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1.
Artigo em Chinês | MEDLINE | ID: mdl-33794635

RESUMO

Objective:To explore the predictive factors for asymptomatic airway hyperresponsiveness(AAHR) in patients with chronic rhinosinusitis with nasal polyps(CRSwNP). Methods:A total of 76 CRSwNP patients who were hospitalized in the Department of Otorhinolaryngology of Fenyang Hospital affiliated to Shanxi Medical University from May 2016 to October 2020 were retrospectively analyzed, including 40 patients in AAHR group and 36 patients in non-airway hyperresponsiveness(non-airway hyperresponsiveness, NAHR) group. The clinical symptoms, CT score of paranasal sinuses, eosinophil(EOS) count in peripheral blood and nasal polyp tissue were compared and analyzed. Logistic regression was used to analyze the risk factors of AAHR, and receiver operating characteristics curve was used to judge the predictive value of the parameters. Results:Compared with NAHR group, AAHR group had more symptoms of mouth breathing and postnasal drip, higher total score of CT in ethmoid sinus, sphenoid sinus, olfactory cleft, and more EOS count in peripheral blood and nasal polyp tissue. The differences were statistically significant. There was a positive correlation between EOS count in peripheral blood and in nasal polyp tissue(r=0.324, P<0.01). Postnasal drip, high posterior ethmoid sinus(PE) score and nasal polyp tissue EOS count were risk factors for AAHR. The predictive value of nasal polyp tissue EOS count was higher than that of PE score(AUC=0.786 and 0.685, respectively). When the PE score was ≥1.5, the sensitivity was 80.0% and the specificity was 55.6%. When the nasal polyp tissue EOS count was ≥5.67/HPF, the sensitivity was 82.5% and the specificity was 66.7%. Conclusion:The occurrence of AAHR in patients with CRSwNP was related to clinical symptoms, paranasal sinus CT score, peripheral and nasal polyp tissue EOS count. PE score and nasal polyp tissue EOS count can be used to predict AAHR, however nasal polyp tissue EOS has higher predictive value.


Assuntos
Pólipos Nasais , Seios Paranasais , Rinite , Sinusite , Doença Crônica , Eosinófilos , Humanos , Pólipos Nasais/complicações , Estudos Retrospectivos , Rinite/complicações , Sinusite/complicações
2.
Medicine (Baltimore) ; 100(9): e24772, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655940

RESUMO

BACKGROUND: To explore the association of chronic rhinosinusitis (CRS) with bronchial asthma (BA) as well as its severity. METHODS: A comprehensive database search will be performed from PubMed, Embase, Cochrane Library, and Web of science for related literatures. Heterogeneity test will be used to assess each outcome indicator. If heterogeneity statistics I2 ≥ 50%, the random effects model will be applied; if I2 < 50%, the fixed effects model will be performed. Sensitivity analysis will be performed in all models. STATA 15.0 software (Stata Corporation, College Station, TX) will be used for statistical analysis. Risk ratio (RR) will be used as the effect size for enumeration data. P < .05 is considered statistically significant. CONCLUSION: This study will evaluate the association of CRS with the prevalence of BA as well as its severity. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/GCTM9.


Assuntos
Asma/complicações , Rinite/complicações , Índice de Gravidade de Doença , Sinusite/complicações , Asma/patologia , Brônquios/patologia , Doença Crônica , Estudos de Coortes , Estudos Transversais , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Rinite/patologia , Sinusite/patologia , Revisões Sistemáticas como Assunto
4.
Artigo em Chinês | MEDLINE | ID: mdl-33540993

RESUMO

Objective:The aim of this study is to explore the diagnosis, clinical manifestations and surgical treatment experience of acute sinusitis complicated with orbital subperiosteal abscess. Methods:The clinical data of 11 patients with acute sinusitis complicated by orbital subperiosteal abscess from 1 year and 8 months to 50 years were retrospectively analyzed, including clinical manifestations, imaging manifestations, bacteriological examinations, surgical methods and therapeutic effects. All patients were given antibacterial drugs, glucocorticoids, and surgery. Results:All 11 patients had unilateral lesions. The imaging examinations all supported the appearance of orbital subperiosteal abscess. Nine patients underwent nasal endoscopic sinus opening+SPOA incision and drainage, 2 patients underwent nasal endoscopic sinus opening+ultrasound guided abscess puncture. Eyelid swelling and exophthalmia of all patients were alleviated when discharged. Ten of the 11 patients had no visual acuity change, and one patient had light perception only when she came to the hospital and recovered to 0.05 when discharged, there was no change in visual acuity after 3 months follow-up. The bacterial cultures of nasal secretion or pus were positive in 7 cases, the main pathogenic bacteria were Staphylococcus aureus(3 cases, includes one case of MRSA), Streptococcus anginosus(2 cases), and Streptococcus intermedius(2 cases). Conclusion:Rhinogenous orbital subperiosteal abscess has a rapid onset and progresses quickly. Once an abscess is formed, patients with poor conservative treatment should choose surgical treatment as soon as possible. The most common surgical method is nasal endoscopic sinus opening+SPOA incision and drainage. If the abscess is located above or above the eyeball, puncture or incision and drainage should be combined with ultrasound guidance.


