente, en pacientes adultos. Su indicación en pediatría no es frecuente; su uso está aprobado a partir de los 12 años por los efectos tóxicos que posee. La intoxicación en niños genera un cuadro clínico potencialmente grave. Se caracteriza por la aparición inmediata de hipotonía, deterioro del sensorio, hipotermia y bradicardia con grado variable de compromiso clínico. Si bien es una intoxicación infrecuente, la anamnesis y el manejo inicial del paciente son la clave en su evolución. Se presenta a un niño de 4 años que, por un error terapéutico, recibió este fármaco y se destaca la instauración rápida y potencialmente grave del cuadro clínico.

Naphazoline is a drug commonly used as a decongestant in adult patients. Its indication in Pediatrics is not frequent, being approved its use from the age of 12 for the toxic effects it possesses. Intoxication in children generates a potentially serious clinical picture. It is characterized by the immediate appearance of hypotonia, deterioration of the sensory, hypothermia and bradycardia of variable degree of clinical compromise. Although it is an infrequent intoxication, the anamnesis and the initial management of the patient are the key in the evolution. We present a 4-year-old boy who, as a therapeutic error, receives this drug, emphasizing the rapid and potentially severe establishment of the clinical picture.

[Severe poisoning with naphazoline: update from a therapeutic error]. / Intoxicación grave con nafazolina: puesta al día a partir de un error terapéutico.

Naphazoline is a drug commonly used as a decongestant in adult patients. Its indication in Pediatrics is not frequent, being approved its use from the age of 12 for the toxic effects it possesses. Intoxication in children generates a potentially serious clinical picture. It is characterized by the immediate appearance of hypotonia, deterioration of the sensory, hypothermia and bradycardia of variable degree of clinical compromise. Although it is an infrequent intoxication, the anamnesis and the initial management of the patient are the key in the evolution. We present a 4-year-old boy who, as a therapeutic error, receives this drug, emphasizing the rapid and potentially severe establishment of the clinical picture.

La nafazolina es un fármaco utilizado como descongestivo, generalmente, en pacientes adultos. Su indicación en pediatría no es frecuente; su uso está aprobado a partir de los 12 años por los efectos tóxicos que posee. La intoxicación en niños genera un cuadro clínico potencialmente grave. Se caracteriza por la aparición inmediata de hipotonía, deterioro del sensorio, hipotermia y bradicardia con grado variable de compromiso clínico. Si bien es una intoxicación infrecuente, la anamnesis y el manejo inicial del paciente son la clave en su evolución. Se presenta a un niño de 4 años que, por un error terapéutico, recibió este fármaco y se destaca la instauración rápida y potencialmente grave del cuadro clínico.

Ophthalmic adverse effects of nasal decongestants on an experimental rat model.

PURPOSE: To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. METHODS: Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). RESULTS: Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. CONCLUSIONS: Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

Ophthalmic adverse effects of nasal decongestants on an experimental rat model / Efeitos oftálmicos adversos de descongestionantes nasais em modelo experimental com ratos

ABSTRACT Purpose: To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. Methods: Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). Results: Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. Conclusions: Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

RESUMO Objetivo: Investigar os possíveis efeitos da exposição crônica de descongestionante nasal e seus excipientes em tecidos oculares, utilizando um modelo experimental com ratos. Métodos: Sessenta ratos Wistar adultos machos foram divididos aleatoriamente em seis grupos. Os primeiros dois grupos foram controle (soro fisiológico) e Otrivina®. Os quatro grupos restantes receberam os excipientes de Otrivina, tais como Xilometazolina, Benzalcônio, Sorbitol e Ácido Etilenodiamino Tetracético (EDTA). Os medicamentos foram aplicados em ambas as narinas dos ratos, duas vezes ao dia, durante 8 semanas. Antes que os ratos fossem sacrificados, a coloração epitelial, o teste de Schirmer e a medida da pressão intraocular foram realizados sob anestesia com Ketamina/Xilasina (50 e 5 mg/kg, respectivamente). Resultados: Defeitos epiteliais e olho seco foram achados comuns nos grupos de estudo. A catarata desenvolveu-se clinicamente em dois casos. A avaliação histopatológica revelou a existência de alterações em todas as partes dos tecidos oculares, tais como edema de córnea, proliferação polipoide e hialinização da parede vascular, formação cística da lente, degeneração da camada de fibra nervosa da retina (RNFL) e formação de corpos amiláceos da glândula lacrimal. Conclusões: O uso prolongado do descongestionante nasal Xilometazolina e seus excipientes pode causar vários problemas oftalmológicos, como olho seco, edema de córnea, catarata, RNFL e dano vascular em ratos. Embora esses resultados tenham sido obtidos a partir de animais experimentais, os oftalmologistas devem ter em mente os potenciais efeitos oftalmológicos adversos desse medicamento e/ou de seus excipientes.

