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1.
J Zoo Wildl Med ; 50(4): 1008-1011, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926538

RESUMO

Curvularia spp. are globally distributed saprophytic fungi, classified in the literature as dematiaceous, or darkly pigmented fungi. These fungi have been increasingly recognized as causing cutaneous, ocular, respiratory, and central nervous system infections in humans, but have been infrequently documented as pathogens in the veterinary literature. A 5-yr-old male Chinese goral (Naemorhedus griseus) presented with bilateral fungal dermatitis of the pinnae, and subsequent pyogranulomatous rhinosinusitis. Clinical signs included epistaxis, mucosanguineous nasal discharge, and dyspnea. Sequential histologic examinations of cutaneous and nasal lesions revealed pyogranulomatous inflammation with extracellular and phagocytized nonpigmented yeasts. Fungal culture and polymerase chain reaction identified Curvularia sp. The absence of pigmentation in tissue in this case suggests that pigmentation may not be a consistent histologic finding for this fungus, emphasizing the importance of molecular identification to prevent misidentification. Despite intensive interventions in this goral, the disease progressed, and was ultimately fatal.


Assuntos
Dermatomiosite/veterinária , Rinite/veterinária , Sinusite/veterinária , Animais , Animais de Zoológico , Antifúngicos/uso terapêutico , Clotrimazol/uso terapêutico , Dermatomiosite/tratamento farmacológico , Dermatomiosite/microbiologia , Griseofulvina/uso terapêutico , Masculino , Rinite/tratamento farmacológico , Rinite/microbiologia , Ruminantes , Sinusite/tratamento farmacológico , Sinusite/microbiologia
2.
FP Essent ; 486: 11-18, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31710453

RESUMO

Upper respiratory tract infections (URTIs) include the common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM). URTIs account for billions of dollars in annual health care costs; acute respiratory tract infections are the most common reason for acute care appointments. Although URTIs typically are viral, these infections are the most common reason for prescription of antibiotics in adults. Recommended therapy for the common cold involves symptom management with over-the-counter drugs, though the Food and Drug Administration advises against use of these drugs in children younger than 6 years. Acute rhinosinusitis also typically is viral. A bacterial etiology is more likely if symptoms last longer than 10 days, the temperature is greater than 39°C (102.2°F), or if symptoms worsen after initial improvement. Antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days. Acute pharyngitis also typically is of viral origin. Antibiotics for streptococcal pharyngitis should be prescribed only if test or culture results are positive. AOM can be managed without antibiotics except in children younger than 6 months, children ages 6 to 23 months with bilateral AOM, children older than 2 years with bilateral AOM and otorrhea, and certain high-risk patients.


Assuntos
Otite Média , Faringite , Infecções Respiratórias , Rinite , Sinusite , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Criança , Humanos , Lactente , Otite Média/diagnóstico , Otite Média/tratamento farmacológico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Rinite/diagnóstico , Rinite/tratamento farmacológico , Sinusite/diagnóstico , Sinusite/tratamento farmacológico
3.
Cochrane Database Syst Rev ; 2019(11)2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31677153

