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1.
Handb Exp Pharmacol ; 268: 151-170, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34085123

RESUMO

Chronic rhinosinusitis (CRS) is a clinical syndrome stemming from persistent inflammation of the sinonasal mucosa. Phenotypically, it is traditionally and widely described according to the presence or absence of polyps. While this distinction is simple to use, it has little bearing on prognosis and treatment, for CRS is essentially an inflammatory disease resulting from dysregulated interaction between a multitude of host and environmental factors. Allergy is merely one of them and, like many of the proposed aetiologies, has been subject to much debate which will be discussed here. As our understanding of CRS continues to evolve, previous so-called conventional wisdom about phenotypes (e.g. CRS with nasal polyps is associated with Type 2 inflammation) is being challenged, and new phenotypes are also emerging. In addition, there is growing interest in defining the endotypes of CRS to deliver precise and personalised treatment, especially pertaining to the development of biologics for the group of severe, difficult-to-treat CRS patients. A proposed model of precision medicine tailored to management of CRS will also be introduced to readers, which can be continually modified to adapt to new discoveries about this exciting condition.


Assuntos
Hipersensibilidade , Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Humanos , Pólipos Nasais/tratamento farmacológico , Medicina de Precisão , Rinite/diagnóstico , Rinite/tratamento farmacológico , Rinite/etiologia , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/etiologia
2.
Diabetes Metab Syndr ; 15(5): 102267, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34509790

RESUMO

AIMS: 1: Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2: Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. METHODS: Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. RESULTS: Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. CONCLUSIONS: New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.


Assuntos
COVID-19/complicações , Mucormicose/epidemiologia , Mucormicose/etiologia , Adulto , COVID-19/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/etiologia , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/etiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/microbiologia , Órbita/microbiologia , Doenças Orbitárias/epidemiologia , Doenças Orbitárias/microbiologia , Prevalência , Rinite/epidemiologia , Rinite/etiologia , Rinite/microbiologia , Fatores de Risco , SARS-CoV-2/fisiologia , Fatores Socioeconômicos
4.
Biomolecules ; 11(7)2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34356683

RESUMO

Janus kinase 2 (JAK2) is a member of the JAK family that transduces cytokine-mediated signals via the JAKs/STATs (signal transducer and activator of transcription proteins) pathway, which plays an important role in many inflammatory diseases. This study investigates the association of p-JAK2 and JAK2-associated cytokines from nasal polyp (NP) tissue with disease severity, and evaluates the p-JAK2-mediated STATs in chronic rhinosinusitis (CRS) with NP. Sixty-one CRSwNP patients with nasal polyps undergoing endoscopic sinus surgery were enrolled, while the turbinate tissues from 26 nasal obstruction patients were examined as the control group. Elevated levels of p-JAK2 were detected in CRSwNP, and significantly correlated with scores of disease severity (LMK-CT, TPS, and SNOT-22). Expressions of the JAK2-associated cytokines, such as IL-5, IL-6, IL-13, G-CSF, and IFN-γ were significantly higher in CRSwNP than in the controls, while the levels of IL-5, IL-6, IL-13, or G-CSF had positive correlation with scores of disease severity. Moreover, markedly increased expression of p-STAT3 in CRSwNP was observed relative to the control. Taken together, these data showed that the JAK2-associated cytokines including IL-6 and G-CSF may stimulate JAK2 phosphorylation to activate p-STAT3, indicating an association with disease severity and supporting its development of JAK2 inhibitor as a potential therapeutic agent for CRS.


Assuntos
Citocinas/metabolismo , Janus Quinase 2/metabolismo , Pólipos Nasais/etiologia , Rinite/etiologia , Sinusite/etiologia , Adulto , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pólipos Nasais/patologia , Fosforilação , Fator de Transcrição STAT3/metabolismo , Índice de Gravidade de Doença
5.
Sci Rep ; 11(1): 16052, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362983