ATR-FTIR spectroscopy and µ-EDXRF spectrometry monitoring of enamel erosion caused by medicaments used in the treatment of respiratory diseases.

Medicaments essential for alleviation of diseases may sometime adversely affect dental health by eroding the enamel, owing to their acidic nature. It is therefore highly desirable to be able to detect these effects quickly and reliably. In this study, we evaluated the erosive capacity of four most commonly prescribed respiratory disease syrup medicaments on enamel using micro-energy-dispersive X-ray fluorescence spectrometry (µ-EDXRF) and attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR). Fifty-five enamel fragments obtained from 30 bovine teeth were treated with artificial saliva (S), acebrofilin hydrochloride (AC), ambroxol hydrochloride (AM), bromhexine hydrochloride (BR), and salbutamol sulfate (SS); by immersing in 3 mL of respective solutions for 1 min, three times a day at intervals of 1 hr, for 5 days. µ-EDXRF analysis of enamel surface did not reveal significant erosion caused by the medications. However, ATR-FTIR showed a detectable shift in the phosphate (PO4 ) antisymmetric stretching mode (ν3 ) at ∼985 cm-1 for AM, BR, and SS, indicating erosion. Multivariate statistical analysis showed that AC, AM, SS, and BR could be classified with 70%, 80%, 100%, and 100% efficiency from S (control), further highlighting the ability of ATR-FTIR to identify degree of erosion. This suggests ATR-FTIR may be used to rapidly and nondestructively investigate erosive effects of medicaments.

Cloridrato de xilometazolina 1 mg/mL solução nasal para pacientes com rinossinusite aguda / Xylometazoline hydrochloride 1 mg / mL nasal solution for patients with acute rhinosinusitis