RESUMO

BACKGROUND: Non-allergic rhinitis is defined as dysfunction and non-infectious inflammation of the nasal mucosa that is caused by provoking agents other than allergens or microbes. It is common, with an estimated prevalence of around 10% to 20%. Patients experience symptoms of nasal obstruction, anterior rhinorrhoea/post-nasal drip and sneezing. Several subgroups of non-allergic rhinitis can be distinguished, depending on the trigger responsible for symptoms; these include occupation, cigarette smoke, hormones, medication, food and age. On a cellular molecular level different disease mechanisms can also be identified. People with non-allergic rhinitis often lack an effective treatment as a result of poor understanding and lack of recognition of the underlying disease mechanism. Intranasal corticosteroids are one of the most common types of medication prescribed in patients with rhinitis or rhinosinusitis symptoms, including those with non-allergic rhinitis. However, it is unclear whether intranasal corticosteroids are truly effective in these patients. OBJECTIVES: To assess the effects of intranasal corticosteroids in the management of non-allergic rhinitis. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 7); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 July 2019. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing intranasal corticosteroids, delivered by any means and in any volume, with (a) placebo/no intervention or (b) other active treatments in adults and children (aged ≥ 12 years). DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes were patient-reported disease severity and a significant adverse effect - epistaxis. Secondary outcomes were (disease-specific) health-related quality of life, objective measurements of airflow and other adverse events. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included 34 studies (4452 participants); however, only 13 studies provided data for our main comparison, intranasal corticosteroids versus placebo. The participants were mainly defined as patients with perennial rhinitis symptoms and negative allergy tests. No distinction between different pheno- and endotypes could be made, although a few studies only included a specific phenotype such as pregnancy rhinitis, vasomotor rhinitis, rhinitis medicamentosa or senile rhinitis. Most studies were conducted in a secondary or tertiary healthcare setting. No studies reported outcomes beyond three months follow-up. Intranasal corticosteroid dosage in the review ranged from 50 µg to 2000 µg daily. Intranasal corticosteroids versus placebo Thirteen studies (2045 participants) provided data for this comparison. These studies used different scoring systems for patient-reported disease severity, so we pooled the data in each analysis using the standardised mean difference (SMD). Intranasal corticosteroid treatment may improve patient-reported disease severity as measured by total nasal symptom score compared with placebo at up to four weeks (SMD -0.74, 95% confidence interval (CI) -1.15 to -0.33; 4 studies; 131 participants; I2 = 22%) (low-certainty evidence). However, between four weeks and three months the evidence is very uncertain (SMD -0.24, 95% CI -0.67 to 0.20; 3 studies; 85 participants; I2 = 0%) (very low-certainty evidence). Intranasal corticosteroid treatment may slightly improve patient-reported disease severity as measured by total nasal symptom score change from baseline when compared with placebo at up to four weeks (SMD -0.15, 95% CI -0.25 to -0.05; 4 studies; 1465 participants; I2 = 35%) (low-certainty evidence). All four studies evaluating the risk of epistaxis showed that there is probably a higher risk in the intranasal corticosteroids group (65 per 1000) compared to placebo (31 per 1000) (risk ratio (RR) 2.10, 95% CI 1.24 to 3.57; 4 studies; 1174 participants; I2 = 0%) (moderate-certainty evidence). The absolute risk difference (RD) was 0.04 with a number needed to treat for an additional harmful outcome (NNTH) of 25 (95% CI 16.7 to 100). Only one study reported numerical data for quality of life. It did report a higher quality of life score in the intranasal corticosteroids group (152.3 versus 145.6; SF-12v2 range 0 to 800); however, this disappeared at longer-term follow-up (148.4 versus 145.6) (low-certainty evidence). Only two studies provided data for the outcome objective measurements of airflow. These data could not be pooled because they used different methods of outcome measurement. Neither found a significant difference between the intranasal corticosteroids and placebo group (rhinomanometry SMD -0.46, 95% CI -1.06 to 0.14; 44 participants; peak expiratory flow rate SMD 0.78, 95% CI -0.47 to 2.03; 11 participants) (very low-certainty evidence). Intranasal corticosteroids probably resulted in little or no difference in the risk of other adverse events compared to placebo (RR 0.99, 95% CI 0.87 to 1.12; 3 studies; 1130 participants; I2 = 0%) (moderate-certainty evidence). Intranasal corticosteroids versus other treatments Only one or a few studies assessed each of the other comparisons (intranasal corticosteroids versus saline irrigation, intranasal antihistamine, capsaicin, cromoglycate sodium, ipratropium bromide, intranasal corticosteroids combined with intranasal antihistamine, intranasal corticosteroids combined with intranasal antihistamine and intranasal corticosteroids with saline compared to saline alone). It is therefore uncertain whether there are differences between intranasal corticosteroids and other active treatments for any of the outcomes reported. AUTHORS' CONCLUSIONS: Overall, the certainty of the evidence for most outcomes in this review was low or very low. It is unclear whether intranasal corticosteroids reduce patient-reported disease severity in non-allergic rhinitis patients compared with placebo when measured at up to three months. However, intranasal corticosteroids probably have a higher risk of the adverse effect epistaxis. There are very few studies comparing intranasal corticosteroids to other treatment modalities making it difficult to draw conclusions.