Assuntos
Celulite Orbitária , Doenças Orbitárias , Sinusite , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Drenagem , Feminino , Humanos , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/etiologia , Doenças Orbitárias/terapia , Estudos Retrospectivos , Sinusite/complicações , Sinusite/tratamento farmacológico
5.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461987

RESUMO

Kimura's disease is a rare, benign, chronic inflammatory disorder characterised by its eosinophilic infiltrate. Patients often present with one or more progressively enlarging subcutaneous lymph nodes in the head and neck region or enlarging salivary glands. We describe the case of a 26-year-old man presenting with severe peripheral eosinophilia and upper airway inflammatory symptoms, who later developed cervical lymphadenopathy and formally diagnosed with Kimura's disease. Based on our English-language MEDLINE literature search, to our knowledge this is the first case report describing treatment of Kimura's disease with mepolizumab.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Eosinofilia/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Eosinofilia/complicações , Eosinofilia/diagnóstico , Humanos , /diagnóstico , Masculino , Rinite/complicações , Rinite/diagnóstico , Rinite/imunologia , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/imunologia
6.
Rev Med Suisse ; 17(720-1): 13-17, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443824

RESUMO

Chronic rhinosinusitis with nasal polyps is a severe form of chronic rhinosinusitis, which has a strong negative impact on quality of life. Rhinoscopy is helpful for diagnosis, and initial management depends on intra-nasal corticosteroids and sometimes short-term oral corticosteroids (1 to 3 weeks). If well-conducted drug therapy fails, surgery is considered. In the event of post-surgery recurrence or in case of concomitant severe asthma, biologic therapies represent an interesting option. These drugs include dupilumab, mepolizumab, benralizumab and omalizumab. The choice of medication depends on the individual patient context, which includes the presence of atopic dermatitis, eosinophilia, or asthma.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Pólipos Nasais/complicações , Pólipos Nasais/tratamento farmacológico , Rinite/complicações , Rinite/tratamento farmacológico , Sinusite/complicações , Sinusite/tratamento farmacológico , Doença Crônica , Humanos , Qualidade de Vida
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370987

RESUMO

Cavernous sinus thrombosis (CST) is a rare and potentially fatal complication of acute sinusitis. Timely diagnosis and management is, therefore, essential in preventing death and neurological disability. Here, we describe the case of a paediatric patient with bilateral CST secondary to acute unilateral pansinusitis that presented with rapidly progressing bilateral periorbital oedema. Initial imaging was negative. This case serves to emphasise the importance of maintaining a high index of suspicion when managing paediatric patients with suspected CST with persistent symptoms. Expeditious investigation and management of our patient in this case resulted in a positive outcome, with resolution of symptoms and no residual neurological deficit.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico , Seio Cavernoso/microbiologia , Cefaleia/etiologia , Sinusite/diagnóstico , Infecções Estreptocócicas/diagnóstico , Administração Intravenosa , Adolescente , Antibacterianos/administração & dosagem , Anticoagulantes/administração & dosagem , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/patologia , Seio Cavernoso/cirurgia , Trombose do Corpo Cavernoso/líquido cefalorraquidiano , Trombose do Corpo Cavernoso/tratamento farmacológico , Trombose do Corpo Cavernoso/etiologia , Diagnóstico Diferencial , Quimioterapia Combinada/métodos , Endoscopia , Cefaleia/líquido cefalorraquidiano , Cefaleia/terapia , Humanos , Angiografia por Ressonância Magnética , Masculino , Sinusite/complicações , Sinusite/microbiologia , Sinusite/terapia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Streptococcus intermedius/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Braz. j. otorhinolaryngol. (Impr.) ; 86(6): 743-747, Nov.-Dec. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1142588

