Soluble epoxide hydrolase inhibitor trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl)urea prevents hyperalgesia through regulating NLRC4 inflammasome-related pro-inflammatory and anti-inflammatory signaling pathways in the lipopolysaccharide-induced pain mouse model.

Epoxyeicosatrienoic acids (EETs) have anti-inflammatory effects and soluble epoxide hydrolase (sEH) inhibition might be a useful therapeutic approach to manage inflammatory disorders. The purpose of the study was to investigate whether nucleotide-binding and oligomerization domain-like receptor (NLR) C4 inflammasome-related pro-inflammatory and anti-inflammatory signaling pathways in the central nervous system (CNS) participates in the effect of trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl)urea (TPPU), a potent sEH inhibitor, to prevent hyperalgesia in the LPS-induced pain mouse model. The latency of pain within 30 s was measured by the hot plate test in male mice injected with saline, lipopolysaccharide (LPS) (10 mg/kg), and/or TPPU (0.3, 0.5, or 1 mg/kg) after 6 h. Hyperalgesia induced by LPS was associated with decreased 14,15-dihydroxyeicosatrienoic acid and interleukin (IL)-1ß levels and enhanced expression of NLRC4, apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC), caspase-1 p20, IL-1ß, and caspase-11 p20 in the brains and spinal cords of the animals. Besides the increased expression of nicotinamide adenine dinucleotide phosphate oxidase (NOX) subunits (gp91phox and p47phox ) and nitrotyrosine, a decrease in NLRC3, inducible nitric oxide synthase (iNOS), and neuronal NOS (nNOS) expression was also observed in the tissues of LPS-treated mice. TPPU at 0.5 mg/kg dose prevented the changes induced by LPS. Likely, decreased activity of pro-inflammatory NLRC4/ASC/pro-caspase-1 and caspase-11 inflammasomes and NOX in addition to enhanced levels of anti-inflammatory EETs and expression of NLRC3, iNOS, and nNOS in the CNS of mice participates in the protective effect of TPPU against LPS-induced hyperalgesia.

[An Uncommon Cause of Epistaxis: Nasopharyngeal Hirudiniasis]. / Epistaksisin Nadir Bir Nedeni: Nazofarengeal Huridiniasis.

The leech that is taken by ingestion of contaminated water can settle on any location at upper respiratory tract from nose to larynx. It sucks blood by adhering to the mucosa and causes mucosal bleeding by secreting hirudin. If the leech goes forward to the larynx, this can be life threatening due to severe airway obstruction. We are presenting 23 year-old male patient who admitted to our hospital with anterior and posterior nose bleeding and dysphagia due to the leech located in the posterior wall of the nasopharynx. The treatment and differential diagnosis of epistaxis is discussed in this article.

Voice Assessment After Treatment of Subacute and Chronic Cough With Inhaled Steroids.

INTRODUCTION: Inhaled steroids are widely used for persistent cough treatment. Although the side effects of long-term inhaled steroids have been well described in the literature, their laryngeal side effects after short-term use have not yet been defined. The aim of this study was to evaluate the effect of 1 month application of inhaled steroid treatment on voice parameters in patients with subacute or chronic cough. Furthermore, the efficacy of inhaled steroids on cough was investigated, as well. MATERIAL AND METHODS: This study included 46 patients (27 females and 19 males) with a persistent cough lasting at least 3 weeks and treated with inhaled steroids. All patients were examined by a pulmonologist and lung auscultation where a posteroanterior chest X-ray and spirometry were performed. The patients were also examined by an otolaryngologist. Anterior rhinoscopy, flexible fiberoptic nasopharyngoscopy, and laryngostroboscopy were performed. Also, the patients' acoustic voice analyses were performed and recorded using a multidimensional voice program. Cough symptom index (CSI) scores were used to evaluate the response to treatment. Patients with an underlying disease that was unresponsive to inhaled steroids were excluded from study. The 46 patients were administered inhaled budesonide 400 mcg twice a day, for 1 month, and their acoustic voice analyses were performed again at the end of the treatment. In addition, CSI scores were determined after stopping medication. RESULTS: When pretreatment and posttreatment acoustic voice analysis parameters (Fo, Jita, Jitt, Shim, APQ, vAm, and NHR) were compared, statistically significant differences were detected for vAm (P = 0.001) and F0 (P0.003). After treatment with inhaled steroids, the CSI score reduced from 3 to 1 (median), and the difference was statistically significant. CONCLUSIONS: Inhaled budesonide treatment in the proper dose seems to be an effective treatment for persistent cough, in the selected patient group. In addition, short-term budesonide application did not cause any negative effects on the voice parameters in these patients. These findings may be related to the steroid formulation used, the application method, and the duration of treatment. Further studies are needed on a larger group of patients with different formulations of inhaled steroids to clarify aforementioned issues.

[Importance of laryngologic examination in chronic cough]. / Kronik öksürükte larengolojik muayenenin önemi.

OBJECTIVES: This study aims to investigate the distribution of etiologic factors related to otorhinolaryngology in chronic cough patients with normal lung examination and spirometric findings, and also highlight the importance of videolaryngostroboscopic (VLS) examination with these patients. PATIENTS AND METHODS: Seventy-six patients (31 males, 45 females; mean age 48.0±15.5 years; range 18 to 83 year) who applied to pulmonology outpatient clinic with cough complaint for more than two months were included in the study. After being evaluated by a pulmonologist, patients were referred to otolaryngology outpatient clinic. To detect the underlying cause of cough, patients' detailed histories, and flexible fiberoptic endoscopy and VLS findings were reviewed. Reflux symptom index (RSI) was used for the diagnosis of gastroesophageal reflux. RESULTS: In RSI ≥13 group, posterior commissure edema was detected in 12 patients (42.9%), and posterior commissure hyperemia was detected in four patients (14.3%). These findings were statistically significantly higher than RSI <13 group (p=0.006 and p=0.016, respectively). No significant difference was present between the group of patients with allergic rhinitis and the group of patients without allergic rhinitis in terms of VLS findings. Mucopurulent secretion rate in posterior commissure in patients with acute sinusitis findings was statistically higher than patients without acute sinusitis findings (p<0.001). CONCLUSION: Chronic cough is a common symptom of many different diseases. Therefore, a multidisciplinary approach is important for diagnosis. Videolaryngostroboscopy is a valuable examination tool in the differential diagnosis of gastroesophageal reflux and acute sinusitis.