Assuntos
Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Rinite/tratamento farmacológico , Administração Intranasal , Humanos , Sprays Nasais , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Minerva Med ; 110(6): 524-529, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31578841

RESUMO

BACKGROUND: In association with standard management, natural pharmaceutical standard (PS) supplements may play an important role in managing and preventing mild-to-moderate symptoms of asthma, a significant health issue that impacts patients and the healthcare system. Quercetin is a natural flavonoid with important biological properties (anti-inflammatory, antihistamine and anti-oxidative actions). METHODS: In this pilot registry, we evaluated the effects of quercetin formulated with the Phytosome® delivery system (Quercefit™, QFit)+standard management (SM) in otherwise healthy subjects with mild-moderate asthmatic attacks and rhinitis. Subjects used either QFit 1 or 2 tabs/day in association with SM or SM only (control group). After 30 days of management, we evaluated the presence of the main signs/symptoms of asthma according to the GINA classification system also considering the need of rescue medication, nasal drops, the use of inhalers, the rhinitis score and oxidative stress. RESULTS: QFit+SM showed superior results compared with SM alone in controlling, preventing and reducing daily and night symptoms, in maintaining higher peak expiratory flow (PEF) and in decreasing PEF variability. The supplementary use of QFit improved additional measures of asthma management, decreasing the use of inhalers, nasal drops, rescue medications and improving the rhinitis score. QFit produced a significantly more evident reduction in oxidative stress compared with SM; Qfit showed a very good safety profile. CONCLUSIONS: This preliminary supplement, concept registry shows a potential protective and preventive effect of quercetin on attacks frequency and in controlling the most common signs/symptoms of asthma in the milder cases of the disease.


Assuntos
Anti-Inflamatórios/uso terapêutico , Asma/tratamento farmacológico , Asma/prevenção & controle , Quercetina/uso terapêutico , Rinite/tratamento farmacológico , Adulto , Feminino , Humanos , Itália , Masculino , Projetos Piloto , Sistema de Registros
5.
Rev Med Suisse ; 15(665): 1748-1751, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580018

RESUMO

Nasal polyposis is a specific phenotype of chronic rhinosinusitis (CRS). Some cases can be managed with topical and infrequent use of systemic steroids, while many patients require surgery. Despite postoperative, regular steroid administration, recurrences may be found especially in patients suffering from Aspirin exacerbated respiratory disease (AERD), a particularly severe form of CRS with polyps, asthma and non-steroid-anti-inflammatory-drug (NSAID) intolerance. We report two cases of difficult-to-treat AERD patients following revision surgery, treated with monoclonal anti-IgE antibody (omalizumab) and successful control of the disease and symptoms. Omalizumab may be a promising alternative in selected cases of CRS with nasal polyps to avoid overuse of systemic steroids and frustrating repetition of paranasal sinus surgeries.


Assuntos
Pólipos Nasais/complicações , Omalizumab/uso terapêutico , Rinite/complicações , Rinite/tratamento farmacológico , Sinusite/complicações , Sinusite/tratamento farmacológico , Doença Crônica , Humanos , Rinite/cirurgia , Sinusite/cirurgia
6.
Biomed Res Int ; 2019: 7150942, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31534961

