Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.216
Filtrar
1.
BMJ Case Rep ; 18(1)2025 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-39778954

RESUMO

A patient in his 70s, admitted to the cardiac intensive care unit with cardiogenic shock, unexpectedly presented with nasal myiasis during a workup for persistently elevated inflammatory markers. CT scans revealed sinusitis and bronchial secretions, while bronchoscopy identified mucus with positive pathogen testing. Nasal endoscopy was crucial in diagnosing myiasis, and immediate mechanical removal of larvae was performed. Definitive treatment involved surgical debridement, turbinectomy and sinus cleansing, leading to a successful recovery without complications. This case emphasises the importance of considering nasal myiasis as a rare but potential cause of sinusitis in critically ill patients, even in non-endemic regions. Early diagnosis using appropriate imaging and endoscopic techniques, followed by prompt treatment, is essential for preventing severe complications. Increased awareness among healthcare professionals is vital for the timely recognition and management of this condition in critical care settings.


Assuntos
Cuidados Críticos , Miíase , Sinusite , Idoso , Humanos , Masculino , Desbridamento , Endoscopia , Miíase/diagnóstico , Doenças Nasais/parasitologia , Doenças Nasais/diagnóstico , Doenças Nasais/cirurgia , Sinusite/diagnóstico , Sinusite/parasitologia , Tomografia Computadorizada por Raios X
2.
Med Mycol J ; 65(4): 111-115, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39617459

RESUMO

Penicillium brasilianum is an environmental filamentous fungus with useful applications in biotechnology. However, human infections caused by P. brasilianum are rare and not well understood. We present the case of a woman in her sixties with poorly controlled diabetes mellitus who was diagnosed with invasive fungal rhinosinusitis (IFRS) and orbital apex syndrome. She underwent endoscopic sinus surgery and received treatment with liposomal amphotericin B. Notably, ß-tubulin gene sequencing identified the filamentous fungus as P. brasilianum, and long-term itraconazole administration suppressed IFRS flares. Our findings underscore the need for increased awareness and understanding of rare fungal pathogens in clinical practice.


Assuntos
Antifúngicos , Penicillium , Rinite , Sinusite , Humanos , Sinusite/microbiologia , Penicillium/isolamento & purificação , Penicillium/genética , Feminino , Rinite/microbiologia , Rinite/cirurgia , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Anfotericina B/administração & dosagem , Pessoa de Meia-Idade , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/diagnóstico , Micoses/microbiologia , Micoses/tratamento farmacológico , Rinossinusite
3.
Respirar (Ciudad Autón. B. Aires) ; 16(4): 417-420, Dic.2024.
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1580716

RESUMO

El síndrome de Kartagener es una variante de la discinesia ciliar primaria, que consiste en una enfermedad hereditaria autosómica recesiva, poco frecuente, caracterizada por la tríada de bronquiectasias, sinusitis y dextrocardia. En este existen mutaciones en los genes responsables de la síntesis de proteínas ciliares, siendo el deterioro de la motilidad ciliar el principal problema fisiopatológico. Se presenta el caso de una paciente de 14 años de edad quien consulta por tos de tres semanas de evolución sin antecedentes de importancia, a quien como hallazgo incidental se le diagnostica dextrocardia. Por alta sospecha de síndrome de Kartagener, se solicitan estudios complementarios y se realiza broncoscopia que obtiene todos los componentes para un síndrome de Kartagener completo.


Kartagener syndrome is a variant of primary ciliary dyskinesia, which consists of a ra-re, autosomal recessive inherited disease, characterized by the triad of bronchiectasis, sinusitis and dextrocardia. In this case, there are mutations in the genes responsible for ciliary protein, with the deterioration of ciliary motility being the main pathophysiological problem. The case of a 14-year-old patient with a three-week history of cough with no significant history is presented. Dextrocardia was diagnosed as an incidental finding. Due to high suspicion of Kartagener syndrome, complementary studies were requested and bronchoscopy was performed, obtaining all the components for a complete Kartagener syndrome.