RESUMO

The proportion of allergic diseases attributable to atopy remains a subject of controversy. This study aimed to estimate the population risk of physician-diagnosed asthma, rhinitis and eczema attributed to atopy among a population sample of Asian school-age children. Asian children aged 5-18 years (n = 1321) in the Prediction of Allergies in Taiwanese CHildren (PATCH) study were tested for serum allergen-specific immunoglobulin E. Physician-diagnosed asthma, rhinitis and eczema were assessed by a modified International Study of Asthma and Allergies in Childhood questionnaire. Atopy was defined as the presence of serum allergen-specific immunoglobulin E. In this population-based study, 50.4% of the subjects with asthma, 46.3% with rhinitis, and 46.7% with eczema were attributable to atopy. The population attributable risk (PAR) of atopy for three allergic diseases was higher in adolescents (asthma, 54.4%; rhinitis, 59.6%; eczema, 49.5%) than younger children aged less than 10 years (asthma, 46.9%; rhinitis, 39.5%; eczema, 41.9%). Among the seven allergen categories, sensitization to mites had the highest PARs for all three allergic diseases (51.3 to 64.1%), followed by sensitization to foods (asthma, 7.1%; rhinitis, 10.4%; eczema 27.7%). In conclusion, approximately half (46.3 to 50.4%) of Asian children in Taiwan with allergic diseases are attributable to atopy.


Assuntos
Asma/epidemiologia , Eczema/epidemiologia , Hipersensibilidade Imediata/complicações , Rinite/epidemiologia , Asma/etiologia , Asma/patologia , Criança , Eczema/etiologia , Eczema/patologia , Feminino , Humanos , Hipersensibilidade Imediata/imunologia , Imunoglobulina E/imunologia , Masculino , Prevalência , Rinite/etiologia , Rinite/patologia , Fatores de Risco , Inquéritos e Questionários , Taiwan/epidemiologia
7.
Int Arch Allergy Immunol ; 182(9): 800-806, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33882500

RESUMO

BACKGROUND: The ciliary beat of the airway epithelium, including the sinonasal epithelium, has a significant role in frontline defense and is thought to be controlled by the level of intracellular Ca2+. Involvement of calmodulin and adenylate/guanylate cyclases in the regulation of ciliary beats has been reported, and here we investigated the interrelation between these components of the ciliary beat regulatory pathway. METHODS: The inferior turbinates were collected from 29 patients with chronic hypertrophic rhinitis/rhinosinusitis during endoscopic sinonasal surgery. The turbinate mucosa was cut into thin strips, and mucociliary movement was observed under a phase-contrast light microscope equipped with a high-speed digital video camera. RESULTS: The ciliary beat frequency (CBF) was significantly increased by stimulation with 100 µM CALP3 (calmodulin agonist), which was completely suppressed by adding 100 µM SQ22536 (adenylate cyclase inhibitor) and 10 µM ODQ (guanylate cyclase inhibitor) together and by adding 1 µM KT5720 (protein kinase A inhibitor) and 1 µM KT5823 (protein kinase G inhibitor) together. The CBF was significantly increased by stimulation with 10 µM forskolin (adenylate cyclase activator) and 10 µM BAY41-2272 (guanylate cyclase activator) and by stimulation with 100 µM 8-bromo-cAMP (cAMP analog) and 100 µM 8-bromo-cGMP (cGMP analog), which was not changed by adding 1 µM calmidazolium (calmodulin antagonist). CONCLUSIONS: These results confirmed that the regulatory pathway of ciliary beats in the human nasal mucosa involves calmodulin, adenylate/guanylate cyclases, and protein kinases A/G and indicate that adenylate/guanylate cyclases and protein kinases A/G act downstream of calmodulin, but not vice versa, and that these cyclases relay calmodulin signaling.


Assuntos
Adenilil Ciclases/metabolismo , Calmodulina/metabolismo , Cílios/fisiologia , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Proteínas Quinases Dependentes de GMP Cíclico/metabolismo , Guanilato Ciclase/metabolismo , Mucosa Nasal/metabolismo , Cálcio/metabolismo , GMP Cíclico/análogos & derivados , Endoscopia , Humanos , Depuração Mucociliar , Rinite/etiologia , Rinite/metabolismo , Rinite/patologia , Rinite/terapia , Transdução de Sinais , Sinusite/etiologia , Sinusite/metabolismo , Sinusite/patologia , Sinusite/terapia
8.
Int Arch Allergy Immunol ; 182(8): 736-743, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33756474