RESUMO

To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper airways (UA). Recently, topical administration of ectoine has just been recognized as adjuvant treatment in the Allergic Rhinitis (AR) and Rhinosinusitis (ARS). The aim of this work is to review the published literature regarding all the potential therapeutic effects of ectoine in the acute and chronic inflammatory diseases of UA. Pertinent studies published without temporal limitation were selected searching on MEDLINE the following terms: "ectoine" and "nasal spray," "oral spray," "upper respiratory tract infections," "rhinosinusitis," "rhinitis," "rhinoconjunctivitis," "pharyngitis," and "laryngitis." At the end of our selection process, six relevant publications were included: two studies about the effect of ectoine on AR, one study about ARS, one study about rhinitis sicca anterior, and two studies about acute pharyngitis and/or laryngitis. Due to its moisturizing and anti-inflammatory properties, topical administration of ectoine could play a potential additional role in treatment of acute and chronic inflammatory diseases of UA, in particular in the management of sinonasal conditions improving symptoms and endoscopic findings. However, these results should be viewed cautiously as they are based on a limited number of studies; some of them were probably underpowered because of their small patient samples.


Assuntos
Diamino Aminoácidos/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Doença Aguda , Administração Tópica , Doença Crônica , Humanos , Inflamação/tratamento farmacológico , Inflamação/patologia , Laringite/tratamento farmacológico , Laringite/patologia , Sprays Orais , Infecções Respiratórias/patologia , Rinite/tratamento farmacológico , Rinite/patologia , Sinusite/tratamento farmacológico , Sinusite/patologia
7.
Eur Arch Otorhinolaryngol ; 276(12): 3373-3381, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560120

RESUMO

PURPOSE: Recalcitrant chronic rhinosinusitis is a persistent inflammatory condition of the sinonasal mucosa despite adequate medical therapy and sinus surgery. This study aimed to demonstrate the effectiveness and safety of dilute povidone-iodine (PVP-I) sinonasal rinses as an adjunctive therapy. METHODS: Prospective cohort study. Twenty-nine recalcitrant CRS patients with endoscopic evidence of ongoing inflammation and purulent discharge were prescribed 0.08% diluted PVP-I rinses. Changes to endoscopic modified Lund-Kennedy (MLK) scores at 7 weeks post-PVP-I rinsing served as the primary outcome measure. RESULTS: The median MLK-discharge score significantly decreased in all patients by 1.50 points post-PVP-I rinsing (p value < 0.01). The total MLK score significantly decreased in all patients by 1.50 points (p value = 0.01). Up to a 17% reduction in serum inflammatory markers was measured post-PVP-I rinsing. Sinonasal culture revealed a shift from moderate-heavy growth to lighter bacterial growth overall. Subjective SNOT-22 scores significantly improved overall by ≥ 1 minimal clinically important difference (MCID > 12; baseline median = 33; follow-up median = 20; p value < 0.01; n = 22). TSH levels increased non-significantly within normal ranges (baseline median = 1.59 mU/L; follow-up median = 1.92 mU/L; p = 0.10; n = 15). Mucociliary clearance time increased non-significantly within normal ranges (baseline median = 9 min; follow-up median = 10 min; p value = 0.53; n = 17). Olfactory Sniffin'16 scores non-significantly decreased within age-related normal ranges (baseline median = 14; follow-up median = 13; p value = 0.72; n = 18). CONCLUSION: A dilute 0.08% PVP-I sinonasal rinse as an ancillary therapy in recalcitrant CRS significantly reduces signs of infection alongside notable symptom improvement, without affecting thyroid function, mucociliary clearance or olfaction.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Povidona-Iodo/administração & dosagem , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Irrigação Terapêutica , Administração Intranasal , Adulto , Anti-Infecciosos Locais/uso terapêutico , Doença Crônica , Estudos de Coortes , Endoscopia , Feminino , Humanos , Inflamação/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Depuração Mucociliar , Lavagem Nasal , Povidona-Iodo/uso terapêutico , Estudos Prospectivos , Rinite/cirurgia , Índice de Gravidade de Doença , Sinusite/cirurgia , Resultado do Tratamento
8.
Rhinology ; 57(6): 420-429, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31490466

RESUMO

BACKGROUND: The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. METHODS: We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). RESULTS: From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. CONCLUSIONS: While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management.


Assuntos
Antibacterianos/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Crônica , Registros Eletrônicos de Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Humanos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Rinite/epidemiologia , Sinusite/epidemiologia , País de Gales/epidemiologia
9.
Rhinology ; 57(4): 241, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374113

RESUMO

Based on data from Asia showing the positive effect of long-term antibiotics in diffuse panbronchiolitis, a number of studies have been performed on the effect of long-term macrolides on symptomatology of chronic rhinosinusitis. Macrolides possess anti-inflammatory and immune-modulating effects and may be helpful in the treatment of CRS.


Assuntos
Antibacterianos , Rinite , Sinusite , Antibacterianos/uso terapêutico , Doença Crônica , Humanos , Macrolídeos , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico
10.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 164-169, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465184

RESUMO

Background: The link between upper and lower airways is recognized clinically as a "unique airway". Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, which could be proportional to rhinitis severity. Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic (AR) and non-allergic rhinitis (NAR) without asthma, according to the clinical grade of rhinitis classified by ARIA (Allergic Rhinitis and Its Impact on Asthma). Methods: In a cross-sectional analytical study, we included patients aged 5 to 18 years with symptoms of AR and NAR without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIA using an adjusted logistic model. Results: We studied 193 patients; 42 (21.7%) had some spirometric abnormalities. Patients with moderate-severe persistent rhinitis had greater impairment of lung function compared to the other grades of rhinitis (p=0.009). This defect was associated with both frequency (p=0.03) and severity of rhinitis (p=0.04) but not with atopic status (p=0.28). A positive bronchodilator response was more frequent in grades moderate-severe of rhinitis than in mild forms (p=0.04). Conclusion: Abnormalities of lung function was more prevalent in moderate-severe persistent rhinitis and was associated with the frequency and severity of rhinitis but not to atopic status. The bronchodilator reversibility was observed in patients with intermittent and persistent moderate-severe rhinitis.


Assuntos
Albuterol/uso terapêutico , Broncodilatadores/uso terapêutico , Pulmão/fisiopatologia , Rinite/complicações , Rinite/tratamento farmacológico , Adolescente , Alérgenos/administração & dosagem , Alérgenos/classificação , Argentina , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Pulmão/efeitos dos fármacos , Masculino , Rinite/diagnóstico , Rinite Alérgica/complicações , Rinite Alérgica/diagnóstico , Rinite Alérgica/tratamento farmacológico , Índice de Gravidade de Doença , Testes Cutâneos , Espirometria
11.
Medicina (Kaunas) ; 55(7)2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31261788

RESUMO

Fungal infections are a subset of infectious processes that an otolaryngologist is required to be familiar with. They can be encountered in otology, rhinology and head and neck surgery. The presence of fungal rhinosinusitis is well recognised by otolaryngologists, but the classifications and appropriate management are not so well understood. The prevalence of fungal sinus disease is thought to be have been increasing in recent decades There is speculation that this may be due to increased awareness, antibiotic overuse and increased use of immunosuppressant medications. Added to this, there has been a large amount published on the role of fungi as a causative organism in chronic rhinosinusitis. Given the importance of fungal rhinosinusitis in clinical practice, we aim to review the classification and current management strategies based on up-to-date literature.


Assuntos
Micoses/complicações , Rinite/etiologia , Sinusite/etiologia , Antifúngicos/uso terapêutico , Humanos , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/tratamento farmacológico , Micoses/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico
12.
J Coll Physicians Surg Pak ; 29(8): 732-735, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31358093

RESUMO

OBJECTIVE: To determine the effect of topical antifungal irrigation fluid containing amphotericin B on nasal polyp and their recurrence pattern, and to study the association of serum IgE in predicting the presence of fungus along with the nasal polyps. STUDY DESIGN: An interventional study. PLACE AND DURATION OF STUDY: Dow University Hospital, Dow International Medical College, DUHS, Karachi, from June 2015 to June 2017. METHODOLOGY: All adult patients having nasal polyps, who had not undergone any previous nasal surgery, were included in the study. Patients aged under 18 years, history of granulomatous diseases, immunosuppression, invasive fungal sinusitis, and pregnant ladies were excluded from the study. The ratio was kept as 1:2; one receiving irrigation with amphotericin B and the other only saline nasal irrigation without the medicine. After surgery, the patients were divided into two groups; 58 patients were in the placebo group and 29 in the amphotericin group. Serum IgE levels were documented before and one month postoperative treatment. Serum IgE level of more than 250 ng/ml was taken as a high value. All the patients were followed for six months. Recurrence was defined as the recurrence of nasal symptoms and recurrence of mucosal thickening based on repeat CT scan. Frequency tables and cross tabulations using Chi-square test were performed with p-values of 0.05 taken as significant were performed on different variables. RESULTS: A total of 87 patients were inducted. Overall 22 (25.3%) patients had recurrence of symptoms at six-month followup visit. Twelve (13.7%) of these were in the placebo group and 10 (11.5%) were in the amphotericin B nasal irrigation group. Serum IgE level preoperatively ranged between 52 - 9344 ng/dl; postoperatively it ranged from 13-1050 ng/dl. When pre and postoperative serum IgE level were compared with each other and CT scan scores, using Chi-square test, the difference was significant (p<0.001). CONCLUSION: Amphotericin B improved the CT scan score of the patients. The nasal irrigation of amphotericin B did not show significant change in the recurrence pattern of chronic sinuses with polyps. Serum IgE can be used as marker for the presence and response to treatment for non-invasive fungal sinusitis.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Lavagem Nasal/métodos , Pólipos Nasais/cirurgia , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adolescente , Adulto , Idoso , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Biomarcadores/sangue , Doença Crônica , Endoscopia , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X
13.
Rhinology ; 57(5): 367-374, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31210177

RESUMO

BACKGROUND: This randomized clinical trial was designed to evaluate the efficacy and safety of Tavipec® (Spicae aetheroleum), a phytomedicine obtained by steam distillation of the flowering tops of Lavandula latifolia, as compared to placebo in adult patients suffering from acute viral rhinosinusitis. METHODOLOGY: Patients with acute viral rhinosinusitis were randomly assigned to treatment with 2 capsules Tavipec® 150 mg or placebo thrice daily over a period of 7 days in a double-blind, parallel-group design. No additional treatment was admitted. The efficacy endpoints comprised the improvement of the main rhinosinusitis symptoms as per Major Symptom Score (MSS) and Sino-Nasal Outcome Test (SNOT-22) as well as of quality of life (QoL) by global assessment scale, evaluated at baseline, day 5 and day 8, respectively. RESULTS: 288 patients were enrolled and randomized to treatment. At day 8 the patients in the Tavipec® group had a significantly lower MSS compared to placebo and the impact of rhinosinusitis symptoms on QoL was significantly reduced. A significantly higher proportion of Tavipec® treated patients experienced a change in SNOT-22 score greater than or equal to 10 points at day 5 or day 8. No new safety signals were identified. CONCLUSIONS: The treatment with Tavipec® effectively reduced the symptoms of acute rhinosinusitis in adult patients.


Assuntos
Extratos Vegetais , Rinite , Sinusite , Doença Aguda , Adulto , Método Duplo-Cego , Humanos , Extratos Vegetais/uso terapêutico , Qualidade de Vida , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Resultado do Tratamento
14.
Vestn Otorinolaringol ; 84(2): 50-56, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31198216

RESUMO

Presented the results of the clinical study of 30 patients with moderate rhinosinusitis (13 (43.3%) men, 17 (56.7%) women, age from 18 to 68 years). Among those patients, the inflammation of one paranasal sinus was observed in 7 (23.3%) cases, polysinusitis was observed in 23 (76. 7%) cases. All patients were randomized into 2 groups of 15 people. In both groups, patients received systemic antibiotic therapy, nasal irrigation therapy, and NSAIDs. In the control group, topical decongestants were used; in the experimental group the antimicrobial drug Polydexa with phenylephrine was used as a local therapy. The purpose of the study was to evaluate the clinical efficacy of Polydexa with phenylephrine in the complex treatment of moderate acute rhinosinusitis. The evaluation criteria were statistically significant comparison of clinical and laboratory parameters of both groups. Confirmed the anti-inflammatory, antimicrobial effects of the drug, made conclusions about the significant clinical efficacy, tolerability, positive effect on mucociliary clearance and safety of nasal spray Polydexa with phenylephrine.


Assuntos
Anti-Infecciosos , Rinite , Sinusite , Adulto , Idoso , Antibacterianos , Anti-Infecciosos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto Jovem
16.
Int Forum Allergy Rhinol ; 9(S1): S27-S31, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31087634

RESUMO

BACKGROUND: Topical antibiotic therapies have been investigated for their use in chronic rhinosinusitis (CRS). However, society guidelines and evidence-based medicine reviews have recommended against the use of topical antibiotic therapy based on randomized controlled trials (RCTs). The purpose of this article is to review recent clinical research published since the aforementioned guidelines were published. METHODS: A structured literature review was performed on clinical studies published in the last 5 years investigating the use of topical antibiotic therapies. RESULTS: One double-blinded, randomized controlled trial (DB-RCT) supported the use of tobramycin using a vibrating aerosolizer; 1 non-blinded non-randomized controlled prospective trial lent support to use of topical ofloxacin for its anti-biofilm properties; and 1 meta-analysis found mupirocin irrigations to be beneficial in the short term. One Cochrane Review was unable to make a recommendation as no trial met the inclusion criteria. An additional systematic review found limited evidence to support the use of topical antibiotics with the exception of mupirocin irrigations that may be considered in Staphylococcus aureus infections. Two retrospective studies found that topical antibiotics change bacterial cultures of the sinuses. CONCLUSION: There is additional evidence to support continuing investigation of topical antibiotic therapies. Further, larger RCTs are required to establish the efficacy of topical antibiotic therapies.


Assuntos
Antibacterianos/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Administração Intranasal , Antibacterianos/administração & dosagem , Doença Crônica , Humanos , Seios Paranasais/efeitos dos fármacos , Guias de Prática Clínica como Assunto , Infecções Estafilocócicas/tratamento farmacológico , Resultado do Tratamento
17.
Int Forum Allergy Rhinol ; 9(S1): S16-S21, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31087635

RESUMO

BACKGROUND: Intranasal steroids have become part of the mainstay in the long-term management of chronic rhinosinusitis. A long-standing problem remains in efficient and easy-to-use delivery of topical corticosteroids to the nasal mucosa. Currently available means of intranasal steroid delivery include sprays, which are generally limited to treating the anterior nasal cavity, and rinses, which are not FDA-approved for this indication. The exhalation delivery system is a novel method of delivering fluticasone to the deeper areas within the nasal cavities, including the posterior nasal cavity and middle and superior meatuses. METHODS: Comprehensive literature review. RESULTS: Recent large scale studies have suggested its efficacy and safety in the use of patients with both chronic sinusitis with polyposis and without polyps. Specifically, studies have demonstrated decreased Sinonasal Outcome Test scores of 20 points following treatment, as well as improvement of polyp grade by 1 or more point in more than 60% of patients. Furthermore, among patients with nasal polyps, there was approximately 60-70% decreased indication for surgery following EDS-FLU use. CONCLUSION: EDS-FLU is an important adjunct therapy for sinonasal inflammatory disease.