Assuntos
Humanos , Feminino , Adolescente , Sinusite , Situs Inversus , Bronquiectasia , Síndrome de Kartagener/diagnóstico , Transtornos da Motilidade Ciliar/congênito , Dextrocardia , Infecções Respiratórias , Biópsia , Broncoscopia , Diagnóstico por Imagem , Técnicas de Laboratório Clínico , Tosse , Guatemala , Doenças Genéticas Inatas/diagnóstico , Infertilidade , Antibacterianos , Mutação/genética
4.
Braz J Otorhinolaryngol ; 90(6): 101490, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39255692

RESUMO

OBJECTIVES: Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a disease characterized by chronic inflammation and tissue remodeling process. The remodeling process in nasal polyps has mainly been studied by histology analysis. However, it is limited to a polyp fragment and requires tissue removal. The present study aims to evaluate the ability of Magnetic Resonance Imaging (MRI) to depict and characterize the remodeling process in patients with CRSwNP. METHODS: 30 patients that met clinical diagnostic criteria for CRSwNP, without previous history of rhinosinusitis surgery were submitted to MRI scan (conventional, diffusion-weighted and DCE MRI) and compared with polyp tissue histological findings, IL-6 concentrations in the tissue and eosinophil count in the blood. The examinations were evaluated, independently, by two radiologists blinded to other radiological and histological data. The pathologist, blinded to MRI results, also compared the tissue sample from the most central and the most peripheral portion of the polypoid tissue adjacent to the floor of the nasal fossa. RESULTS: This study demonstrated a characteristic pattern of nasal polyps, whose peripheral portions of nasal polypoid tissue are edematous, whereas the central portions in the middle meatus and in the middle and upper ethmoid are predominantly fibrotic. ADC values found in the most anterior portion of the polyps may be a marker for radiological phenotyping the remodeling process. This non-invasive analysis presented a high degree of agreement in the fibrosis and edema rating by two radiologists and the histological analysis was concordant with the MRI findings. The polyps were characterized as eosinophilic, and no relationship was found between the severity of the eosinophilic inflammatory process or concentration of IL-6 and the remodeling process. CONCLUSION: MRI by using T2-weighted imaging sequence and ADCs values allows tissue characterization and is an effective tool for the differentiation of edematous and fibrotic components in CRSwNP.


Assuntos
Imageamento por Ressonância Magnética , Mucosa Nasal , Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/patologia , Pólipos Nasais/complicações , Sinusite/diagnóstico por imagem , Sinusite/patologia , Sinusite/complicações , Doença Crônica , Rinite/diagnóstico por imagem , Rinite/patologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Mucosa Nasal/diagnóstico por imagem , Mucosa Nasal/patologia , Interleucina-6/análise , Interleucina-6/sangue , Eosinófilos/patologia , Idoso , Adulto Jovem , Inflamação/diagnóstico por imagem , Inflamação/patologia , Rinossinusite
5.
Medicina (B Aires) ; 84(4): 756-759, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-39172577

RESUMO

Epidural abscesses are rare intracranial infections. They can occur from neurosurgical procedures, or head and neck infections. Successful treatment usually requires a combination of drainage procedure and antibiotic therapy. We present the case of a young patient with an intracranial epidural abscess and meningitis secondary to sinusitis who received only corticosteroids and antibiotic therapy, with good evolution.


Los abscesos epidurales son infecciones intracraneales de baja frecuencia. Pueden ocurrir derivados de procedimientos neuroquirúrgicos, o infecciones de cabeza y cuello. El tratamiento exitoso generalmente requiere la combinación de un procedimiento de drenaje y antibioticoterapia. Se presenta el caso de un paciente joven, con un absceso epidural intracraneal y meningitis, secundario a sinusitis que recibió solo tratamiento con corticoides y antibioticoterapia con buena evolución.


Assuntos
Antibacterianos , Abscesso Epidural , Sinusite , Humanos , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/diagnóstico por imagem , Antibacterianos/uso terapêutico , Sinusite/tratamento farmacológico , Sinusite/complicações , Masculino , Imageamento por Ressonância Magnética , Adulto
6.
Braz J Otorhinolaryngol ; 90(6): 101473, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39111129

RESUMO

OBJECTIVE: To investigate the efficacy of cluster nursing intervention based on Enhanced Recovery After Surgery (ERAS) for xerostomia in chronic rhinosinusitis after nasal endoscopic surgery. METHODS: A total of 80 patients with chronic rhinosinusitis who underwent functional nasal endoscopic surgery between January 2020 and December 2021 were selected and randomly divided into a control group (n = 40) and an experimental group (n = 40). Patients in the control group were treated with general nursing, while ERAS-based cluster nursing intervention was adopted for the experimental group, in addition to general nursing. Xerostomia stage and comfort level were observed at 2 h, 6 h, 24 h and 48 h after surgery; negative emotions before and after nursing were also observed. RESULTS: After the intervention, the xerostomia stage and comfort level at 6, 24 and 48 after surgery were higher in the experimental group (p < 0.05). Negative emotions in the experimental group were lower after nursing (p < 0.001). The self-rating depression scale and self-rating anxiety scale scores increased after nursing in both two groups (p < 0.05). CONCLUSION: Enhanced recovery after surgery-based cluster nursing intervention can alleviate xerostomia, improve patients' comfort levels, reduce their negative emotions and accelerate postoperative recovery.