CONTEXTO: A rinossinusite é uma inflamação da mucosa nasal que reveste as cavidades nasais e os seios paranasais. É classificada como aguda quando os sinais e sintomas se findam em até doze semanas. Em geral é uma doença autolimitante, com duração de até dez dias e indicação de tratamento sintomático. Persistindo os sintomas por mais de dez dias, deve-se considerar o uso de anti-inflamatório esteroide por via nasal ou, em casos de febre, considerar tratamento com antimicrobiano. São alternativas terapêuticas para pacientes com rinossinusite aguda: analgésicos, soluções salinas, descongestionantes nasais agonistas adrenérgicos, antiinflamatórios esteroides e antibióticos. Há na RENAME alternativas farmacológicas para o tratamento da rinossinusite aguda: dipirona sódica, paracetamol, ibuprofeno, cloreto de sódio 0,9%, budesonida, amoxicilina e azitromicina. TECNOLOGIA: Cloridrato de xilometazolina 1 mg/mL solução nasal. INDICAÇÃO: Congestão nasal em pacientes com rinossinusite aguda. PERGUNTA: Para pacientes (crianças, adultos e idosos) com obstrução/congestão nasal o uso de descongestionantes nasais tópicos (oximetazolina, nafazolina, fenoxazolina e xilometazolina) é melhor estratégia terapêutica que o cloreto de sódio 0,9% para o alívio dos sintomas de congestão nasal associadas à rinossinusite aguda? EVIDÊNCIAS CIENTÍFICAS: Oximetazolina associada a fenoximetilpenicillina, quando comparada a placebo associado a fenoximetilpenicillina, numa escala visual analógica variando entre 0 e 100 mm, reduziu a congestão nasal de 53,5 para 17,5 mm em quatorze dias. A redução com o comparador foi de 56,3 a 15,6 mm e a diferença entre os tratamentos não foi considerada significativa. Xilometazolina, comparada a solução isotônica de sais minerais, em escore entre 0 e 13, melhorou a inflamação da mucosa nasal de 6,06 a 8,62 em sete dias e a 10,29 em quatorze dias. A melhora com a solução isotônica foi de 6,14 a 9,70 em sete dias e a 10,36 em quatorze dias. A solução isotônica foi significativamente melhor em sete dias. Os eventos adversos encontrados foram considerados leves ou não associados aos fármacos em estudo. Um parecer técnico-científico complementar foi realizado para avaliar o efeito rebote com o uso de descongestionantes nasais agonistas adrenérgicos. Em três estudos clínicos, foi demonstrado que a utilização desses fármacos por períodos prolongados (até trinta dias) é causadora de congestão nasal em pacientes saudáveis. Essa congestão nasal é acentuada quando cloreto de benzalcônio é um dos componentes da solução nasal. RECOMENDAÇÃO DA CONITEC: Após discussão sobre as evidências apresentadas e suas limitações, na 56ª reunião da CONITEC, realizada na data de 08/06/2017, o plenário considerou que o cloridrato de xilometazolina não deve ser incorporado no SUS para o tratamento de congestão nasal associada a rinossinusite aguda. A matéria será disponibilizada em Consulta Pública com recomendação preliminar não favorável. CONSULTA PÚBLICA: Nenhuma contribuição foi enviada nesta Consulta Pública. RECOMENDAÇÃO INICIAL DA CONITEC: Os membros do Plenário da CONITEC, em sua 56ª reunião ordinária, recomendaram que a matéria fosse enviada à Consulta Pública com recomendação preliminar não favorável à incorporação, após discussão sobre as evidências apresentadas e suas limitações. DECISÃO: Não incorporar o cloridrato de xilometazolina 0,1% solução nasal para pacientes com rinossinusite agudano âmbito do Sistema Único de Saúde - SUS, dada pela Portaria nº 60, publicada no DOU nº 243, do dia 20 de dezembro de 2017, seção 1, pág. 99.(AU)

Prenatal diagnosis and physical model reconstruction of agnathia-otocephaly with limb deformities (absent ulna, fibula and digits) following maternal exposure to oxymetazoline in the first trimester.

Agnathia-otocephaly or agnathia-sinotia-microstomy syndrome is the most severe malformation affecting the first branchial arch. It is a rare congenital anomaly characterized by absence of the lower jaw and abnormal ear positioning. Prenatal diagnosis is possible on conventional 2-D ultrasound in the second trimester. Three-dimensional ultrasound enhances detection of abnormal facial phenotype, especially in surface rendering mode. In addition, 3-D volume datasets are used to produce a physical model of the anomaly. We present a case of second trimester ultrasound diagnosis of agnathia-otocephaly associated with limb deformities. A physical model produced using 3-D ultrasound volume datasets facilitated better understanding of this congenital malformation, and improvement of parental counselling and management by the multispecialist team.

Not Just a Drop in the Bucket-Inversion of Oxymetazoline Nasal Decongestant Container Increases Potential for Severe Pediatric Poisoning.

Oxymetazoline is an over-the-counter nasal decongestant with potent alpha agonist properties. In overdoses as small as 1-2 mL, toxicity can be seen including bradycardia and respiratory depression. We demonstrated that inverting the container increased the volume delivered 20- to 30-fold compared with holding it upright in an in vitro model.

Use of Cough and Cold Medications in Severe Bronchiolitis before and after a Health Advisory Warning against Their Use.