RESUMO

Abstract Introduction: Chronic rhinosinusitis with nasal polyps, a prevalent disease affecting around 2% of the world population, is characterized by symptomatic inflammation of the nasal mucosa and impairment of quality of life. Chronic rhinosinusitis with nasal polyps has a multifactorial etiology, involving a dysfunctional host response to environmental factors. Thus, inflammatory models may be useful to shed light on the pathophysiology of this disease. Micronucleus count has been used to screen DNA damage in various tissues. Objective: To investigate the association between frequency of micronucleus in exfoliated cells from the nasal cavity of patients with chronic rhinosinusitis with nasal polyps and disease severity. Methods: This cross-sectional study included 21 patients with chronic rhinosinusitis with nasal polyps and 19 controls without disease. None of the participants were smokers. Results: Mean micronucleus count was 3.690 per 1000 cells (±2.165) in individuals with vs. 1.237 per 1000 cells (±0.806) in controls; (Student's t test = 4.653, p< 0.001). Nasal surgery in the past 5 years and aspirin-exacerbated respiratory disease were not associated with nicronucleus count (p= 0.251). Conclusion: Micronucleus count seems to be linked to chronic rhinosinusitis with nasal polyps, providing a new perspective for the evaluation of this disorder.


Resumo Introdução: A rinossinusite crônica com pólipos nasais, doença prevalente que afeta cerca de 2% da população mundial, é caracterizada por inflamação sintomática da mucosa nasal e comprometimento da qualidade de vida. A rinossinusite crônica com pólipos nasais tem etiologia multifatorial, envolvendo resposta disfuncional do hospedeiro a fatores ambientais. Assim, modelos inflamatórios podem ser úteis para esclarecer a fisiopatologia dessa doença. A contagem de micronúcleos tem sido usada para rastrear danos no DNA em vários tecidos. Objetivo: Investigar a associação entre a frequência de micronúcleos em células esfoliadas da cavidade nasal de pacientes com rinossinusite crônica com pólipos nasais e a gravidade da doença. Método: Estudo transversal que incluiu 21 pacientes com rinossinusite crônica com pólipos nasais e 19 controles sem doença. Nenhum dos participantes era fumante. Resultados: A contagem média de micronúcleos foi de 3,690 por 1.000 células (± 2,165) nos indivíduos doentes e 1,237 por 1.000 células (± 0,806) nos controles (teste t de Student = 4,653; p < 0,001). A cirurgia nasal nos últimos 5 anos e a doença respiratória exacerbada por aspirina não foram associadas à contagem de micronúcleos (p = 0,251). Conclusão: A contagem de micronúcleos parece estar ligada à rinossinusite crônica com pólipos nasais, proporcionando uma nova perspectiva para a avaliação dessa doença.


Assuntos
Humanos , Sinusite/complicações , Rinite/complicações , Pólipos Nasais/complicações , Qualidade de Vida , Doença Crônica , Estudos Transversais , Células Epiteliais
9.
Acta otorrinolaringol. esp ; 71(5): 296-302, sept.-oct. 2020. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195216

RESUMO

ANTECEDENTES Y OBJETIVO: La propagación de una infección a partir de los senos paranasales es poco frecuente pero grave. Entre un 4 y un 20% de las rinosinusitis se pueden complicar; de ellas, las orbitarias (60-75%) son las más prevalentes. La gran mayoría se presentan en la edad pediátrica, si bien en la edad adulta son más graves. Nuestro objetivo es analizar las características epidemiológicas de estos pacientes así como plantear un protocolo de actuación ante esta situación. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo de 21 pacientes diagnosticados de una complicación orbitaria en el curso de una rinosinusitis aguda entre 2005 y 2018. El diagnóstico se basó en la historia clínica, la exploración endoscópica y las pruebas de imagen. Todos los pacientes recibieron antibioterapia intravenosa y fueron valorados por oftalmología. Se llevó a cabo un tratamiento quirúrgico urgente en caso de existir un absceso o mala evolución con el tratamiento médico. RESULTADOS: La edad media de los pacientes fue de 24 años. El 52% fueron varones y el 48% mujeres. Según la clasificación de Chandler, el 43% (9/21) fueron celulitis preseptales (7 adultos y 2 niños), el 10% (2/21) celulitis orbitarias (un adulto y un niño), el 43% (9/21) abscesos subperiósticos (2 adultos y 7 niños), hubo un caso de absceso orbitario en un adulto y ningún caso de trombosis de seno cavernoso. Se solicitó una TC a todos los pacientes y se optó por el tratamiento quirúrgico en caso de absceso subperióstico u orbitario, a excepción de 2 abscesos de pequeño tamaño (< 4 mm), subperiósticos mediales y en edad pediátrica (< 4 años) que presentaron una correcta evolución con tratamiento conservador. El abordaje quirúrgico fue por vía endoscópica endonasal: se resecó la lámina papirácea y se mantuvo intacta la periórbita en el caso de abscesos subperiósticos, pero se incidió en ella en el absceso orbitario. Se complementó con un abordaje externo palpebral en los 4 casos que presentaron una colección en el techo de la órbita o en la pared lateral. Dos pacientes adultos jóvenes (10%) presentaron de manera concomitante una complicación intracraneal. CONCLUSIONES: Las complicaciones orbitarias de la rinosinusitis aguda son poco frecuentes pero potencialmente graves. Es importante conocerlas y sospecharlas para actuar con rapidez. El tratamiento multidisciplinar, la localización y la extensión del cuadro son esenciales para el correcto manejo de estas complicaciones. El abordaje quirúrgico se realiza mediante endoscopia endonasal. Su limitación son las colecciones localizadas en el techo de la órbita o en pared lateral, en las que se tendrá que complementar la actuación con un abordaje externo palpebral