Assuntos
Endoscopia , Recuperação Pós-Cirúrgica Melhorada , Rinite , Sinusite , Xerostomia , Humanos , Feminino , Masculino , Sinusite/cirurgia , Pessoa de Meia-Idade , Rinite/cirurgia , Adulto , Endoscopia/métodos , Xerostomia/prevenção & controle , Xerostomia/etiologia , Doença Crônica , Complicações Pós-Operatórias/prevenção & controle
7.
Otolaryngol Head Neck Surg ; 171(5): 1552-1561, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39087780

RESUMO

OBJECTIVES: To determine the inflammatory profile of CRSwNP in Brazil and characterize the subgroups of CRSwNP patients in this population through cluster analysis. STUDY DESIGN: Multicenter cross-sectional study involving 15 centers representing different regions of Brazil. SUBJECTS AND METHODS: Clinical data of 166 patients and 80 controls, aged 18 to 70 years old, number of surgeries for CRS, history of asthma and aspirin sensitivity, and Lund-Mackay scores on CT scans. During nasal endoscopy, we obtained the Lund-Kennedy scores and collected 2 samples of nasal polyps: one for eosinophil and neutrophil tissue counts and one to quantify different cytokines. RESULTS: 79.6% of our patients had 10 or more eosinophils/HPF. CRSwNP groups exhibited significantly lower concentrations of TNF-alpha and significantly higher concentrations of IFN-gamma, CCL11/Eotaxin, CCL24/Eotaxin-2/MPIF-2, and CCL26/Eotaxin-3 versus the control group (Kruskal-Wallis test). Comparison between CRSwNP groups (≥10 vs <10 eosinophils/HPF) showed no difference in cytokine concentration (Mann-Whitney test). Hierarchical clustering and PCA according to cytokine concentrations revealed 2 main Clusters, with a significantly higher concentration of all cytokines in Cluster 1 (n = 35) than in Cluster 2 (n = 121), except IL-6 and IL-33 (Mann-Whitney test). According to ROC curve analysis the best cut-off to differentiate the 2 clusters was 43 eosinophils/HPF. The group with ≥43 presented a higher prevalence of men and a higher Lund-Mackay score (Mann-Whitney test). CONCLUSIONS: CRSwNP patients in Brazil present mixed inflammation, with 2 distinct groups (high and low inflammatory pattern) that can be distinguished by tissue eosinophilia of ≥43 eosinophils/HPF cut-off in nasal polyps.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/complicações , Sinusite/complicações , Adulto , Pessoa de Meia-Idade , Masculino , Estudos Transversais , Brasil/epidemiologia , Feminino , Rinite/complicações , Doença Crônica , Idoso , Adolescente , Citocinas , Adulto Jovem , Eosinófilos , Análise por Conglomerados , Rinossinusite
8.
Braz J Otorhinolaryngol ; 90(5): 101463, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39059323

RESUMO

OBJECTIVE: An ethmoid-dominant shadow on computed tomography is an indicator of type 2 inflammation, and is one of the main items used to diagnose and classify the severity of eosinophilic chronic rhinosinusitis in the Japanese diagnostic criteria. Ethmoid sinus dominance is examined using the Lund-Mackay scoring system and may be overestimated due to scoring characteristics. We aim to investigate the accuracy of evaluations of ethmoid dominance using the conventional scoring system and the possibility of conducting an objective evaluation using a more detailed other scoring system. METHODS: Patients diagnosed with eosinophilic chronic rhinosinusitis and who underwent bilateral endoscopic sinus surgery were enrolled in the present study. Computed tomography was performed preoperatively on all subjects. The bilateral anterior and posterior ethmoid sinuses and bilateral maxillary sinus were scored, and the ethmoid-to-maxillary ratio was calculated using 3 different scoring systems: Lund-Mackay (each sinus score ranges between 0 and 2), simplified Zinreich (score ranging between 0 and 3), and Zinreich (score ranging between 0 and 5). RESULTS: A total of 149 patients were eligible for the present study. Significant differences were observed in ethmoid-to-maxillary ratio evaluated by the 3 different scoring systems (2.4 ±â€¯0.7, 3.0 ±â€¯1.1, and 3.7 ±â€¯2.2). Only 2 patients were negative for ethmoid dominance by the Lund-Mackay scoring system, while 14 were negative by the simplified-Zinreich and Zinreich scoring systems. Severity changed from the initial grade in 12 patients. CONCLUSIONS: The present results confirmed a potential overestimation when only the Lund-Mackay scoring system was used to assess ethmoid dominance. Ethmoid dominance has been identified as one of the main predictive factors for the long-term postoperative outcomes of eosinophilic chronic rhinosinusitis and is included in the Japanese diagnostic criteria. A detailed evaluation of ethmoid dominance is desirable for more accurate evaluations of the severity and prognosis of eosinophilic chronic rhinosinusitis.


