Reliability of nasofibroscopy for the evaluation of adenoid hypertrophy and its correlation with clinical symptoms

Abstract Objective: To analyze the reliability of estimating the percentage of rhinopharyngeal obstruction by the adenoid using nasofibroscopy and its correlation with clinical symptoms. Methods: Cross-sectional observational study was conducted, involving 80 patients between 4 and 14 years old, recruited from Santa Casa of São Paulo general otorhinolaryngology outpatient service during the years of 2020 and 2021. All patients underwent nasal endoscopy examination, and the recorded videos were randomly assigned to four evaluators in two different sessions, with a minimum interval of 1 month. The evaluators estimated the percentage of rhinopharyngeal obstruction caused by the adenoid. Intra- and inter-evaluator correlations were established by comparing the reports from each evaluator. The data were compared to the Pro Image J Software report, that also estimates a percentage of obstruction by computer graphics. To correlate the grading of obstruction with clinical symptoms, all patients completed the OSA (Obstructive Sleep Apnea) 18 questionnaire, a validated tool for assessing sleep apnea in children. The questionnaire data were then compared to the average scores assigned by the evaluators. Results: Satisfactory intra- and inter-rater correlations were observed, and the results were consistent with the Pro Image J Software. However, no correlation was found between the percentage of obstruction and the severity of clinical symptoms. Conclusion: Nasofibroscopy demonstrates good reliability in assessing a percentage of rhinopharyngeal obstruction caused by adenoids. However, there is no correlation between the degree of obstruction of the rhinopharynx and the clinical symptoms. Level of evidence: 4.

Reliability of nasofibroscopy for the evaluation of adenoid hypertrophy and its correlation with clinical symptoms.

OBJECTIVE: To analyze the reliability of estimating the percentage of rhinopharyngeal obstruction by the adenoid using nasofibroscopy and its correlation with clinical symptoms. METHODS: Cross-sectional observational study was conducted, involving 80 patients between 4 and 14 years old, recruited from Santa Casa of São Paulo general otorhinolaryngology outpatient service during the years of 2020 and 2021. All patients underwent nasal endoscopy examination, and the recorded videos were randomly assigned to four evaluators in two different sessions, with a minimum interval of 1 month. The evaluators estimated the percentage of rhinopharyngeal obstruction caused by the adenoid. Intra- and inter-evaluator correlations were established by comparing the reports from each evaluator. The data were compared to the Pro Image J Software report, that also estimates a percentage of obstruction by computer graphics. To correlate the grading of obstruction with clinical symptoms, all patients completed the OSA (Obstructive Sleep Apnea) 18 questionnaire, a validated tool for assessing sleep apnea in children. The questionnaire data were then compared to the average scores assigned by the evaluators. RESULTS: Satisfactory intra- and inter-rater correlations were observed, and the results were consistent with the Pro Image J Software. However, no correlation was found between the percentage of obstruction and the severity of clinical symptoms. CONCLUSION: Nasofibroscopy demonstrates good reliability in assessing a percentage of rhinopharyngeal obstruction caused by adenoids. However, there is no correlation between the degree of obstruction of the rhinopharynx and the clinical symptoms.

Insulin induces steroidogenesis in canine luteal cells via PI3K-MEK-MAPK.

Glucose uptake increases in canine luteal cells under insulin treatment. We hypothesize that insulin also increases luteal cell steroidogenesis. Dogs underwent elective ovariohysterectomy from days 10-60 post ovulation and their corpora lutea (CL) and blood samples were collected. Deep RNA sequencing determined differentially expressed genes in CL; those related to insulin signaling and steroidogenesis were validated in vivo by qPCR and their respective proteins by Western blotting and immunofluorescence. Next, luteal cell cultures were stimulated with insulin with or without inhibition of MAPK14, MAP2K1 and PI3K. Studied proteins except P450 aromatase showed the same expression pattern of coding genes in vivo. The expression of HSD3B and CYP19A1 was higher in insulin-treated cells (P < 0.005). Following respective pathway blockades, the culture medium had decreased concentrations of progesterone (P4) and 17b-estradiol (E2) (P < 0.01). Our results indicate that insulin increases HSD3B and CYP19A1 expression via MAPK and PI3K, and contributes to the regulation of P4 and E2 production in canine luteal cells.

Follicular development and morphological changes in the vaginal epithelium during the estrous cycle of Galea spixii.

The current study aimed to determine if characteristics observed in vaginal cytology during the estrous cycle of female SYT cavies corresponded with proliferation of the vaginal epithelium, characterized by proliferating cell nuclear antigen (PCNA) immunolocalization, and with follicular development at different phases of the estrous cycle. After determining estrous cycle phases by vaginal cytology, females were euthanized at metestrus, diestrus, proestrus, and estrus. Histological study of the vaginal epithelium and ovary were then performed. Immunohistochemistry for PCNA in vaginal tissue at each cycle phase was also performed. Superficial cornified cells and early post-ovulatory follicles were found at estrus. Few nuclei below the enucleate superficial cells were immunoreactive to PCNA. At metestrus, the vaginal epithelium underwent desquamation and lost the superficial cornified cells; basal and intermediate cells appeared, and the post-ovulatory follicle formed an early corpus luteum. No PCNA immunoreactivity was observed. At diestrus, the corpus luteum was developed, and the vaginal epithelium contained basal and intermediate cells. There was PCNA immunoreactivity in the cellular nucleus in the germinative stratum of the epithelium. Because of the growth and maturation of ovarian follicles, the vaginal epithelium suffered intense proliferation at proestrus. Vaginal cytology revealed large intermediate cells and nucleated and enucleated superficial cornified cells. In the ovary, mature follicles were present. More apparent immunoreactivity of PCNA in the germinative layer was found. In summary, we inferred that vaginal exfoliative findings matched the proliferation process of the vaginal epithelium. PCNA immunolocalization occurred as well as corresponding follicular development in the ovaries.

Effect of the association of 1-methyl-DL-tryptophan with paclitaxel on the expression of indoleamine 2,3-dioxygenase in cultured cancer cells from patients with breast cancer.

Breast cancer is the most common type of cancer among women and the survival of patients affected by it is increasing, mainly due to several new approaches in early diagnosis and more effective treatments. The enzyme indoleamine 2,3-dioxygenase (IDO) is expressed in many cells, including tumor cells. IDO acts by inhibiting the proliferation of T lymphocytes, thus compromising their cytotoxic activity. 1-Methyl-DL-tryptophan (1MT) is a competitive inhibitor of IDO, which blocks its immunosuppressive effect. Paclitaxel is an antineoplastic drug largely used in breast cancer therapy. Thus, this study aimed to determine the in vitro effect of the association of 1MT and paclitaxel chemotherapy, as an approach to reduce tumor growth. It is believed that this would allow the restoration of T lymphocyte proliferation capability and its cytotoxic response. The supplemented cultures showed that the most significant differences in the expression of IDO were observed in the group treated with paclitaxel associated with 1-MT continuous supplementation, reducing enzyme expression from 12.06 to 3.56 %. This association was more effective in reducing IDO expression and could collaborate in developing a new therapeutic strategy for breast cancer treatment.

Influência do estrógeno e do interferon γ sobre a expressão da indoleamina-2,3-dioxigenase em cultura de células de placenta e embriões de ratas Wistar / Estrogen and interferon γ influence on 2, 3 indoleamine-dioxygenase expression in culture of placenta and fetal cells from Wistar rats

A indoleamina 2,3-dioxigenase (IDO) é uma enzima responsável por catabolizar o aminoácido triptofano. Sua presença no ambiente uterino placentário está relacionada à tolerância imunológica ao semi-aloenxerto, pois impede a proliferação de células imunológicas maternas, seja pela falta do aminoácido, ou pela ação de alguns catabólitos oriundos da quebra do triptofano, como o ácido quinolínico, que é tóxico principalmente para os linfócitos T. Pouco se conhece sob a influência de substâncias (hormônios e citocinas) presentes na interface materno fetal e a expressão dessa enzima. Por esta razão, formulou-se a hipótese de que hormônios e interleucinas presentes na região uteroplacentária poderiam exercer algum efeito na expressão da IDO. Células oriundas da interface materno fetal de ratas Wistar foram mantidas em cultivo, onde receberam suplementação com estradiol e interferon-γ. A expressão da enzima foi avaliada pela técnica de citometria de fluxo nos períodos de 4, 24 e 48 horas e confirmação da presença proteica por imuno-histoquímica. Os resultados mostraram um aumento na expressão de IDO após a adição de estrógeno (9,03±0,81/11,25±0,25) e interferon-γ (9,03±0,81/20,43±0,60). O efeito do interferon-γ já era esperado como relatado na literatura, contudo, a elevação da expressão da IDO pela adição do estrógeno constitui nova informação sobre possíveis mecanismos envolvidos na ativação da enzima. O melhor esclarecimento desses achados poderia contribuir para uma melhor compreensão da participação dessa enzima na tolerância materno-fetal e para uma futura modulação terapêutica da mesma...

The indoleamine 2,3-dioxygenase (IDO) is an enzyme responsible for catabolizing the tryptophan. Its presence in the placental uterine environment is related to immunological tolerance to the semi-allograft because it prevents proliferation of maternal immune cells, either by the lack of this amino acid or by the action of its catabolites, such as the quinolinic acid, which is particularly toxic for T lymphocytes. Little is known regarding the influence of hormones and cytokines on the expression of IDO in the maternal fetal interface. Therefore, the hypothesis that some hormones and interleukins present in uteroplacental region could have an effect on the expression of IDO on cultured cells was tested. Cells derived from the fetal maternal interface from Wistar rats were kept in culture and supplemented with estradiol and interferon-γ. Expression of the enzyme was assessed by flow cytometry at periods of 4, 24 and 48 hours and confirmation of the presence of protein by immunohistochemistry. The results showed an increasing of IDO expression after the addition of estrogen (9.03±0.81 to 11.25±0.25) and interferon-γ (9.03±0.81 to 20.43±0.60). The effect of interferon-γ was expected as reported in the literature, however, elevated IDO expression by estrogen represents new information on possible mechanisms involved in the enzyme activation. These findings could provide a better understanding of IDO contribution on maternal-fetal tolerance and may collaborate to future therapeutic modulation of this enzyme...

Análise financeira das internações de diabéticos submetidos à amputação de membros inferiores em hospital público / Financial analysis of diabetic patients hospitalizations submitted to lower limb amputation in a public hospital

Este estudo trata-se de uma pesquisa descritiva de análise documental que analisou o custo apurado no ano de 2006, decorrente da internação de 21 pacientes diabéticos submetidos à amputação de membros inferiores em um hospital público e o valor repassado pelo Sistema Único de Saúde (SUS) referente a esse procedimento. Entre os pacientes estudados, 57,1% eram do gênero feminino e 42,9% do masculino, com idades entre 40 a 90 anos. O tempo de diagnóstico variou entre 5 e 25 anos. A média de internações foi de 14 dias por paciente. O custo para o hospital foi de R$ 99.455,74; com valor médio por paciente de R$ 4.735,98. O valor total repassado ao hospital pelo SUS foi de R$ 27.740,15, valor 3,6 vezes menor que os as despesas do hospital. O SUS realiza o repasse de acordo com os valores pré-determinados por sua tabela de procedimento. A prevenção é a única alternativa para diminuir o percentual de amputação e aumentar a sobrevida dos portadores de diabetes. Faz-se necessário um diagnóstico precoce, além de melhor controle do diabetes mellitus com políticas governamentais e institucionais apropriadas.

This study is a documental descriptive analysis which aimed to verify the cost established in 2006, in relation to the hospitalization of 21 diabetic patients submitted to the lower limb amputation in a public hospital and the value transferred by the Unified Health System (SUS) regarding this procedure. Among the studied patients, 57.14% were female and 42.86% male, aged 40 to 90 years. The time of diagnosis varied from 5 to 25 years. The average of hospitalization was 14 days per patient. The cost to the hospital was R$99,455.74, average cost per patient was R$ 4,735.98. The total amount transferred by SUS to the hospital was R$ 27,740.15, a cost 3.6 times lower than the hospital costs. The SUS transferring is in accordance with the predetermined values for its table of procedure. Prevention is the only alternative to reduce the rate of amputation and improve survival of diabetes patients. It is necessary an early diagnosis and better control of diabetes mellitus with appropriate government and institutional policies.

Amputação de membros inferiores de portadores de diabetesmellitus: análise dos custos da internação em hospital público / Amputation of inferior limbs of diabetic patients: analysis ofhospitalization cost in public hospital / Amputación de los miembros inferiores de portadores de diabetesmellitus: análisis de los costes de la internación en hospital público

Trata-se de um estudo descritivo que analisa o custo da internação em hospital universitário público deportadores de diabetes mellitus que sofreram amputação de membros inferiores. As informações foram obtidaspor meio de dados secundários, que foram tabulados no programa Excel 2003. Foram analisados dados de 21portadores de diabetes mellitus (DM), dos quais 57,14% eram do sexo feminino e de idade média de 66 anos,com predominância do DM tipo 2, tendo sido todos diagnosticados entre 5 e 25 anos. O tempo médio deinternação foi de 14 dias e a amputação de perna foi o procedimento mais encontrado (10). O custo total dasinternações, somando-se custos de diárias, procedimentos cirúrgicos, exames, medicações e materiais médicohospitalares,foi de R$ 99.455,74, com custo médio por paciente de R$ 4.735,99. Este custo é alto e demonstra aimportância da adoção de medidas preventivas por meio de políticas governamentais e institucionais apropriadasque enfatizem um diagnóstico precoce e melhor controle do diabetes.

This is a descriptive study about the cost of hospitalization of patients with diabetes mellitus who sufferedamputation of limbs in a public university hospital. The information was obtained through secondary data whichwere tabulated in Excel 2003. We analyzed 21 patients with diabetes mellitus (DM), 57.14% female, mean age 66years, with prevalence of type 2 DM diagnosed between 5 to 25 years ago. The mean hospital stay was 14 daysand leg amputation was the most frequent procedure (10). The total cost of hospitalizations resulting from thesum of daily costs, surgical procedures, laboratorial tests, medications and hospital medical materials was R$99,455.74, with average cost per patient of $ 4735.99. This cost is high and shows how important it is to adopt theprevention actions through appropriate government and institutional actions that emphasize a preventivediagnosis and a more efficient diabetes control system.

Se trata de un estudio descriptivo que analiza el costo del ingreso en un hospital universitario público deportadores de diabetes mellitus que sufrieron amputación de miembros inferiores. Las informaciones fueronobtenidas a través de datos secundarios, que fueron tabulados en el programa Excel 2003. Fueron analizadosdatos de 21 potadores de diabetes mellitus (DM), de los cuales un 57,12% eran del sexo femenino y de edadmedia de 66 años, con predominancia de DM tipo 2, han sido todos diagnosticados entre los 5 y 25 años. Eltiempo medio de ingreso fue de 14 días y la amputación de la pierna fue el procedimiento más encontrado (10).El costo total de los ingresos, sumándose costos diarios, procedimientos quirúrgicos, exámenes, medicinas ymateriales médico hospitalario, fue de R$ 99.455,74, con costo medio por paciente de R$ 4.735,99. Este costoes alto y demuestra la importancia de la adopción de medidas preventivas por medio de políticasgubernamentales e institucionales apropiadas que acentúen un diagnóstico precoz y mejor control de la diabetes.

Analysis of the bactericidal effect of ozone pneumoperitoneum.

PURPOSE: To assess the bactericidal action of ozone pneumoperitonium, and to compare the results with CO2. METHODS: It was used 36 Wistar rats. The animals, under anesthesia, were inoculated with 2ml of E. coli ATCC at a concentration of 10(10)UFC, and 1ml of BaSO4, into the peritoneal cavity. They were divided into three groups: Group 1, CO2 pneumoperitoneum was performed for 15 minutes; Group 2, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 42microg/ml, and Group 3, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 62microg/ml. Six animals from each group were sacrificed after the experiment, and the remaining 6 observed for 24 hours. Material was collected from the cavity of all animals for microbiological study. RESULTS: Ozone presented a greater bactericidal effect than CO2 in those animals sacrificed immediately after pneumoperitoneum. In the animals studied 24 hours after pneumoperitoneum evidenced no difference in bactericidal effect between the two gases. Moreover, no difference in mortality was observed. CONCLUSION: Ozone has a more potent bactericidal effect than carbon dioxide gas, although this did not influence survival of the animals.

Analysis of the bactericidal effect of ozone pneumoperitoneum / Análise do efeito bactericida do pneumoperitônio de ozônio

PURPOSE: To assess the bactericidal action of ozone pneumoperitonium, and to compare the results with CO2. METHODS: It was used 36 Wistar rats. The animals, under anesthesia, were inoculated with 2ml of E. coli ATCC at a concentration of 10(10)UFC, and 1ml of BaSO4, into the peritoneal cavity. They were divided into three groups: Group 1, CO2 pneumoperitoneum was performed for 15 minutes; Group 2, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 42µg/ml, and Group 3, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 62µg/ml. Six animals from each group were sacrificed after the experiment, and the remaining 6 observed for 24 hours. Material was collected from the cavity of all animals for microbiological study. RESULTS: Ozone presented a greater bactericidal effect than CO2 in those animals sacrificed immediately after pneumoperitoneum. In the animals studied 24 hours after pneumoperitoneum evidenced no difference in bactericidal effect between the two gases. Moreover, no difference in mortality was observed. CONCLUSION: Ozone has a more potent bactericidal effect than carbon dioxide gas, although this did not influence survival of the animals.

OBJETIVO: Avaliar a ação bactericida do pneumoperitônio de ozônio comparando-o à ação do CO2. MÉTODOS: Foram utilizados 36 ratos Wistar. Após anestesia e inoculação de 2ml de E. coli ATCC na concentração de 10(10) UFC e 1ml de BaSO4 na cavidade peritoneal, os animais foram divididos em três grupos: Grupo 1, realização de pneumoperitônio de CO2 por 15 minutos; Grupo 2, realização de pneumoperitônio de ozônio durante 5 minutos na concentração de 42µg/ml, e Grupo 3, realização de pneumoperitônio de ozônio durante 5 minutos na concentração de 62µg/ml. Seis animais de cada grupo foram sacrificados após experimento e os outros seis foram observados por 24 horas. Em todos os animais colheu-se material da cavidade para estudo microbiológico. RESULTADOS: O ozônio teve maior efeito bactericida em comparação ao CO2 nos animais sacrificados logo após pneumoperitônio. Nos animais estudados após 24 horas não houve diferença do efeito bactericida entre os gases. Também não se observou alteração da mortalidade. CONCLUSÃO: O ozônio tem efeito bactericida mais potente que o gás carbônico, embora não tenha influenciado a sobrevida dos animais.