Assuntos
Sistemas de Liberação de Medicamentos , Fluticasona/administração & dosagem , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Administração Intranasal/efeitos adversos , Doença Crônica , Sistemas de Liberação de Medicamentos/efeitos adversos , Expiração , Humanos , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/patologia , Rinite/patologia , Sinusite/patologia , Resultado do Tratamento
18.
Int Forum Allergy Rhinol ; 9(S1): S22-S26, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31087636

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) causes severe symptoms that lead to poor quality of life. When optimal medical therapy does not improve CRS symptoms, then endoscopic sinus surgery (ESS) can be used in patients with persistent symptoms and radiographic evidence of CRS to improve patients' symptoms and quality of life. Despite appropriate and complete sinus surgery, there can be issues after sinus surgery such as synechiae formation and recurrence of polyps in certain CRS patients that can decrease long-term outcomes. Corticosteroids are used to decrease postoperative scarring and edema as well as prevent recurrence of nasal polyp formation after sinus surgery. However, the use of oral or systemic steroid can lead to serious short-term and long-term complications. Therefore, a safer alternative would be the topical delivery of steroid via steroid-eluting sinus implants. METHODS: A literature review was performed to identify clinical studies evaluating steroid-eluting implants. Two forms of steroid-eluting implants were identified, Propel family products and Sinuva. The research findings from clinical studies using various steroid-eluting sinus implants are reviewed and discussed. RESULTS: Four prospective randomized clinical studies were identified for the Propel family products. Two prospective randomized clinical studies were identified for Sinuva. The results from the clinical studies showed that the use of the various steroid-eluting sinus implants can improve postoperative results after ESS as well as treat the recurrence of nasal polyps after sinus surgery without the need for additional sinus surgery. CONCLUSION: The novel steroid-eluting implants appear to be beneficial for CRS patients immediately post-operatively as well as for nasal polyps patients. Interestingly, these implants could be used as a substitute for the beneficial effect of systemic steroid use for CRS patients.


Assuntos
Implantes Absorvíveis , Stents Farmacológicos , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Esteroides/administração & dosagem , Implantes Absorvíveis/efeitos adversos , Doença Crônica , Stents Farmacológicos/efeitos adversos , Humanos , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/cirurgia , Cirurgia Endoscópica por Orifício Natural , Rinite/cirurgia , Sinusite/cirurgia , Resultado do Tratamento
19.
Int Forum Allergy Rhinol ; 9(S1): S9-S15, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31087637

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) has previously been thought to occur secondary to infectious or obstructive etiologies. However, in recent years, primary CRS has been more discretely defined as diffuse airway inflammation, similar to asthma. Adequate medical and surgical therapy are needed to control the inflammation. Our purpose in this study was to evaluate the efficacy and safety of topical corticosteroid treatment. METHODS: A focused literature review was conducted and we identified 11 original articles from the years 2013-2018 evaluating safety or efficacy of topical corticosteroid irrigations. RESULTS: Eleven articles were identified. One study found significant benefit between corticosteroid irrigations versus corticosteroid sprays. Two studies found significant benefit between corticosteroid irrigations compared to saline irrigations while two did not. One study found significant improvement in certain patient populations when using corticosteroid irrigations compared to no irrigation. Five studies found no significant increase in risk of adverse side effects with the use of topical corticosteroids. CONCLUSION: Many factors are associated with efficacious and adequate treatment of primary CRS. The pathology must be correctly diagnosed and be inflammatory in nature. The treatment paradigm should include wide and complete endoscopic sinus surgery for the adequate delivery of topical therapy. Topical therapy should be delivered in large-volume, low-pressure devices with adequate dosing. Although there is some systemic absorption, multiple studies have demonstrated that long-term, daily use of topical corticosteroids does not increase intraocular pressure, suppress the hypothalamic-pituitary-adrenal axis, or increase the risk of subcapsular cataracts. Therefore, topical corticosteroid irrigations should be considered a part of first-line medical treatment in postsurgical CRS patients.


Assuntos
Corticosteroides/uso terapêutico , Lavagem Nasal , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Doença Crônica , Humanos , Lavagem Nasal/efeitos adversos , Sprays Nasais , Cirurgia Endoscópica por Orifício Natural , Rinite/cirurgia , Solução Salina/administração & dosagem , Solução Salina/efeitos adversos , Solução Salina/uso terapêutico , Sinusite/cirurgia , Resultado do Tratamento
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