Assuntos
Seio Etmoidal , Rinite , Sinusite , Tomografia Computadorizada por Raios X , Humanos , Seio Etmoidal/diagnóstico por imagem , Doença Crônica , Feminino , Masculino , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Pessoa de Meia-Idade , Rinite/diagnóstico por imagem , Rinite/cirurgia , Adulto , Índice de Gravidade de Doença , Idoso , Eosinofilia/diagnóstico por imagem , Adulto Jovem , Endoscopia , Reprodutibilidade dos Testes , Adolescente , Rinossinusite
9.
Int. j. odontostomatol. (Print) ; 18(2): 243-247, jun. 2024. ilus
Artigo em Espanhol | LILACS | ID: biblio-1564650

RESUMO

Las fístulas bucosinusales son complicaciones poco frecuentes originadas a partir de comunicaciones bucosinusales de larga trayectoria o no tratadas que predisponen a desarrollar cuadros patológicos tales como infecciones, sinusitis y un establecimiento crónico de la fístula si no es tratada de manera apropiada y oportuna. El tratamiento indicado es el cierre quirúrgico de esta comunicación, la cual puede ser lograda mediante múltiples técnicas; siendo el tamaño, localización y compromiso de los tejidos blandos circundantes los factores principales para considerar una técnica por sobre otra. El siguiente artículo tiene como objetivo presentar el manejo de una fístula bucosinusal de larga data en un paciente de 71 años con antecedentes médicos de radioterapia de cabeza y cuello.


Oroantral fistulae are rare complications originating from non-treated or long-term oroantral communications which can contribute to the development of certain pathological entities such as local infections, sinusitis and chronic fistula formation. The treatment modality indicated is surgical closure of the communication, which can be achieved through multiple techniques, being the size, location and nearby soft tissue the main factors for considering one technique over another. The objective of the following article is to present the management of an oroantral fistula in a 71 year old patient with a medical history of head and neck radiotherapy.


Assuntos
Humanos , Masculino , Idoso , Sinusite/complicações , Sinusite Maxilar/cirurgia , Sinusite Maxilar/complicações , Tomografia Computadorizada por Raios X , Fístula Bucoantral/cirurgia , Fístula Bucoantral/etiologia
10.
Braz J Otorhinolaryngol ; 90(4): 101436, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38696892

RESUMO

OBJECTIVE: This narrative review explores alternative non-antibiotic antimicrobial agents for CRS management in adults. METHODS: Alternative antimicrobial agents using EPOS 2020 guidelines as reference were selected, and articles dated from 2003 to 2022 in English, Portuguese, or Spanish using PubMed and EMBASE databases. The parameters analyzed included study design, evidence level, population characteristics, CRS characteristics, interventions, outcomes, sample size, randomization, blinding, and side effects. Reviews, unrelated contexts,in vitro experiments, and duplicates were excluded. RESULTS: 148 articles were screened; 19 articles were selected for analysis. Randomized controlled trials and cohort studies assessing non-antibiotic antimicrobial treatments for CRS were included. Xylitol demonstrated effectiveness in reducing CRS symptoms, particularly SNOT-22 scores, surpassing saline irrigation benefits. Manuka honey showed potential microbiological benefits in recalcitrant CRS, but symptomatic and endoscopic improvements remained inconclusive. Baby shampoo irrigation improved nasal mucociliary clearance and postoperative outcomes. Colloidal silver nasal irrigation showed limited efficacy in reducing CRS symptoms or endoscopic scores. Povidone-Iodine (PI) nasal irrigation yielded mixed results, with varying effects on culture negativity and SNOT-20 scores. Bacteriophage treatment exhibited promise in decreasing specific bacterial strains and cytokine levels. CONCLUSION: Non-antibiotic antimicrobial therapies, including xylitol, manuka honey, baby shampoo, colloidal silver, PI, bacteriophages, lactoferrin, and carrageenan offer potential alternatives for CRS in adult patients. Xylitol, baby shampoo, and PI presented benefits in improving symptoms and nasal endoscopic scores, however, the number of studies is limited for conclusive recommendations and safety assessments. CRS management should adopt a comprehensive approach, particularly for non-infectious or immune-related cases, moving beyond antibiotics. Antibiotics should be reserved for confirmed bacterial infections. Overall, this review shows the importance of exploring non-antibiotic therapies to enhance the management of CRS.


