ABSTRACT
Introduction: Type 2 (T2) asthma is often associated with chronic rhinosinusitis with nasal polyposis (CRSwNP). Additionally, nonsteroidal anti-inflammatory drug (NSAID) intolerance leads to NSAID-exacerbated respiratory disease (N-ERD). Previous transcriptomic data in non-CRSwNP T2 asthma patients showed differentially expressed genes. We focused on ALOX15, CLC, CYSLTR2, HRH4 and SMPD3 to investigate their role in T2 asthma. Methods: The study included 100 healthy controls and 103 T2 asthma patients, divided into patients with asthma (n=54), patients with asthma and CRSwNP (n=29) and patients with N-ERD (n=20). Quantitative PCR analysis was performed on blood-derived RNA samples first to validate the five differentially expressed genes. The data were further analysed to find potential associations and biomarkers. Results: Patients, regardless of stratification, exhibited significantly higher gene expression than healthy controls. The patterns of association revealed that ALOX15 was exclusively present in the non-comorbidity group, SMPD3 and CLC in the comorbidity groups, and HRH4 in all patient groups. ALOX15, CYSLTR2 and SMPD3 expression showed potential as biomarkers to confirm the diagnosis of T2 asthma using peripheral blood eosinophils as the initial criterion. Peripheral blood eosinophils combined with gene expression, especially SMPD3, may improve the diagnosis. CLC and CYSLTR2 expression play a specific role in discriminating N-ERD. Discussion: We validated the transcriptomic data of five differentially expressed genes in T2 asthma. Different patterns of association were identified in patient stratification, suggesting that different molecular mechanisms underlie the spectrum of T2 asthma. Potential biomarkers were also found and used to design an algorithm with practical diagnostic utility for T2 asthma, including risk stratification for N-ERD.
ABSTRACT
In recent years, there has been growing interest in understanding the potential role of microbiota dysbiosis or alterations in the composition and function of human microbiota in the development of chronic rhinosinusitis with nasal polyposis (CRSwNP). This systematic review evaluated the literature on CRSwNP and host microbiota for the last ten years, including mainly nasal bacteria, viruses, and fungi, following the PRISMA guidelines and using the major scientific publication databases. Seventy original papers, mainly from Asia and Europe, met the inclusion criteria, providing a comprehensive overview of the microbiota composition in CRSwNP patients and its implications for inflammatory processes in nasal polyps. This review also explores the potential impact of microbiota-modulating therapies for the CRSwNP treatment. Despite variability in study populations and methodologies, findings suggest that fluctuations in specific taxa abundance and reduced bacterial diversity can be accepted as critical factors influencing the onset or severity of CRSwNP. These microbiota alterations appear to be implicated in triggering cell-mediated immune responses, cytokine cascade changes, and defects in the epithelial barrier. Although further human studies are required, microbiota-modulating strategies could become integral to future combined CRSwNP treatments, complementing current therapies that mainly target inflammatory mediators and potentially improving patient outcomes.
Subject(s)
Gastrointestinal Microbiome , Nasal Polyps , Rhinosinusitis , Humans , Chronic Disease , Dysbiosis/microbiology , Microbiota , Nasal Polyps/microbiology , Rhinosinusitis/microbiologyABSTRACT
BACKGROUND: Precision medicine is a promising strategy to identify biomarkers, stratify asthmatic patients according to different endotypes, and match them with the appropriate therapy. This proof-of-concept study aimed to investigate whether gene expression in peripheral blood could provide a valuable noninvasive approach for the molecular phenotyping of asthma. METHODS: We performed whole-transcriptome RNA sequencing on peripheral blood of 30 non-atopic non-asthmatic controls and 30 asthmatic patients. A quantitative PCR (qPCR) validation study of PTGDR2 that encodes for CRTH2 receptor, expressed in cells involved in T2 inflammation, was developed in a cohort of 361 independent subjects: 94 non-asthmatic non-atopic controls, 187 asthmatic patients [including 82 with chronic rhinosinusitis with nasal polyposis (CRSwNP) and 24 with aspirin-exacerbated respiratory disease (AERD)], 52 with allergic rhinitis, and 28 with CRSwNP without asthma. RESULTS: PTGDR2 was one of the most differentially overexpressed genes in asthmatic patients' peripheral blood (p-value 2.64 × 106). These results were confirmed by qPCR in the validation study, where PTGDR2 transcripts were significantly upregulated in asthmatic patients (p < 0.001). This upregulation was mainly detected in some subgroups such as allergic asthma, asthma with CRSwNP, AERD, eosinophilic asthma, and severe persistent asthma. PTGDR2 expression was detected in different blood cell types, and its correlation with eosinophil counts showed differences in some groups of asthmatic patients. CONCLUSIONS: We found that PTGDR2 expression levels could identify asthma patients, introduce a minimally invasive biomarker for adult asthma molecular phenotyping, and add additional information to blood eosinophils. Although further studies are required, analyzing PTGDR2 expression levels in peripheral blood of asthmatics might assist in selecting patients for treatment with specific antagonists.
ABSTRACT
When using ventilators in the management of the coronavirus disease 2019 patient, dense and abundant mucous secretions are formed, obstructing the endotracheal tube and making its aspiration difficult. This situation is worsened if in order to minimize the risk of infection of the medical personnel, the humidifier is disconnected. This circumstance forces the tube to be removed, cleaned, or changed, increasing the workload of the intensive care unit staff. Other therapies tested until now, like mesna, acetylcysteine, or hypertonic saline solution, are valid alternatives, although they have not shown great efficacy for this specific procedure in the past. The sanitary emergency forced the collaboration between a pharmacist and an otorhinolaryngologist to develop the cocamidopropyl betaine surfactant formula, after several tests with different concentrations of the surfactant. The objective of this compounding formula was to resolve a mechanical problem and avoid reintubation due to obstruction of the ventilator tube. The cocamidopropyl betaine surfactant solution 0.075% in saline 0.9% (physiological serum) solution demonstrated to be a well-tolerated formula, using inexpensive materials, was simple to prepare, and was easy to use in clinical practice.
Subject(s)
Betaine/analogs & derivatives , Coronavirus Infections/therapy , Equipment Contamination/prevention & control , Intubation, Intratracheal , Pneumonia, Viral/therapy , Surface-Active Agents/pharmacology , Betacoronavirus , Betaine/pharmacology , COVID-19 , Humans , Hygiene , Pandemics , SARS-CoV-2 , Ventilators, MechanicalABSTRACT
Los leiomiosarcomas son tumores mesenquimales malignos, que se originan en las células del músculo liso. Las localizaciones de aparición más frecuentes son el miometrio y el tracto gastrointestinal. En la región de cabeza y cuello los leiomiosarcomas aparecen de forma excepcional. Presentamos el caso de un leiomiosarcoma en la región posterior del cuello, en un paciente radiado 20 años antes por un tumor de nasofaringe. La incidencia de este tipo de tumores que cumple los criterios de tumor radioinducido se sitúa entre el 0,035 y el 0,2%. Los sarcomas radioinducidos son difíciles de diagnosticar en estadios tempranos, debido a la induración y la fibrosis de la zona radiada y a la sintomatología inespecífica que presentan. Su pronóstico es malo (AU)
Leiomyosarcomas are mesenchymal malignant tumours that appear in smooth muscle cells. Their most frequent locations are the uterus and gastrointestinal tract. Their occurrence in head and neck is considered exceptional. We present a patient with a posterior neck region leiomyosarcoma who had received radiation for a nasopharyngeal carcinoma 20 years earlier. The incidence ratio of these tumours in radiated patients (therefore considered radiation-induced) ranges from 0,035 to 0,2%. Radiation-induced sarcomas are difficult to diagnose due to the induration and fibrosis in the radiated area and the non-specific symptoms that they present. Their prognosis is very poor (AU)
Subject(s)
Humans , Male , Aged , Leiomyosarcoma/etiology , Neoplasms, Radiation-Induced/pathology , Head and Neck Neoplasms/pathology , Risk FactorsSubject(s)
Antibodies, Monoclonal/adverse effects , Cranial Nerve Diseases/chemically induced , Hidradenitis Suppurativa/drug therapy , Interferon-alpha/adverse effects , Melanoma/chemically induced , Nose Neoplasms/chemically induced , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Glossopharyngeal Nerve , Humans , Hypoglossal Nerve , Infliximab , Interferon alpha-2 , Male , Middle Aged , Recombinant Proteins/adverse effectsABSTRACT
INTRODUCTION: Leiomyosarcomas are mesenchymal malignant tumours that appear in smooth muscle cells. Their most frequent locations are the uterus and gastrointestinal tract. Their occurrence in head and neck is considered exceptional. We present a patient with a posterior neck region leiomyosarcoma who had received radiation for a nasopharyngeal carcinoma 20 years earlier. The incidence ratio of these tumours in radiated patients (therefore considered radiation-induced) ranges from 0,035 to 0,2%. Radiation-induced sarcomas are difficult to diagnose due to the induration and fibrosis in the radiated area and the non-specific symptoms that they present. Their prognosis is very poor.