We compared the use of cough and cold medications in 2 multicenter studies of young children hospitalized with bronchiolitis before and after the 2008 Food and Drug Administration cough and cold medications advisory. Although cough and cold medication use decreased after the advisory, nearly 20% of children age 12-23.9 months with severe bronchiolitis received cough and cold medications.

Internal nasal dimensions of adults with nasal obstruction.

UNLABELLED: Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry.

Dimensoes internas nasais de adultos com obstrucao nasal / Internal nasal dimensions of adults with nasal obstruction

O desvio septal (DS) e a hipertrofia de conchas (HC) aumentam a resistência ao fluxo aéreo respiratório, podendo prejudicar a patência nasal. OBJETIVO: Caracterizar a geometria nasal de indivíduos com obstrução nasal (ON) por DS e/ou HC usando rinometria acústica. Forma de estudo: Clínico prospectivo. MÉTODO: Foram avaliados 30 adultos com queixa de ON e DS+HC (n = 24), DS (n = 5) ou HC (n = 1) ao exame clínico e determinadas as áreas seccionais transversas em três principais deflexões do rinograma (AST1, AST2, AST3), suas distâncias relativamente às narinas (dAST1, dAST2, dAST3) e os volumes dos segmentos 1,0-3,2 cm (V1), 3,3-6,4 cm (V2) e 7,0-12,0 cm (V3), pré e pós-descongestão nasal (DN). Foram consideradas, para análise, as somas de AST e V das cavidades direita e esquerda e a média de dAST. RESULTADOS: Os valores médios (± DP) pré-DN corresponderam a 0,83 ± 0,23 (AST1), 1,66 ± 0,52 (AST2) e 2,36 ± 0,77 (AST3) cm2, 2,19 ± 0,20 (dAST1), 4,01 ± 0,33 (dAST2) e 5,85 ± 0,37 (dAST3) cm, 2,77 ± 0,51 (V1), 6,52 ± 1,99 (V2), 26,00 ± 9,62 (V3) cm3, todos menores (p < 0,05) que valores de referência do laboratório. A DN causou aumentos proporcionalmente maiores neste grupo ON, sugerindo componente funcional associado. A análise individual mostrou 12 casos com resultados normais, apesar da ON. CONCLUSÃO: A maioria dos pacientes com ON estrutural apresentou resultados sugestivos de comprometimento da patência nasal ao exame rinométrico. .

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry. .

Correlation of three variables describing nasal patency (HD, MCA, NOSE score) in healthy subjects.

UNLABELLED: Rhinoresistometry and acoustic rhinometry are two established apparative methods to objectify the respiratory function of the nose. Both methods use different variables to describe nasal patency: "hydraulic diameter", HD, in rhinoresistometry, and "minimal cross-sectional area", MCA1 (nasal isthmus) and MCA2 (head of the inferior turbinate and cavernous body of the nasal septum), in acoustic rhinometry. OBJECTIVE: This study analyzes the mutual correlation of HD and MCA as a pilot study in patients without nasal pathologies. Additionally, we investigated if these objective variables correlate with the NOSE score, a validated tool to measure subjective perception of nasal patency. METHOD: Planned data collection in a collective of 24 healthy subjects without nasal pathologies. RESULTS: Statistically significant, weak to moderate correlations were found between HD and MCA2 before decongestion. A moderate correlation was found between both HD and MCA2 and the NOSE score on the narrower side. CONCLUSION: In the assessment of nasal patency, it seems advisable to determine HD, MCA1 and MCA2, but also a subjective variable such as the NOSE score, which all seem to be not fully redundant variables. In further studies, the correlation of the variables should be assessed in patients with nasal pathologies.

Brazilian Academy of Rhinology position paper on topical intranasal therapy.

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.

Effect of cough and cold medication restriction and label changes on pediatric ingestions reported to United States poison centers.