Assuntos
Rinite , Sinusite , Humanos , Rinite/tratamento farmacológico , Rinite/microbiologia , Doença Crônica , Sinusite/tratamento farmacológico , Sinusite/microbiologia , Anti-Infecciosos/uso terapêutico , Mel , Xilitol/uso terapêutico , Rinossinusite
11.
Rev. méd. Maule ; 39(1): 32-39, mayo. 2024. tab
Artigo em Espanhol | LILACS | ID: biblio-1562972

RESUMO

Acute rhinosinusitis is a common condition, mainly of viral etiology and self-limiting course. There is coexistence of microbiological agents that favor bacterial superinfection. Therefore, it is necessary to know evidence that supports diagnostic approach in adults out- patients. Having reviewed the evidence, we mention the isolated symptoms and signs have such a low performance to guide the diagnostic approach, some with statistical evidence such as hemifacial pain, colored nasal discharge and radiographic alterations suggestive of rhinosinusitis. Also, it is possible to improve clinical performance by combining suggestive findings. The imaging study has little evidence that supports them, because non-specific and non-concordant findings. Finally, empirical management with antibiotics does not statistically or clinically modify the evolution of an acute non-complicated condition.


La rinosinusitis aguda es una condición frecuente, principalmente de etiología viral y de curso autolimitado. Existe coexistencia de agentes microbiológicos que favorece la sobreinfección bacteriana. Por ello, es necesario conocer la evidencia que dirige el enfrentamiento diagnóstico en pacientes adultos ambulatorios. Habiéndose revisado la evidencia, mencionamos que los síntomas y signos aislados poseen bajo rendimiento para guiar el proceso diagnóstico, destacando algunos con mejores atributos diagnósticos, pero de significancia estadística bastante discreta, como lo son el dolor hemifacial, la descarga nasal coloreada y alteraciones de la radiografía sugerentes de rinosinusitis. También, que se puede mejorar discretamente el rendimiento clínico combinando algunos de estos hallazgos sugerentes. El estudio imagenológico posee poca evidencia que lo respalde, dado la presencia de hallazgos inespecíficos o no concordantes, inclusive en pacientes asintomáticos. Finalmente, respecto de manejo empírico con antibióticos, destaca que su uso no modifica estadística ni clínicamente la evolución de un cuadro agudo no complicado.


Assuntos
Humanos , Pessoa de Meia-Idade , Sinusite/tratamento farmacológico , Rinite/diagnóstico , Rinite/tratamento farmacológico , Pólipos Nasais/tratamento farmacológico , Seios Paranasais/diagnóstico por imagem , Sinais e Sintomas , Radiografia , Cloreto de Sódio/uso terapêutico , Doença Crônica
12.
Braz J Otorhinolaryngol ; 90(4): 101424, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38581960

RESUMO

OBJECTIVES: The purpose of this study is to investigate the lung function in Chronic Rhinosinusitis (CRS) patients with Chronic Cough (CC). METHODS: A total of 1413 CC patients were retrospectively screened and 109 CRS patients with CC were enrolled. Lung function, Lund-Mackay Computed Tomography (CT) score, smoking status, peripheral blood eosinophil count, and immunoglobulin E concentration in serum samples, and Sino-Nasal Outcome Test were examined. Normal control subjects are also recruited. RESULTS: The Forced Expiratory Volume in 1 second (FEV1.0), Percent Predicted FEV1.0, and FEV1.0/Forced Vital Capacity (FVC) ratio in the patients were significantly low as compared with the control subjects. The FEV1.0/FVC ratio was negatively correlated with the Lund-Mackay CT scores of the patients with a high CT score. CONCLUSIONS: The CRS patients with CC should be investigated with lung function. In addition, the multidisciplinary evaluation including a pulmonologist is needed to manage the CRS patients with CC. LEVEL OF EVIDENCE: Level 4.


Assuntos
Tosse , Rinite , Sinusite , Tomografia Computadorizada por Raios X , Humanos , Sinusite/fisiopatologia , Sinusite/complicações , Masculino , Doença Crônica , Rinite/fisiopatologia , Rinite/complicações , Feminino , Tosse/fisiopatologia , Tosse/etiologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Estudos de Casos e Controles , Testes de Função Respiratória , Volume Expiratório Forçado/fisiologia , Capacidade Vital/fisiologia , Idoso , Pulmão/fisiopatologia , Pulmão/diagnóstico por imagem , Adulto Jovem , Imunoglobulina E/sangue , Rinossinusite , Tosse Crônica
13.
Braz J Otorhinolaryngol ; 90(3): 101410, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490010