BACKGROUND AND OBJECTIVE: The spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60-75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. MATERIALS AND METHODS: We carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. RESULTS: The average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (< 4 years) with a small and medial subperiosteal abscess (< 4 mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. CONCLUSION: Orbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Sinusite/epidemiologia , Rinite/epidemiologia , Doenças Orbitárias/epidemiologia , Sinusite/complicações , Rinite/complicações , Doenças Orbitárias/etiologia , Sinusite/terapia , Rinite/terapia , Doença Aguda , Estudos Retrospectivos , Algoritmos , Espanha/epidemiologia
10.
Rev Chilena Infectol ; 37(1): 77-81, 2020 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-32730404

RESUMO

The episodes of febrile neutropenia are severe cases that require an exhaustive etiological study and a quick start of antimicrobial agents. Within the possible microorganisms, fungal origins are also found, and depending on its tissue invasion, they can reach a high mortality rate. A case of a pediatric patient who suffered from acute myeloid leukemia is reported, and after his induction chemotherapy, the patient showed an episode of febrile neutropenia, which matches a rhinosinusal infection caused by Exserohilum rostratum, a filamentous fungi that is uncommonly associated with pathological cases. An antifungal therapy and an early surgical treatment were started, which lead to a positive response, without complications to the patient. After the monitoring and receiving secondary prophylaxis during the episodes of neutropenia, the patient hasn't presented new injuries nor rhinosinusal damage.


Assuntos
Antifúngicos , Ascomicetos , Leucemia Mieloide Aguda , Micoses , Sinusite , Antifúngicos/uso terapêutico , Ascomicetos/isolamento & purificação , Criança , Humanos , Leucemia Mieloide Aguda/complicações , Micoses/complicações , Micoses/tratamento farmacológico , Neutropenia/etiologia , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/microbiologia , Resultado do Tratamento
11.
Ann Allergy Asthma Immunol ; 125(4): 481-483, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32717301
12.
Am J Otolaryngol ; 41(5): 102554, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32521299

RESUMO

PURPOSE: Nasal douching is commonly used as a postoperative management strategy for chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies to date have compared the effectiveness of nasal douching in CRSwNP phenotypes after endoscopic sinus surgery (ESS). We evaluated the efficacy of seawater types in eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (nonECRSwNP) after ESS. METHODS: Patients with bilateral CRSwNP who had undergone ESS were blindly randomized to receive buffered hypertonic seawater (BHS) (n = 48) or physiological seawater (PS) (n = 45). CRSwNP patients were stratified by phenotypes (ECRSwNP and nonECRSwNP) retrospectively according to whether tissue eosinophils exceeded 10%. Follow-up evaluations were conducted at 2, 8, 16, and 24 weeks after surgery. Evaluations included the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale (VAS), Lund-Kennedy endoscopic score (LKES), saccharine clearance time (SCT), and adverse events. RESULTS: All of the patients experienced significant improvements in SNOT-22 scores, VAS scores, and LKES over time. BHS resulted in better improvement of LEKS and SCT relative to PS at 8 weeks postoperatively. Mucosal edema formation was significantly reduced with less crusting among HBS recipients at 8 weeks. After stratification, only patients in the nonECRSwNP + BHS subgroup showed a significant improvement in LEKS and SCT at 8 weeks postoperatively. Side effect profiles were not significantly different among the groups. CONCLUSIONS: BHS has a better inhibitory effect on mucosal edema and crusting during the early postoperative care period of CRSwNP. Among all of the patients, nonECRSwNP patients showed a significant improvement in LEKS and SCT at 8 weeks.


Assuntos
Seio Etmoidal/cirurgia , Soluções Isotônicas/administração & dosagem , Pólipos Nasais/cirurgia , Pólipos Nasais/terapia , Cuidados Pós-Operatórios/métodos , Rinite/cirurgia , Rinite/terapia , Solução Salina Hipertônica/administração & dosagem , Sinusite/cirurgia , Sinusite/terapia , Irrigação Terapêutica/métodos , Adulto , Tampões (Química) , Doença Crônica , Método Duplo-Cego , Edema/prevenção & controle , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal , Pólipos Nasais/complicações , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Doenças dos Seios Paranasais/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Rinite/complicações , Sinusite/complicações , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(25): e20572, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569182

RESUMO

RATIONALE: Infection is a major trigger or pathogenic origin in a substantial proportion of glomerulonephritis (GN) patients, typically manifesting infection-related GN (IRGN). Various microorganisms, infection sites, and clinical and histopathological features are involved in IRGN. Once an infectious origin is identified and successfully eradicated, nephrotic syndrome or kidney dysfunction is spontaneously resolved. However, if patients are asymptomatic and the origin is undetermined, the diagnosis and treatment of GN is challenging. This case presentation reported on an IRGN case manifesting steroid-resistant nephrotic syndrome associated with asymptomatic sinusitis as a pathogenic origin. PATIENT CONCERNS: A 68-year-old male presented with severe kidney dysfunction and edema in both extremities. DIAGNOSIS: The patient was clinically diagnosed with hypocomplementemic nephrotic syndrome and kidney dysfunction and histopathologically with diffuse proliferative GN and a focal pattern of membranoproliferative GN. The findings suggested that idiopathic membranoproliferative glomerulonephritis type I was more likely than IRGN, given a critical lack of apparent infection. INTERVENTIONS: Combined intravenous methylprednisolone, oral prednisolone, and cyclosporin did not improve the patient's condition. Thus, IRGN associated with inapparent infectious origin was suspected. Repeated thorough and careful examinations including CT scan showed sinusitis in his left maxillary sinus. Moreover, reanalysis of kidney specimen revealed positive nephritis-associated plasmin receptor in glomeruli, a typical finding for IRGN, supporting a pathogenic significance of his sinusitis. Medical treatment was initiated with 200 mg oral clarithromycin daily. OUTCOMES: Oral clarithromycin gradually improved proteinuria and hypocomplementemia and resulted in nephrotic syndrome remission in parallel with opacification resolution of sinuses shown on CT. LESSONS: This case presentation showed that asymptomatic sinusitis is potentially a pathogenic IRGN origin. A gold standard therapy for idiopathic GN, corticosteroid could be damaging in uncontrolled or underdiagnosed infection. In asymptomatic patients, a thorough screening of infectious diseases, including sinusitis, together with a renal histological evaluation of glomerular nephritis-associated plasmin receptor deposition is also essential in treating a wide spectrum of GN.


Assuntos
Glomerulonefrite Membranoproliferativa/diagnóstico , Sinusite/complicações , Idoso , Doenças Assintomáticas , Diagnóstico Diferencial , Glomerulonefrite Membranoproliferativa/etiologia , Glomerulonefrite Membranoproliferativa/patologia , Humanos , Masculino , Síndrome Nefrótica/congênito , Síndrome Nefrótica/diagnóstico , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Am J Otolaryngol ; 41(5): 102564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32593046

RESUMO

Acute rhinosinusitis (ARS) can be characterized as bacterial (ABRS) and require antibiotic therapy only in 0.5-5% of cases. In most cases, the disease is in a viral and post-viral form, which requires pathogenetic and symptomatic treatment. The study objective was to determine the efficacy of BNO 1012 extract in the technology of delayed antibiotic prescribing in children with acute rhinosinusitis. METHODS: 292 children aged 6 to 11 years with ARS were randomized in the multicenter, comparative study. They received an extract of five medicinal plants in addition to standard symptomatic therapy or standard therapy only. EVALUATION CRITERIA: reduction of the sinusitis severity according to a 4-point medical assessment scale (nasal congestion, severity of anterior and posterior rhinorrhea) at each visit, dynamics of self-scoring of rhinorrhea and headache (according to a 10-point visual analogue scale), "therapeutic benefit" in days, frequency of antibiotic prescriptions due to the use of an extract of five plants. RESULTS: The use of the 5-plant extract BNO 1012 in addition to the standard symptomatic treatment of acute rhinosinusitis provides a clinically significant, adequate reduction in the severity of rhinorrhea, nasal congestion and post-nasal drip, assessed by a physician at V2 (p < 0.005). Significant differences are noted in the patient's self-scoring of rhinorrhea on the second or third day in viral RS, and from the fourth to the eighth day in post-viral RS. Symptoms of similar intensity in control group were observed at V3. Thus, in the first week of treatment, the treatment group compared to the control one showed a "therapeutic benefit" of three days. The use of BNO 1012 in patients with acute rhinosinusitis can 1.81-fold reduce the prescription of antibacterial drugs. CONCLUSION: The combination of five medicinal plants is effective for the treatment of acute rhinosinusitis in children aged 6 to 11 years. Its use provides a significant "therapeutic benefit" when administered in addition to standard symptomatic therapy, reducing the need for antibiotic use.


Assuntos
Antibacterianos/administração & dosagem , Sobremedicalização/prevenção & controle , Fitoterapia , Extratos Vegetais/administração & dosagem , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Administração Oral , Criança , Feminino , Humanos , Masculino , Obstrução Nasal/tratamento farmacológico , Obstrução Nasal/etiologia , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Rinite/complicações , Rinite/microbiologia , Rinite/virologia , Sinusite/complicações , Sinusite/microbiologia , Sinusite/virologia
15.
Ann Otol Rhinol Laryngol ; 129(12): 1153-1162, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32517494

RESUMO

OBJECTIVES: To determine the utility of Second-look endoscopy with debridement (SLED) after functional endoscopic sinus surgery (ESS) in pediatric cystic fibrosis (CF) patients. To compare outcomes in pediatric CF patients undergoing sinus surgery for chronic sinusitis with or without SLED. To describe findings present at the time of SLED. METHODS: Retrospective chart review of 61 ESS procedures performed at a tertiary care pediatric center from 2013 to 2016. Data collected included demographics, SLED findings, and 6-month pre-/postoperative disease specific outcomes including incidence of sinonasal and pulmonary exacerbations and revisions. RESULTS: Sixty-one cases were reviewed. SLED was performed in 38 cases on average 22.4 days postoperatively. Average preoperative Lund-Mackay score was 14.9 and 14.8 among patients undergoing ESS with and without SLED, respectively. Pre-/postoperative intranasal steroid use and extent of surgery performed was similar among all patients. At the time of SLED, rates of synechiae, polyps and maxillary antrostomy obstruction were 26.3%, 23.7%, and 7.9%, respectively. The incidence and number of days to onset of postoperative sinonasal exacerbations requiring antibiotic therapy within 6 months of ESS were 1.0 (SD 1.0) and 85 days (SD 45.7); and 1.3 (SD 1.0) and 80.4 days (SD 40.5) for patients undergoing ESS with and without SLED, respectively (P value .33). The number of days to first pulmonary exacerbation was 113.9 (SD 45.5) and 47.4 (SD 34.1) among SLED and non-SLED patients, respectively (P value .01). No significant difference was observed in revision rates and time to revision ESS (30% and overall average 1.4 years, respectively). CONCLUSION: The utility of SLED among pediatric CF patients remains unclear. While debridement did not have a significant impact on sinonasal exacerbations or revision rates, pulmonary exacerbations for patients undergoing SLED were delayed. Further studies are needed to clarify the impact of SLED.


Assuntos
Fibrose Cística/complicações , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Rinite/cirurgia , Cirurgia de Second-Look/métodos , Sinusite/cirurgia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Desbridamento/métodos , Endoscopia/métodos , Feminino , Humanos , Masculino , Seio Maxilar/cirurgia , Pólipos Nasais/epidemiologia , Pólipos Nasais/cirurgia , Seios Paranasais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Rinite/complicações , Sinusite/complicações , Aderências Teciduais/epidemiologia , Aderências Teciduais/cirurgia
16.
Ann Otol Rhinol Laryngol ; 129(9): 886-893, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32390460

RESUMO

OBJECTIVE: This study explored the impact of laryngopharyngeal reflux (LPR) on quality-of-life outcomes captured by Sino-Nasal Outcome Test (SNOT-22) and Reflux Symptom Index (RSI) in patients with chronic rhinosinusitis (CRS) and patients with symptoms of LPR. METHODS: In a retrospective chart review, SNOT-22 and RSI scores were analyzed in patients seen at a tertiary care center with CRS, LPR, or both CRS and LPR. SNOT-22 items were grouped into sleep, nasal, otologic, and emotional symptom subdomains. RESULTS: A total of 138 patients (36 with CRS alone, 60 with LPR alone, and 42 with both CRS and LPR) were included. Compared to patients with CRS alone, those with CRS and LPR (CRS+LPR) had higher SNOT-22 total (50.54 ± 19.53 vs 35.31 ± 20.20, P < .001), sleep (19.61 ± 9.31 vs 14.42 ± 10.34, P < .022), nasal (17.38 ± 7.49 vs 11.11 ± 8.52, P < .001), otologic subdomains (9.17 ± 5.07 vs 5.53 ± 5.14, P < .002), and RSI (22.06 ± 9.42 vs 10.75 ± 8.43, P < .003). Patients with LPR alone had higher RSI compared to those with CRS (18.48 ± 9.77 vs 10.75 ± 8.43, P < .037). RSI and SNOT-22 scores were positively correlated irrespective of patient group (R = 0.289, P = .003). CONCLUSION: Compared to patients with CRS or LPR alone, those with CRS+LPR demonstrated higher RSI and total and subdomain SNOT-22 scores. Patients with LPR alone had elevated SNOT-22 despite absent endoscopic evidence of sinusitis.


Assuntos
Refluxo Laringofaríngeo/complicações , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Rinite/complicações , Sinusite/complicações , Doença Crônica , Humanos , Estudos Retrospectivos
17.
Rhinology ; 58(3): 213-217, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32415826

RESUMO

BACKGROUND: European direct and indirect cost data is missing for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). This study was aimed to establish the economic burden of CRSwNP based on a Dutch cohort of patients. METHODS: A cross-sectional study was performed in adult patients with CRSwNP (N=115) to calculate mean annual direct medical costs and indirect costs per patient with CRSwNP. Outpatient visits, general practitioner visits, first aid visits, hospitalisation and patient travel expenses were measured with the iMTA medical consumption questionnaire. Missed workdays (absenteeism) and decreased productivity during paid work (presenteeism) or during daily life were measured with the and the iMTA productivity cost questionnaire. RESULTS: Total direct costs were €1501 per patient/year, primarily due to outpatient department visits and hospitalisation. Indirect costs were €5659 per patient/year, with productivity losses as major cost expense. CONCLUSION: Adult patients with CRSwNP have higher indirect costs than direct costs and this forms a substantial burden to society. Total annual costs of patients with CRSwNP are estimated to be 1,9 billion/year in the Netherlands.


Assuntos
Absenteísmo , Pólipos Nasais , Sinusite , Adulto , Efeitos Psicossociais da Doença , Estudos Transversais , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/economia , Países Baixos , Sinusite/complicações , Sinusite/economia , Sinusite/terapia
18.
Ann Allergy Asthma Immunol ; 125(3): 304-310.e1, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32387168

RESUMO

BACKGROUND: Predicting postoperative olfactory decline in patients with chronic rhinosinusitis (CRS) remains a considerable challenge. OBJECTIVE: To evaluate patterns of postoperative olfactory function in patients with CRS and explore potential predictors of postoperative olfactory decline. METHODS: A total of 76 patients with CRS electing endoscopic sinus surgery (ESS) were enrolled in this prospective study. Olfaction was assessed with Sniffin' Sticks preoperatively and 3 months postoperatively. Preoperative peripheral venous blood and superior turbinate at surgery were collected for eosinophil quantification. Olfactory cleft was evaluated by computed tomography and endoscopy. Postoperative olfactory decline was defined by a decrease in threshold-discrimination-identification (TDI) score more than 0 point. Multivariable logistic regression analysis was conducted to identify potential predictors associated with postoperative olfactory decline in TDI score. RESULTS: A total of 30.26% of patients with CRS (23/76) presented with olfactory decline 3 months post-ESS. Patients with CRS with olfactory decline showed significantly higher preoperative tissue eosinophils (P < .001), blood eosinophil count (P = .002), blood eosinophil percentage (P = .009), and preoperative TDI scores (P = .017) than patients with CRS without olfactory decline. After adjusting for patient demographics and comorbidities, the preoperative tissue eosinophilia was significantly associated with patients with CRS with postoperative olfactory decline (odds ratio = 1.103; P = .038). An absolute count of 23.5 eosinophils per high-power field in superior turbinate was the best predictor of olfactory decline with the highest area under the receiver operating characteristic curve of 0.901. CONCLUSION: Superior turbinate eosinophilia is highly associated with olfactory decline in patients with CRS 3 months after ESS.


Assuntos
Eosinofilia/etiologia , Transtornos do Olfato/etiologia , Complicações Cognitivas Pós-Operatórias/etiologia , Rinite/etiologia , Sinusite/complicações , Conchas Nasais/patologia , Doença Crônica , Endoscopia/métodos , Eosinofilia/patologia , Eosinófilos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/patologia , Transtornos do Olfato/patologia , Complicações Cognitivas Pós-Operatórias/patologia , Período Pré-Operatório , Rinite/patologia , Sinusite/patologia , Sinusite/cirurgia , Olfato/fisiologia
19.
Ann Otol Rhinol Laryngol ; 129(9): 872-877, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32389067

RESUMO

OBJECTIVES/HYPOTHESIS: The presence of eosinophilia and nasal polyps are well-established prognostic indicators of chronic rhinosinusitis (CRS). The importance of demographic background, such as age, as independent variables has not been elucidated while taking these factors into account. STUDY DESIGN: Respective review. METHODS: CRS patients who underwent primary surgical treatment were subdivided based on age (young adults = age 18-39, adults = age 40-64, and elderly = age 65+). Groups were then subdivided based on tissue eosinophilia and nasal polyposis. Sinonasal Outcome Test (SNOT-22), Lund-Kennedy (LK) endoscopy scores, and Lund-McKay (LM) CT scores were compared preoperatively, and postoperatively during a 5-year period. RESULTS: A total of 431 CRS patients identified and then subsequently broken down into 63 young adults (YA), 209 adults (A), and 159 elderly (E). There was no statistical difference between tissue eosinophilia and presence of polyps between the groups. All three groups had similar short- and long-term SNOT-22 patterns postoperatively. At presentation, young adults had significantly higher SNOT-22 score (33.2 YA, 25.3 A, 23.5 E, P = .029) and significantly higher rhinologic scores (1.9 YA, 1.3 A, 1.3 E, P = .0012) than the adult and elderly patients. Objective disease severity using LK endoscopy scores were only significantly higher in young adults at 1-year time (P = .0026). There was no statistical difference between the groups in regards to preoperative LM CT scores. CONCLUSIONS: Young adults are more likely to present with overall higher subjective SNOT-22 scores over adults and elderly patients, despite similar objective findings in the groups. Short- and long-term postoperative improvement holds across all age groups. LEVEL OF EVIDENCE: 4.


Assuntos
Rinite/diagnóstico , Rinite/cirurgia , Sinusite/diagnóstico , Sinusite/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Doença Crônica , Eosinofilia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Estudos Retrospectivos , Rinite/complicações , Sinusite/complicações , Resultado do Tratamento , Adulto Jovem
20.
Value Health ; 23(5): 632-641, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32389229

RESUMO

OBJECTIVES: To qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP). METHODS: A targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192). A subset of 10 participants reported symptoms and impacts using a smartphone or tablet application (app) over a 10-day period. RESULTS: A paucity of qualitative evidence regarding patient experience of NP was identified from the literature or blog review. Twenty-seven participant interviews were conducted. Thirty-six symptoms were identified, including 7 primary symptoms (nasal congestion [n = 27 of 27], breathing difficulties [n = 27 of 27], postnasal drip [n = 25 of 27], runny nose [n = 24 of 27], head/facial pressure [n = 23 of 27], loss of smell [n = 23 of 27], loss of taste [n = 22 of 27]) and 29 secondary symptoms (the most common were mucus/catarrh and nose bleeds [both n = 20 of 27]). Most symptoms were reported to vary both within and between days. Sixty impacts of severe NP were reported, including impacts on sleep (n = 22 of 27), physical functioning (n = 21 of 27), activities of daily living (n = 21 of 27), emotional well-being (n = 27 of 27), treatment (n = 23 of 27), social life (n = 26 of 27), and work (n = 19 of 27). Symptoms/impacts reported using the app were consistent with interview findings, although new symptoms were identified (ear pain, throat pain, nasal scabs, and nasal burning). These results supported the development of a conceptual model outlining concepts related to symptoms, impacts, and treatment of NP. CONCLUSIONS: Severe, recurrent, bilateral NP are associated with a range of symptoms that have significant detrimental impact on HRQoL.


Assuntos
Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Qualidade de Vida , Recidiva , Rinite/complicações , Sinusite/complicações , Atividades Cotidianas , Adulto , Feminino , Alemanha , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/tratamento farmacológico , Pesquisa Qualitativa , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Estados Unidos
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