RESUMO

INTRODUCTION: Few studies assess biologicals such as, omalizumab, mepolizumab, benralizumab, and dupilumab in patients suffering from chronic rhinosinusitis with nasal polyposis (CRSwNP). The reported success rate in these studies differ, and it remains uncertain if there are any biomarkers to predict successful therapy. Our aim was to analyze the therapeutic outcome in a real life setting and to identify predictive biomarkers for successful treatment. METHODS: Data from patients with CRSwNP treated with a monoclonal antibody between November 2014 and January 2020 were analyzed retrospectively. Improvement in the polyp score and clinical symptoms like nasal obstruction, sense of smell, nasal discharge, and facial pain were evaluated. Other characteristics, including use of nasal or systemic steroids, comorbidities, previous history of sinus surgery, eosinophilia tissue, blood values (eosinophils, total immunoglobulin E, eosinophilic cationic protein, and interleukin 5), and allergic sensitization in serum were also investigated to identify possible predictive biomarkers. RESULTS: Forty-eight treatments in 29 patients (m/f = 15/14) aged 27-70 years were reviewed. Treatments with mepolizumab showed the best success rates (78.9%), followed by omalizumab (50%) and benralizumab treatments (50%). However, a correlation between biomarkers and treatment success could not be found. DISCUSSION/CONCLUSION: Treatment of CRSwNP with biologicals is a promising option for severe cases not responding to conventional therapy, including difficult-to-treat patients. Predictive biomarkers for a successful treatment could not be identified, but the reduction of eosinophilic cationic protein was linked with the response.


Assuntos
Antialérgicos/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Pólipos Nasais/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Idoso , Antialérgicos/administração & dosagem , Antialérgicos/efeitos adversos , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Biomarcadores , Terapia Combinada , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/diagnóstico , Pólipos Nasais/etiologia , Estudos Retrospectivos , Rinite/diagnóstico , Rinite/etiologia , Sinusite/diagnóstico , Sinusite/etiologia , Avaliação de Sintomas , Resultado do Tratamento
10.
JAMA Otolaryngol Head Neck Surg ; 147(4): 360-367, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33538760

RESUMO

Importance: Eosinophilic chronic rhinosinusitis (eCRS), contemporarily classified as diffuse type 2 dominant chronic rhinosinusitis (CRS), is characterized by eosinophil-dominant mucosal inflammation. Contemporary management of eCRS as an inflammatory airway condition is multimodal with corticosteroid irrigations after the surgical creation of a neosinus cavity. Objectives: To assess long-term treatment outcomes in patients with primary diffuse type 2 CRS or eCRS receiving multimodal treatment. Design, Setting, and Participants: A prospective cohort study of patients seen in a tertiary rhinology practice recruited from May 2010 to November 2018 was conducted. Follow-up duration was 12 months or more following endoscopic sinus surgery (ESS) with a neosinus cavity formed. Data analysis was performed from August to November 2020. Consecutive adult (≥18 years) patients diagnosed with primary diffuse type 2 dominant CRS or eCRS based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 criteria were included. Type 2 inflammation was defined as more than 10 eosinophils per high-power field obtained from sinus mucosal biopsy and managed with neosinus cavity ESS and ongoing corticosteroid irrigations. Exclusion criteria were less than 12 months of follow-up and secondary CRS. Interventions: Endoscopic sinus surgery with complete removal of intersinus bony partitions to create a neosinus cavity. Nasal irrigation (240 mL) with betamethasone, 1 mg, or budesonide, 1 mg, daily for 3 to 6 months after ESS and tapered to an as-needed basis (minimum, 2-3 per week). Main Outcomes and Measures: Poor control was defined as polyp recurrence (polyp growth in >1 sinus area on a single side), use of long-term systemic therapy (biologic therapy or ≥3 consecutive months of oral corticosteroids), and revision surgery involving polypectomy. The disease in patients with no poor control criteria was defined as well controlled, and the disease in those with 1 or more criteria was considered poorly controlled. Maintenance medical therapy use and patient-reported outcomes based on the 22-item Sinonasal Outcomes Test for preoperative and last follow-up were collected. Results: Of the 222 participants recruited with primary diffuse type 2 dominant CRS or eCRS and minimum of year of follow-up, 126 were men (56.8%). Mean (SD) age was 54.8 (13.6) years, and median (SD) follow-up was 2.2 (2.2) years. Of the 222 patients, 195 (87.8%) had well-controlled disease, 16 (7.2%) had polyp recurrence, 7 (3.2%) continued to receive long-term oral corticosteroid therapy, 5 (2.3%) received biologic therapy, and 8 (3.6%) underwent a revision polypectomy. Clinically meaningful change on the 22-item Sinonasal Outcomes Test and the nasal subdomain score was maintained at the last follow-up in 134 patients (67.0%). Poor disease control was not associated with poor adherence to irrigation use. Conclusions and Relevance: The findings of this cohort study suggest that long-term disease control and reduction in symptom burden in patients with primary diffuse type 2 CRS or eCRS might be achieved when managed as an inflammatory disorder. Maintenance corticosteroid irrigations in the population examined appeared to be successfully self-tapered to disease activity.