RESUMO

OBJECTIVE: Our aim in this study is to identify the core genes of chronic rhinosinusitis with nasal polyps and analyze the correlations between it and inflammation-related genes. METHODS: GSE72713 dataset containing gene expression data of ECRSwNP, nonECRSwNP and healthy samples was obtained from Gene Expression Omnibus (GEO) and filtered by limma to identify DEGs among three groups, then the functions and correlated pathways of DEGs were analyzed using GO and KEGG. The core DEGs were selected by the intersection of DEGs and the PPI network was constructed via STRING. The correlations between the expression levels of CRSwNP core gene and inflammation-related genes were analyzed via the Mann-Whitney U test. RESULTS: The DEGs among ECRSwNP, nonECRSwNP, and CTRL were filtered respectively, and enrichment analysis showed they were associated with olfaction and/or immune responses. The PPI network was constructed by 7 core DEGs obtained via the intersection among three groups, and ALOX15 was confirmed as the core gene in the network. Subsequently, the correlations between the expression levels of ALOX15 and inflammation-related genes were illustrated. CONCLUSION: In this study, the core gene ALOX15 was selected from the DEGs among ECRSwNP, nonECRSwNP, and CTRL. IL5, IL1RL1, and IL1RAP were found to exhibit a significant positive correlation with ALOX15. LEVEL OF EVIDENCE: Level 3.


Assuntos
Inflamação , Pólipos Nasais , Rinite , Sinusite , Pólipos Nasais/genética , Humanos , Sinusite/genética , Rinite/genética , Doença Crônica , Inflamação/genética , Araquidonato 15-Lipoxigenase/genética , Perfilação da Expressão Gênica , Mapas de Interação de Proteínas/genética , Estudos de Casos e Controles , Rinossinusite
15.
Braz J Otorhinolaryngol ; 90(4): 101413, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38537503

RESUMO

OBJECTIVE: A retrospective analysis was performed to explore the clinical effect of the Posterior Nasal Nerve (PNN) resection combined with hormone transnasal nebulization on Difficult-to-Treat Rhinosinusitis (DTRS). METHODS: A total of 120 DTRS patients were selected and divided into a control group (n = 60) and a study group (n = 60) according to different treatments. The control group patients were treated via PNN resection, followed by normal saline transnasal nebulization; the study group patients were given PNN resection and then treated with budesonide suspension transnasal nebulization. Subsequently, the comparison was performed between the two groups in terms of (1) Clinical baseline characteristics; (2) Sino-nasal Outcome Test (SNOT)-22 scores before treatment and after 3-months, 6-months and 12-months of treatment; (3) Lund-MacKay scores before treatment and after 10, 30, 90, and 180 days of treatment; (4) Incidence of adverse reactions during treatment. RESULTS: There was no significant difference in SNOT-22 or Lund-Kennedy scores between the two groups before treatment (p > 0.05). After treatment, the SNOT-22 and Lund-Kennedy scores of the control and the study groups were decreased, and compared with the control group, the SNOT-22 and Lund-Kennedy scores in the study group improved more significantly (p < 0.05). In addition, the study group and the control group presented with 1 and 4 cases of nasal adhesion, 2 and 3 cases of epistaxis, 1 and 4 cases of sinus orifice obstruction, 1 and 3 cases of lacrimal duct injuries, respectively. The incidence of adverse reactions in the study group was significantly lower than that in the control group (8.3% vs. 23.3%) (p < 0.05). CONCLUSION: PNN resection combined with hormone transnasal nebulization treatment can improve the symptoms and quality of life of DTRS patients, with good clinical efficacy but few adverse reactions. Therefore, such combination treatment deserves a promotion and application clinically. LEVEL OF EVIDENCE: Level 3.


Assuntos
Budesonida , Rinite , Sinusite , Humanos , Estudos Retrospectivos , Sinusite/cirurgia , Sinusite/tratamento farmacológico , Rinite/cirurgia , Rinite/tratamento farmacológico , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Budesonida/administração & dosagem , Nebulizadores e Vaporizadores , Teste de Desfecho Sinonasal , Idoso , Adulto Jovem , Terapia Combinada , Rinossinusite
16.
Braz J Otorhinolaryngol ; 90(3): 101394, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38367543