OBJECTIVE: To determine the impact of industry and Food and Drug Administration initiatives implemented to limit the use of over-the-counter (OTC) cough and cold medications in children younger than 6 years of age. STUDY DESIGN: This is a retrospective database study of OTC cough and cold medication ingestions reported to US poison centers between 2000 and 2010. Data analyzed from the National Poison Data System included the month and year of ingestion, reason for ingestion, health care utilization, and medical outcome. Ingestion frequencies were stratified by age and reason. Data were divided into pre- and postintervention periods for comparative analysis. RESULTS: Unintentional ingestions of OTC cough and cold medications decreased 33.4% and therapeutic errors by 46.0%. Health care facility referral declined for unintentional ingestions (28.9% <2 years of age, 19.9% 2-5 years of age, P < .0001) and therapeutic errors in children younger than 2 years of age (59.2%, P < .0001). Moderate and severe adverse outcomes decreased for unintentional ingestions in children younger than 2 years of age by 32.4% and by 21.3% in 2- to 5-year olds, P < .0001. CONCLUSIONS: The restriction of OTC cough and cold medications has led to a decline in unintentional ingestions, therapeutic errors, health care facility referral, and serious medical outcomes in children younger than 2 years of age. There has also been a decline in ingestions in 2- to 5-year-old children.

Correlação de três variáveis na descrição da permeabilidade nasal (HD, MCA, escala NOSE) de pacientes saudáveis / Correlation of three variables describing nasal patency (HD, MCA, NOSE score) in healthy subjects

Rinoresistometria e rinometria acústica são dois métodos utilizados na avaliação da função respiratória nasal. Ambos utilizam variáveis diferentes para descrever a permeabilidade nasal: o diâmetro hidráulico, HD, na rinoresistometria; e as áreas mínimas da seção transversal, MCA1 (istmo nasal) e MCA2 (cabeça do corneto inferior e corpo cavernoso do septo nasal), na rinometria acústica. OBJETIVO: Analisar a relação entre HD e MCA em pacientes sem afecções nasais e identificar se tais variáveis objetivas apresentam correlação com a escala NOSE, uma ferramenta validada para avaliar a percepção subjetiva de permeabilidade nasal. MÉTODO: Coleta estruturada dos dados de 24 indivíduos saudáveis sem afecções nasais. RESULTADOS: Correlações estatisticamente significativas de fracas a moderadas foram identificadas entre HD e MCA2 antes do descongestionamento. Foi identificada correlação moderada entre HD, MCA2 e escala NOSE no lado mais estreito. CONCLUSÃO: Na avaliação de permeabilidade nasal, parece ser recomendável determinar HD, MCA1 e MCA2, bem como uma variável subjetiva como a escala NOSE, que não aparentam ser variáveis completamente redundantes. Estudos futuros devem avaliar a correlação destas variáveis em pacientes com afecções nasais.

Rhinoresistometry and acoustic rhinometry are two established apparative methods to objectify the respiratory function of the nose. Both methods use different variables to describe nasal patency: "hydraulic diameter", HD, in rhinoresistometry, and "minimal cross-sectional area", MCA1 (nasal isthmus) and MCA2 (head of the inferior turbinate and cavernous body of the nasal septum), in acoustic rhinometry. OBJECTIVE: This study analyzes the mutual correlation of HD and MCA as a pilot study in patients without nasal pathologies. Additionally, we investigated if these objective variables correlate with the NOSE score, a validated tool to measure subjective perception of nasal patency. METHOD: Planned data collection in a collective of 24 healthy subjects without nasal pathologies. RESULTS: Statistically significant, weak to moderate correlations were found between HD and MCA2 before decongestion. A moderate correlation was found between both HD and MCA2 and the NOSE score on the narrower side. CONCLUSION: In the assessment of nasal patency, it seems advisable to determine HD, MCA1 and MCA2, but also a subjective variable such as the NOSE score, which all seem to be not fully redundant variables. In further studies, the correlation of the variables should be assessed in patients with nasal pathologies.

Posicionamento da Academia Brasileira de Rinologia sobre terapias tópicas nasais / Brazilian Academy of Rhinology position paper on topical intranasal therapy

Opresente documento tem por objetivo esclarecer àqueles que tratam das doenças nasossinusais, tanto especialistas quanto generalistas, sobre as terapêuticas tópicas nasais. Por meio de uma revisão das evidências científicas, a Academia Brasileira de Rinologia vem proporcionar sua visão prática e atualizada sobre as medicações tópicas nasais mais utilizadas, excetuando-se as medicações que possuam antibióticos tópicos na sua formulação.

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.

Brugada syndrome after using cold medicine: is there any relation?

Brugada syndrome (BrS) is associated with increased risk of ventricular arrhythmias and sudden death. Some drugs can trigger the electrocardiographic and arrhythmic manifestations of this syndrome. Cold medicines for symptom relief are sold without prescription in Brazil and most contain antihistamines and adrenergic agonists. We report a case of BrS probably triggered by the use of such medication.

Prevalência do uso de vasoconstritores nasais em acadêmicos de uma universidade privada do Rio Grande do Sul / Prevalence of use of nasal vasoconstrictors among students of a private university of Rio Grande do Sul

Introdução: Rinite medicamentosa é uma forma de rinite não alérgica, induzida por drogas associada ao o uso prolongado de vasoconstritores nasais. O objetivo deste estudo consiste em avaliar a prevalência do uso de vasoconstritores nasais em uma amostra de acadêmicos de diferentes cursos da graduação e compará-la entre os acadêmicos da faculdade de Medicina e demais cursos da graduação da Universidade Luterana do Brasil (ULBRA), Canoas. Método: Estudo transversal realizado durante o primeiro semestre de 2012. A associação entre as variáveis foi avaliada pelo teste qui-quadrado de Pearson ou exato de Fisher. O nível de significância adotado foi de 5% (p<0,05) e as análises foram realizadas no programa SPSS versão 18.0. Resultados: A amostra total foi composta por 405 acadêmicos. O período de uso nos grupos foi menor do que três dias (aproximadamente 43%). Cerca de 15% dos estudantes em cada grupo utilizaram gota descongestionante por mais de uma e menos de duas semanas. 10% dos estudantes utilizaram gota descongestionante por até 30 dias. 4.5% (grupo medicina) e 3% (outros cursos) utilizaram por dois meses. 6,8% dos estudantes de medicina utilizaram descongestionante nasal por mais do que um ano, comparado a 5,5% no grupo dos outros cursos. Conclusão:A diferença observada entre a prevalência do uso de vasoconstritores nasais entre acadêmicos do curso de medicina e acadêmicos dos outros cursos não foi significativa. Entretanto, foi alta prevalência do uso de vasoconstritores nasais nos grupos, o que mostra a necessidade de uma maior conscientização a respeito dos riscos da utilização de tais medicações.

Introduction: Drug-induced rhinitis is a form of non-allergic rhinitis associated with prolonged use of nasal vasoconstrictors. The objective of this study is to assess the prevalence of use of nasal vasoconstrictors in a sample of students of different undergraduate programs and compare them with undergraduate students of medicine and other academic courses of the Lutheran University of Brazil (ULBRA), Canoas. Methods: Cross-sectional study carried out in the first half of 2012. The association between variables was evaluated using the chi-square test or Fisher exact test. The level of significance was set at 5% (p <0.05) and the analyses were performed using SPSS version 18.0. Results: The sample was composed of 405 students. The period of use in the groups was less than three days (approximately 43%). About 15% of students in each group used decongestant drops for more than one and less than two weeks. 10% of students used drop decongestant for up to 30 days. 4.5% (medical group) and 3% (other courses) used them for two months. 6.8% of the medical students used nasal decongestant for more than one year, compared to 5.5% in the group of other courses. Conclusion: The difference between the prevalence of nasal vasoconstrictors in students of medicine and in other academic courses was not significant. However, the prevalence of nasal vasoconstrictors in all groups was high, which shows the need for greater awareness about the risks of using such medications.