Assuntos
Glucocorticoides/administração & dosagem , Lavagem Nasal , Seios Paranasais/cirurgia , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Betametasona/administração & dosagem , Budesonida/administração & dosagem , Doença Crônica , Estudos de Coortes , Endoscopia , Eosinofilia/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal , Pólipos Nasais/cirurgia , Complicações Pós-Operatórias , Rinite/etiologia , Sinusite/etiologia
11.
Int Arch Allergy Immunol ; 182(4): 265-276, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33588407

RESUMO

There is emerging evidence that the respiratory microbiota influences airway health, and there has been intense research interest in its role in respiratory infections and allergic airway disorders. This review aims to summarize current knowledge of nasal microbiome and virome and their associations with childhood rhinitis and wheeze. The healthy infant nasal microbiome is dominated by Corynebacteriaceae and Staphylococcaceae. In contrast, infants who subsequently develop respiratory disorders are depleted of these microbes and are instead enriched with Proteobacteria spp. Although human rhinovirus and human respiratory syncytial virus are well-documented major viral pathogens that trigger rhinitis and wheezing disorders in infants, recent limited data indicate that bacteriophages may have a role in respiratory health. Future work investigating the interplay between commensal microbiota, virome, and host immunological responses is an important step toward understanding the dynamics of the nasal community in order to develop a strategical approach to combat these common childhood respiratory disorders.


Assuntos
Microbiota , Mucosa Respiratória/microbiologia , Sons Respiratórios/etiologia , Rinite/epidemiologia , Rinite/etiologia , Viroma , Adolescente , Fatores Etários , Criança , Pré-Escolar , Suscetibilidade a Doenças , Humanos , Lactente , Recém-Nascido , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia
12.
Respir Med ; 176: 106250, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33385738

RESUMO

BACKGROUND: Coexistence of asthma, rhinitis, and eczema has been studied in children, but data are lacking in adults. As new treatments emerge, epidemiological data on the coexistence are needed. AIMS: To study the prevalence of concomitant asthma, rhinitis and eczema in the general adult population and among those sensitized to aeroallergens, and to study associations between background characteristics and risks of phenotypes of asthma, rhinitis, and eczema. METHODS: In the West Sweden Asthma Study, phenotypes and sensitization profiles of 1103 randomly selected adults (16-75 years) were assessed. The methods included measures of serum-IgE and structured interviews on asthma, rhinitis, eczema, their associated symptoms, and relevant risk factors. RESULTS: Among all participants and in those sensitized, 2% and 6% had concomitant asthma, rhinitis, and eczema, respectively, and the condition did not differ by age or sex. Corresponding figures for asthma and rhinitis, but not eczema, was 8% and 19%, respectively. Determinants of coexistence of the three conditions were family history of asthma/allergy, body mass index, and occupational exposure to gas, dust and fumes. Allergic sensitization in those with asthma, rhinitis and eczema was found in 78%, in those with asthma and rhinitis but not eczema in 65%, in those with asthma and eczema but not rhinitis in 40%, while only 5% were sensitized among those having asthma only. CONCLUSIONS: In the general adult population about 2% have concomitant asthma, rhinitis, and eczema. Of sensitized adults, about 6% has coexistence of the three conditions.