RESUMO

INTRODUCTION: Biologics targeting type 2 inflammation have revolutionized the way we treat patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Particularly in severe and difficult-to-control cases, these drugs have provided a new reality for these patients, allowing for the effective and safe treatment of extensive diseases that were not completely managed with the typical strategy of surgery and topical medications. OBJECTIVES: The experience achieved with the approval of these medications by ANVISA for use in CRSwNP and the knowledge obtained regarding outcomes, adverse effects, and the ideal patient profile prompted the update of the previously published guideline, with a detailed review of the most recent scientific literature, the personal experiences of experts, and the adaptation to the reality of the Brazilian healthcare system, both public and private. RESULTS: We proposed a new eligibility criterion for biologics in patients with CRSwNP based on four pillars of indication: the impact of the disease on the patient's life, whether in the presence of specific symptoms or in overall quality of life; the extent of sinonasal disease; the presence of type 2 comorbidities, considering other associated diseases that may also benefit from anti-T2 biologics, and the presence of biomarkers to define type 2 inflammation, especially those associated with worse disease prognoses. CONCLUSIONS: This innovative and pioneering method has two major advantages. First, it ensures a comprehensive evaluation of patients; second, it is flexible, as advancements in our understanding of the disease and changes in cost-effectiveness can be addressed by simply adjusting the required score for indication, without the need to modify the entire evaluation scheme.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/complicações , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/imunologia , Rinite/imunologia , Rinite/tratamento farmacológico , Rinite/complicações , Doença Crônica , Brasil , Produtos Biológicos/uso terapêutico , Qualidade de Vida , Rinossinusite
17.
Braz J Otorhinolaryngol ; 90(2): 101377, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38232516

RESUMO

OBJECTIVE: Mucociliary transport function in the airway mucosa is essential for maintaining a clean mucosal surface. This function is impaired in upper and lower airway diseases. Nasal polyps are a noticeable pathological feature that develop in some of the patients with chronic rhinosinusitis. Like ordinary nasal mucosae, nasal polyps have a ciliated pseudostratified epithelium with vigorous ciliary beating. We measured ex vivo Mucociliary Transport Velocity (MCTV) and Ciliary Beat Frequency (CBF) and explored the expressions of Planar Cell Polarity (PCP) proteins in nasal polyps in comparison with turbinate mucosae. METHODS: Inferior turbinates and nasal polyps were surgically collected from patients with chronic rhinosinusitis. Ex vivo MCTV and CBF were measured using a high-speed digital imaging system. Expressions of PCP proteins were explored by fluorescence immunohistochemistry and quantitative RT-PCR. RESULTS: The MCTV of nasal polyps was significantly lower than that of the turbinates (7.43 ±â€¯2.01 vs. 14.56 ±â€¯2.09 µm/s; p = 0.0361), whereas CBF did not differ between the two tissues. The MCTV vector was pointed to the posteroinferior direction in all turbinates with an average inclination angle of 41.0 degrees. Immunohistochemical expressions of Dishevelled-1, Dishevelled-3, Frizzled3, Frizzled6, Prickle2 and Vangl2 were lower in the nasal polyps than in the turbinates. Confocal laser scanning microscopy showed that Frizzled3 was localized along the cell junction on the apical surface. The expression levels of mRNAs for Dishevelled-1, Dishevelled-3 and Frizzled3 in the nasal polyps were also decreased in comparison with the turbinates. CONCLUSION: These results indicate that muco ciliary transport in nasal polyps is impaired although vigorous ciliary beating is maintained, and that the impairment may be caused by a decrease in Dishevelled/Frizzled proteins and resultant PCP disarrangement. LEVEL OF EVIDENCE: Level 3.


Assuntos
Pólipos Nasais , Sinusite , Humanos , Pólipos Nasais/metabolismo , Depuração Mucociliar , Cílios/metabolismo , Cílios/patologia , Mucosa Nasal/metabolismo , Sinusite/metabolismo
18.
Braz J Otorhinolaryngol ; 90(2): 101371, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38070374

RESUMO

OBJECTIVES: Metabolic Syndrome (MetS) has been established as a significant factor in the pathogenesis of numerous chronic inflammatory conditions. However, its role in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is unknown. This study aims to investigate the association between MetS, its components, and the risk of postoperative recurrence in Chinese patients with CRSwNP. METHODS: A retrospective cohort study was conducted on CRSwNP patients who underwent endoscopic sinus surgery in our hospital. Patients were divided into MetS and non-MetS groups, and the clinical characteristics and recurrence rates were compared. All CRSwNP patients were followed up for more than 2-years and further categorized into non-recurrent and recurrent groups. Binary logistic regression analyses were performed to examine the effects of MetS and its components on the risk of postoperative recurrence. RESULTS: A total of 555 CRSwNP patients were enrolled in the present study, 157 patients were included in the MetS group and 398 patients were categorized into the non-MetS group. The recurrence rate in the MetS group was significantly higher compared to the non-MetS group (p < 0.05). The rate of MetS, overweight or obesity, hyperglycemia and dyslipidemia were higher in the recurrent group in comparison with the non-recurrent group (p < 0.05). Multivariate logistic regression analysis suggested that MetS, overweight or obesity, hyperglycemia, dyslipidemia, and accompanying allergic rhinitis were associated with the risk of postoperative recurrence of CRSwNP (p < 0.05). Moreover, adjusted and unadjusted regression models showed that MetS was an independent risk factor for postoperative recurrence of CRSwNP, and the risk increased with more components of MetS included (p < 0.05). CONCLUSION: Our findings revealed that MetS independently increased the risk of postoperative recurrence in patients with CRSwNP, with the risk escalating as the number of MetS components increased. Moreover, accompanying allergic rhinitis was also demonstrated to be a potential risk factor for CRSwNP recurrence. LEVEL OF EVIDENCE: Level 4.