Subject(s)
Head and Neck Neoplasms/diagnosis , Leiomyosarcoma/diagnosis , Neoplasms, Radiation-Induced/diagnosis , Aged , Humans , MaleABSTRACT
Introducción: La cirugía endoscopica nasosinusal presenta una serie de complicaciones que varían en función de la técnica usada y la experiencia del cirujano. Esta técnica requiere una curva de aprendizaje la cual se debe ir desarrollando a lo largo del programa de formación del residente. Métodos: Estudio descriptivo y retrospectivo, se realizó una revisión de las historias clínicas de 192 pacientes intervenidos de cirugía endoscopica por poliposis nasosinusal, todas estas cirugías fueron realizadas por residentes de nuestro departamento, entre enero de 2002 y enero de 2008. Se describe el sexo, edad, grado de poliposis, complicaciones mayores y menores. Todos estos procedimientos fueron realizados por residentes de 3.er y 4.° año bajo la supervisión de un especialista. Resultados: De 192 pacientes, 127 (66,14) eran varones y 65 (33,85%) mujeres, con edades comprendidas entre 24 y 78 años, con una media de edad de 49 años. El grado de poliposis por endoscopia era: grado i 19 (9,8%), grado ii 55 (28,6%) y grado iii 118 (61,45%). Ocurrieron 44 (22,9%) complicaciones totales, 40 (20,8%) menores y 4 (2,08%) mayores. La complicación menor mas frecuente fue la sinequia en 21 casos (10,93%) seguida de sangrado sin necesidad de transfusión en 12 (6,25%) pacientes. La complicación mayor fue ruptura de la lamina papiracea en 4 (2,08%) pacientes. No se presentó ningún caso de ceguera, rinolicuorrea, o muerte. Conclusión: La cirugía endoscopica nasosinusal en un programa de entrenamiento de residentes es un procedimiento relativamente seguro especialmente cuando se realiza bajo la supervisión de un especialista (AU)
Introduction: Endoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. Methods: Descriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. Results: Of the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade I, 19 (9.8%) cases; grade II, 55 (28.6%); and grade III, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21 (10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. Conclusions: Endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision (AU)
Subject(s)
Humans , Adult , Aged , Female , Male , Middle Aged , Young Adult , Otorhinolaryngologic Surgical Procedures/methods , Endoscopy/adverse effects , Paranasal Sinus Diseases/surgery , Internship and Residency , Paranasal Sinuses/surgery , Nasal Polyps/surgery , Retrospective Studies , Professional Training , Postoperative Complications/epidemiologyABSTRACT
INTRODUCTION: Endoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. METHODS: Descriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. RESULTS: Of the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade i, 19 (9.8%) cases; grade ii, 55 (28.6%); and grade iii, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21(10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. CONCLUSIONS: Endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.
Subject(s)
Clinical Competence , Endoscopy/adverse effects , Internship and Residency , Nasal Polyps/surgery , Paranasal Sinuses/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Young AdultABSTRACT
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Subject(s)
Humans , Male , Child , Foreign Bodies/complications , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Mouth Floor/injuries , RadiographySubject(s)
Foreign Bodies , Mouth Floor/injuries , Child , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Humans , Male , RadiographyABSTRACT
BACKGROUND AND OBJECTIVES: The authors attempt to expand knowledge about a subjective balance disorder they have called phobic orthostatic insecurity, a condition representing the second cause of medical visits (22.3 %) to their ENT and neuro-otology clinic, and attempt to identify relationships with similar conditions described in psychiatry (agoraphobia, somatoform vertigo, and space-phobia) and in neurology (phobic postural vertigo). They also propose a simple diagnostic method and present their therapies and results. PATIENTS AND METHOD: A total of 151 patients with an indefinite symptomatology of "dizziness" "vertigo" or "insecurity" were evaluated (from 1999 to 2005) by means of a full medical history and an appropriate neurological examination, pharmacological treatments with anxiolytics-antidepressives, a measurement of the degree of depression with the Beck test (a kind of psychiatric benchmark) and with a specific standardized test. RESULTS: Three symptoms and one exploratory condition, among others, were found in all 151 patients studied; these constitute the four bases for a positive diagnosis. This is confirmed if the treatment achieves total remission (this occurred in 69.53 % of all patients) or a sub-total remission (24.49 %), according to valuation scale for insecurity in all situations. CONCLUSIONS: The statistical analysis showed a symptomatic concordance within the group analyzed, a syndromic equivalence between patients and satisfactory results with the antidepressive treatments (94 %), thus confirming the diagnostic and aetiopathogenic hypotheses for the disorder and, later, providing a logical method for diagnosis. The authors propose to assimilate this diagnostic protocol (and therapeutic when no specialist psychotherapy teams are available) to most of the psychogenic insecurity syndromes described.
Subject(s)
Hypotension, Orthostatic/psychology , Phobic Disorders/diagnosis , Phobic Disorders/etiology , Vertigo/diagnosis , Vertigo/etiology , Adolescent , Adult , Aged , Agoraphobia/diagnosis , Agoraphobia/etiology , Agoraphobia/psychology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Phobic Disorders/psychology , Severity of Illness Index , Somatoform Disorders/diagnosis , Somatoform Disorders/psychologyABSTRACT
Introducción y objetivos: Los autores describen y tratan de extender el conocimiento de una frecuente afección a la que denominan inseguridad fóbica ortostática que, en su unidad de otorrinolaringología-neurootología, resulta ser la segunda causa (22,3 %) de consultas por vértigos reales o aparentes, así como de establecer analogías y diferencias de dicho trastorno con otras afecciones similares descritas en psiquiatría (agorafobia, vértigo somatomorfo y vértigo espacial) y en neurología (vértigo postural fóbico). Proponen para su diagnóstico un sencillo método, y exponen su tratamiento y resultados. Pacientes y método: Se analiza a 151 pacientes con síntomas indefinidos de mareo, vértigo o inseguridad, seleccionados entre 1999 y 2005, a los que, además de una anamnesis y una exploración neurootológica adecuadas, realizaron un interrogatorio estandarizado específico, un test de Beck (de referencia psiquiátrica) y un tratamiento farmacológico ansiolítico-antidepresivo. Resultados: Encontraron, entre otros, 3 síntomas y 1 condición exploratoria que se cumplen en todos los enfermos y constituyen los 4 pilares del diagnóstico positivo. Éste se convierte en seguro cuando el tratamiento consigue una remisión total (en el 69,53 % de todos los pacientes) o subtotal (en el 24,49 %), según su escala de valoración de la inseguridad para todas las situaciones. Conclusiones: El estudio estadístico permite extraer una concordancia sintomática dentro del grupo analizado, una equivalencia sindrómica entre los enfermos y unos resultados satisfactorios del tratamiento antidepresivo (en el 94 %), lo que permite verificar las hipótesis etiopatogénica y diagnóstica sospechadas ante el trastorno y obtener, consecuentemente, un método lógico de diagnóstico y tratamiento. Los autores proponen asimilar a este protocolo diagnóstico, incluso terapéutico cuando no se disponga de equipos psicoterapéuticos especializados, la mayor parte de los síndromes psicógenos de inseguridad descritos
Background and objectives: The authors attempt to expand knowledge about a subjective balance disorder they have called phobic orthostatic insecurity, a condition representing the second cause of medical visits (22.3 %) to their ENT & neuro-otology clinic, and attempt to identify relationships with similar conditions described in psychiatry (agoraphobia, somatoform vertigo, and space-phobia) and in neurology (phobic postural vertigo). They also propose a simple diagnostic method and present their therapies and results. Patients and method: A total of 151 patients with an indefinite symptomatology of dizziness vertigo or insecurity were evaluated (from 1999 to 2005) by means of a full medical history and an appropriate neurological examination, pharmacological treatments with anxiolytics-antidepressives, a measurement of the degree of depression with the Beck test (a kind of psychiatric benchmark) and with a specific standardized test. Results: Three symptoms and one exploratory condition, among others, were found in all 151 patients studied; these constitute the four bases for a positive diagnosis. This is confirmed if the treatment achieves total remission (this occurred in 69.53 % of all patients) or a sub-total remission (24.49 %), according to valuation scale for insecurity in all situations. Conclusions: The statistical analysis showed a symptomatic concordance within the group analyzed, a syndromic equivalence between patients and satisfactory results with the antidepressive treatments (94 %), thus confirming the diagnostic and aetiopathogenic hypotheses for the disorder and, later, providing a logical method for diagnosis. The authors propose to assimilate this diagnostic protocol (and therapeutic when no specialist psychotherapy teams are available) to most of the psychogenic insecurity syndromes described