Assuntos
Asma/epidemiologia , Eczema/epidemiologia , Rinite/epidemiologia , Adulto , Fatores Etários , Idoso , Alérgenos/imunologia , Asma/etiologia , Biomarcadores/sangue , Índice de Massa Corporal , Comorbidade , Eczema/etiologia , Feminino , Humanos , Imunização , Imunoglobulina E/sangue , Masculino , Anamnese , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Prevalência , Rinite/etiologia , Fatores de Risco , Adulto Jovem
13.
J Med Virol ; 93(4): 2499-2504, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33417259

RESUMO

Various new clinical signs and symptoms, such as dysfunction of smell (anosmia) and taste (dysgeusia) have emerged ever since the coronavirus disease 2019 (COVID-19) pandemic begun. The objective of this study was to identify the clinical presentation and factors associated with 'new loss/change of smell (anosmia) or taste (dysgeusia)' at admission in patients positive by real time polymerase chain reaction for SARS-CoV-2 infection. All adult COVID-19 patients with new onset anosmia or dysgeusia at admission were included in study group. Equal number of age and gender matched COVID-19 patients without anosmia or dysgeusia at admission were included in the control group. A total of 261 COVID-19 patients were admitted during the study period of which 55 (21%) had anosmia and or dysgeusia. The mean (SD) age was 36 (13) years and majority were males (58%, n = 32). Comorbidity was present in 38% of cases (n = 21). Anosmia and dysgeusia were noted in more than 1/5th of the cases. Anosmia (96%, n = 53) was more common than dysgeusia (75%, n = 41). Presence of both ansomia and dysgeusia was noted in 71% of patients (n = 39). On comparing the cases with the controls, on univariate analysis, fever (higher in cases), rhinitis (lower in cases), thrombocytopenia, elevated creatinine and bilirubin (all higher in cases) were significantly associated with anosmia or dysgeusia. On multivariate analysis, only rhinitis (odds ratio [OR]: 0.28; 95% confidence interval [CI]: 0.09-0.83; p = .02) thrombocytopenia (OR: 0.99; 95% CI: 0.99-0.99; p = .01) and elevated creatinine (OR: 7.6; 95% CI: 1.5-37.6; p = .01) remained significant. In this retrospective study of COVID-19 patients, we found anosmia and dysgeusia in more than 1/5th of the cases. Absence of rhinitis, low platelet counts and elevated creatinine were associated with anosmia or dysgeusia in these patients.


Assuntos
Anosmia/epidemiologia , COVID-19/epidemiologia , Disgeusia/epidemiologia , Adulto , Anosmia/sangue , Anosmia/fisiopatologia , Anosmia/virologia , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/fisiopatologia , Estudos de Casos e Controles , Disgeusia/sangue , Disgeusia/fisiopatologia , Disgeusia/virologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Pandemias , Contagem de Plaquetas , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Rinite/epidemiologia , Rinite/etiologia , SARS-CoV-2/isolamento & purificação , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia
14.
Int Arch Allergy Immunol ; 182(6): 535-545, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33494088

RESUMO

INTRODUCTION: Eosinophilic chronic rhinosinusitis (ECRS) is a refractory chronic disease defined by recurrent nasal polyps with severe eosinophilic infiltration. This is mainly due to enhanced type 2-dominant immune responses, but the underlying mechanism is still not fully understood. OBJECTIVE AND METHODS: In the present study, we aimed to determine the characteristics of dendritic cells (DCs) and cytokine profiles of T cells in the peripheral blood of individuals with ECRS and age- and sex-matched healthy controls (HC). RESULTS AND CONCLUSION: The ratios of myeloid (m)DC1s to DCs and PD-L1+ mDC1s to mDC1s were higher in ECRS patients than in HC. The proportions of plasmacytoid (p)DCs in DCs, and human leukocyte antigen-DR+ pDCs and ILT3+ pDCs in pDCs were lower in ECRS patients than in HC. In a characterization of T cells, IL-4+CD4+, IFN-γ+CD4+, IL-4+IFN-γ+CD4+, IL-4+Foxp3+CD4+, IFN-γ+Foxp3+CD4+, IFN-γ+IL-4-Foxp3-CD4+, IL-4+CD8+, IL-4+IFN-γ+CD8+, and IL-4+Foxp3+CD8+ T-cell populations were significantly higher in ECRS patients than in HC. These results suggest that the enhanced immune regulation of mDC1, diminished capacity of pDCs, and increased proportion of the T-cell phenotypes in peripheral blood might be factors in ECRS pathogenesis.


Assuntos
Citocinas/metabolismo , Eosinofilia/patologia , Rinite/etiologia , Rinite/metabolismo , Sinusite/etiologia , Sinusite/metabolismo , Linfócitos T/imunologia , Linfócitos T/metabolismo , Biomarcadores , Estudos de Casos e Controles , Doença Crônica , Humanos , Imunofenotipagem , Pólipos Nasais/etiologia , Pólipos Nasais/metabolismo , Pólipos Nasais/patologia , Rinite/diagnóstico , Sinusite/diagnóstico
16.
Int Arch Allergy Immunol ; 182(1): 65-75, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32927462

RESUMO

INTRODUCTION: The recurrence occurs frequently among patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and predictors that could be conveniently detected during practice in outpatient service are needed. OBJECTIVE: We aimed to illustrate that the concentration of Charcot-Leyden crystal (CLC) in nasal secretions can effectively and noninvasively predict polyp recurrence. METHODS: 108 patients with CRSwNP were divided into recurrence (n = 68) and recurrence-free (n = 40) groups. Preoperative CLC concentrations in nasal secretions were collected and detected by ELISA. Polyp tissues were harvested during biopsy or endoscopic sinus surgery and were evaluated for inflammatory cells by histopathological staining. Demographic information and the clinical characteristics of each patient were reviewed for associations with recurrence. Binary logistic regression analysis was performed to determine predictive factors for polyp recurrence. Receiver operating characteristic (ROC) curves and the Youden index were performed to determine their predictive values. Survival analysis was performed to compare recurrence risk of patients with different CLC concentrations. RESULTS: Sixty-eight (62.96%) patients developed recurrence during a 12- to 33-month postoperative follow-up. CLC concentrations in nasal secretions were positively correlated with eosinophil percent in polyp tissue and peripheral blood and were significantly higher in patients of the recurrence group than in the patients of the recurrence-free group (p < 0.001). Binary logistic regression and ROC curve demonstrated that CLC protein in nasal secretions is predictive of polyp recurrence. According to the Youden index, a CLC concentration of 34.24 ng/mL can predict postoperative polyp recurrence with 92.6% sensitivity and 87.5% specificity. Patients with CLC concentrations higher than the cutoff value yielded a higher risk of recurrence (p < 0.001, HR = 11.31, 95% CI: 6.41-19.98). CONCLUSIONS: CLC protein in nasal secretions may serve as a promising noninvasive biomarker to predict CRSwNP recurrence.


Assuntos
Glicoproteínas/metabolismo , Lisofosfolipase/metabolismo , Mucosa Nasal/metabolismo , Pólipos Nasais/patologia , Rinite/diagnóstico , Rinite/metabolismo , Sinusite/diagnóstico , Sinusite/metabolismo , Biomarcadores , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Eosinófilos/imunologia , Eosinófilos/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Pólipos Nasais/etiologia , Prognóstico , Curva ROC , Rinite/etiologia , Sinusite/etiologia
17.
Respir Investig ; 59(1): 126-134, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32978100

RESUMO

BACKGROUND: Eosinophilic chronic rhinosinusitis (ECRS) is often complicated by asthma and can be difficult to diagnose. This study aimed to clarify the usefulness of the self-administered odor questionnaire (SAOQ) and visual analog scale (VAS) to identify olfactory disorders in patients with asthma. METHODS: This retrospective study was conducted on patients with asthma who were referred to the Otolaryngology clinic between May and September 2018. The treatment step of asthma, asthma control test (ACT), pulmonary function test, peripheral blood eosinophils, and fractional exhaled nitric oxide (FeNO) were analyzed. ECRS was diagnosed based on the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study score. Olfactory dysfunction was evaluated using the SAOQ and VAS for olfactory disorders. RESULTS: The study included 56 patients (18 males and 38 females), who were divided into two groups; those with ECRS (n = 18) and those without ECRS (n = 38). Age, sex, treatment step, ACT score, and pulmonary function were not significantly different between the groups. The ECRS group had a significantly higher FeNO value (89.1 ppb vs. 39.1 ppb) and a significantly lower SAOQ score (40.1% vs. 96.1%). The area under the receiver operating characteristic curve for the efficacy of ECRS diagnosis was 0.88, 0.889, 0.799, and 0.757 for SAOQ, VAS, blood eosinophil count, and FeNO, respectively. CONCLUSION: The SAOQ and VAS scores were useful tools that presented similar results to the blood eosinophil count and FeNO, and may help to improve the diagnosis of ECRS in patients with asthma.


Assuntos
Asma/complicações , Técnicas de Diagnóstico do Sistema Respiratório , Eosinofilia/diagnóstico , Transtornos do Olfato/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Olfato/fisiologia , Inquéritos e Questionários , Escala Visual Analógica , Idoso , Doença Crônica , Eosinofilia/etiologia , Eosinófilos , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Estudos Retrospectivos , Rinite/etiologia , Sinusite/etiologia
18.
Auris Nasus Larynx ; 48(3): 408-414, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32859445

RESUMO

OBJECTIVE: Nasal irrigation is an important step of functional endoscopic sinus surgery (FESS) postoperative care. This study was performed to compare the effects of diluted baby shampoo (BS) and normal saline solution (NSS) irrigation on patients' quality of life (QoL) and surgical outcomes after FESS. METHODS: This study included 77 patients who underwent FESS to treat chronic rhinosinusitis with nasal polyps. Lund-Mackay score, Lund-Kennedy endoscopic score (LKES), synechia score and QoL (using the Sinonasal Outcome Test (SNOT-22)) were evaluated. RESULTS: LKES was significantly better in the BS group (p=0.001), especially in terms of nasal discharge and crust formation (p=0.024 and p=0.030, respectively) at 1 month postoperatively. However, no significant difference was found at 3, 6 or 12 months postoperatively (p=0.833, p=0.263, and p=0.346, respectively). The reduction of SNOT-22 score (between preoperative assessment and 1 month postoperatively) was significantly better in the BS than in the NSS group (p=0.025). However, no statistically significant differences were found between groups at 3, 6, or 12 months postoperatively (p=0.312, p=0.280, and p=0.285, respectively). In the evaluation of SNOT-22 subdomains, changes in psychological, rhinological and extranasal rhinological subdomains were significantly better in the BS group at 1 month postoperatively (p=0.019, p=0.010 and p=0.002, respectively). CONCLUSION: Compared to irrigation with NSS, BS usage following FESS led to reductions of crusting, nasal discharge and synechia formation; moreover, it was associated with improved SNOT-22 scores, especially in psychological, rhinological and extranasal rhinological subdomains.


Assuntos
Endoscopia , Preparações para Cabelo , Pólipos Nasais/cirurgia , Rinite/terapia , Solução Salina , Sinusite/terapia , Irrigação Terapêutica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Qualidade de Vida , Estudos Retrospectivos , Rinite/etiologia , Sinusite/etiologia , Resultado do Tratamento
19.
J Microbiol Immunol Infect ; 54(3): 466-473, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32094074

RESUMO

BACKGROUND: The association between oxidative stress and atopic diseases is uncertain. Several risk factors for atopic diseases have been identified, however, a comprehensive investigation of the relationship between oxidative stress markers and atopic indices related to atopic diseases is currently lacking. METHODS: We investigated 132 children who completed a 7-years follow-up in a birth cohort. Oxidative stress markers including plasma glutathione peroxidase (GPx), myeloperoxidase (MPO), total anti-oxidant capacity (TAC), and urine 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels were measured. Allergen-specific IgE levels, FeNO levels, and pulmonary function tests were also obtained. RESULTS: The activity of GPx and levels of MPO were inversely correlated to food (shrimp and crab) and house dust mite sensitization respectively. The 8-OHdG levels were strongly negatively correlated with FeNO levels (p < 0.01). A significant positive correlation was found between TAC levels and pre-and post-bronchodilator FVC % and FEV1% predicted (p < 0.05). All oxidative stress markers were not associated with the risk of atopic diseases. However, GPx-related crab sensitization and 8-OHdG related FeNO levels were significantly associated with increased risk of allergic rhinitis, while MPO-related mite sensitization and TAC-related pulmonary function parameters were strongly associated with risk of asthma (p < 0.01). CONCLUSION: Oxidative stress is strongly correlated with allergic indices, potentially playing a role in the modulation of allergic responses contributing to atopic diseases.


Assuntos
Asma/etiologia , Imunoglobulina E/sangue , Estresse Oxidativo , Rinite/etiologia , Alérgenos , Asma/fisiopatologia , Criança , Estudos de Coortes , Feminino , Glutationa Peroxidase/sangue , Humanos , Imunoglobulina E/imunologia , Masculino , Peroxidase/sangue , Testes de Função Respiratória , Rinite/fisiopatologia , Fatores de Risco
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