Assuntos
Dislipidemias , Hiperglicemia , Síndrome Metabólica , Pólipos Nasais , Rinite Alérgica , Rinite , Rinossinusite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Rinite/complicações , Rinite/cirurgia , Síndrome Metabólica/complicações , Estudos Retrospectivos , Sobrepeso/complicações , Sinusite/complicações , Sinusite/cirurgia , Rinite Alérgica/complicações , Obesidade/complicações , Dislipidemias/complicações , Hiperglicemia/complicações , Doença Crônica , Recidiva
19.
Rhinology ; 62(1): 101-110, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37864409

RESUMO

BACKGROUND: Inhibitors of apoptosis proteins (IAPs) modulate the inflammatory process, and may facilitate the formation of chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to observe if IAPs were differently expressed between patients with CRSwNP and controls, and to correlate the expression of IAPs with some inflammatory markers, as with the response to nasal corticosteroids in patients with CRSwNP. METHODOLOGY: We obtained nasal biopsies from patients with CRSwNP (n=27) and controls (n=16). qRT-PCR measured the expression of IAPs and caspases, while Luminex assay measured the concentration of cytokines. Unpaired parametric tests and Principal Component Analysis (PCA) were used for statistical analysis. RESULTS: We observed lower expression of IAP genes (XIAP, BIRC2/IAP1, and BIRC3/IAP2) in CRSwNP patients compared to controls, and we identified that patients with bad response to corticosteroids presented lower levels of BIRC2/IAP1, XIAP, BCL2, CASP9, and IL-17, and higher levels of CASP7 and TGF-B. CONCLUSIONS: IAPs expression was downregulated in CRSwNP, and was associated with poorer response to nasal corticosteroids. The present findings suggest the importance of IAPs as a link between environment and the host inflammatory responses, and this pathway could be explored as a potential new target therapy for patients with CRSwNP.


Assuntos
Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/genética , Citocinas/metabolismo , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/metabolismo , Apoptose , Corticosteroides , Doença Crônica , Rinite/complicações , Rinite/tratamento farmacológico , Rinite/metabolismo
20.
Oral Maxillofac Surg ; 28(1): 63-77, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37266797

RESUMO

PURPOSE: To evaluate and compare the reported sinusitis occurrence after the sinus lift procedure and zygomatic implant placement. METHODS: This meta-analysis has been registered at PROSPERO. Studies were searched on six databases. Two authors screened titles and abstracts and fully analyzed the studies against the inclusion and exclusion criteria. The RoB 2.0 and the ROBINS-I tools were used to assess the quality and risk of bias of the included studies. The random-effects model was used for the meta-analysis. The prevalence of sinusitis was calculated based on the total of patients. Subgroup analysis was performed by sinus lift or zygomatic implant surgery technique. RESULTS: The search identified 2419 references. After applying the inclusion criteria, 18 sinus lift and 9 zygomatic implant placement studies were considered eligible. The pooled prevalence of sinusitis after sinus lift procedure was 1.11% (95% CI 0.30-2.28). The prevalence after zygomatic implant placement was 3.76% (95% CI 0.12-10.29). In the subgroup analysis, the lateral window approach showed a prevalence of sinusitis of 1.35% (95% CI 0.34-2.8), the transcrestal technique of 0.00% (95% CI 0.00-3.18), and the SALSA technique of 1.20% (95% CI 0.00-5.10). Regarding the techniques for zygomatic implant placement, the sinus slot technique showed a prevalence of 21.62% (95% CI 9.62-36.52) and the intrasinus technique of 4.36% (95% CI 0.33-11.08), and the prevalence after the extrasinus technique was 0.00% (95% CI 0.00-1.22). CONCLUSION: The sinusitis occurrence rate was higher after zygomatic implant placement than after sinus lift procedure and this occurrence was different depending on the used technique.


Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Sinusite , Humanos , Implantação Dentária Endóssea/métodos , Implantes Dentários/efeitos adversos , Seio Maxilar/cirurgia , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Levantamento do Assoalho do Seio Maxilar/métodos , Sinusite/epidemiologia , Sinusite/cirurgia , Maxila/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA