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1.
Med Clin North Am ; 104(1): 95-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757240

RESUMO

Asthma affects approximately 300 million people worldwide and approximately 7.5% of adults in the United States. Asthma is characterized by inflammation of the airways, variable airflow obstruction, and bronchial hyperresponsiveness. The diagnosis of asthma is a clinical one with the history and physical examination being significant, but objective measures, such as pulmonary function testing, can be used to aid in the diagnosis. There are multiple associated comorbidities with asthma, including rhinitis, sinusitis, gastroesophageal reflux disease, obstructive sleep apnea, and depression. There is often an allergic component of asthma, and patient education is vital.


Assuntos
Asma/epidemiologia , Adulto , Asma/diagnóstico , Depressão/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Humanos , Testes de Função Respiratória , Rinite/epidemiologia , Sinusite/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Estados Unidos/epidemiologia
2.
Lancet ; 394(10209): 1638-1650, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31543428

RESUMO

BACKGROUND: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) generally have a high symptom burden and poor health-related quality of life, often requiring recurring systemic corticosteroid use and repeated sinus surgery. Dupilumab is a fully human monoclonal antibody that inhibits signalling of interleukin (IL)-4 and IL-13, key drivers of type 2 inflammation, and has been approved for use in atopic dermatitis and asthma. In these two studies, we aimed to assess efficacy and safety of dupilumab in patients with CRSwNP despite previous treatment with systemic corticosteroids, surgery, or both. METHODS: LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52 were two multinational, multicentre, randomised, double-blind, placebo-controlled, parallel-group studies assessing dupilumab added to standard of care in adults with severe CRSwNP. SINUS-24 was done in 67 centres in 13 countries, and SINUS-52 was done in 117 centres in 14 countries. Eligible patients were 18 years or older with bilateral CRSwNP and symptoms despite intranasal corticosteroid use, receiving systemic corticosteroids in the preceding 2 years, or having had sinonasal surgery. Patients in SINUS-24 were randomly assigned (1:1) to subcutaneous dupilumab 300 mg or placebo every 2 weeks for 24 weeks. Patients in SINUS-52 were randomly assigned (1:1:1) to dupilumab 300 mg every 2 weeks for 52 weeks, dupilumab every 2 weeks for 24 weeks and then every 4 weeks for the remaining 28 weeks, or placebo every 2 weeks for 52 weeks. All patients were randomly assigned centrally with a permuted block randomisation schedule. Randomisation was stratified by asthma or non-steroidal anti-inflammatory drug-exacerbated respiratory disease status at screening, previous surgery at screening, and country. Patients with or without comorbid asthma were included. Coprimary endpoints were changes from baseline to week 24 in nasal polyp score (NPS), nasal congestion or obstruction, and sinus Lund-Mackay CT scores (a coprimary endpoint in Japan), done in an intention-to-treat population. Safety was assessed in a pooled population of both dupilumab groups in SINUS-52 up to week 24 and the dupilumab group in SINUS-24 and the placebo groups in both studies until week 24. The trials are complete and registered at ClinicalTrials.gov, NCT02912468 and NCT02898454. FINDINGS: Between Dec 5, 2016, and Aug 3, 2017, 276 patients were enrolled in SINUS-24, with 143 in the dupilumab group and 133 in the placebo group receiving at least one study drug dose. Between Nov 28, 2016, and Aug 28, 2017, 448 patients were enrolled in SINUS-52, with 150 receiving at least one dose of dupilumab every 2 weeks, 145 receiving at least one dose of dupilumab every 2 weeks for 24 weeks and every 4 weeks until week 52, and 153 receiving at least one dose of placebo. Dupilumab significantly improved the coprimary endpoints in both studies. At 24 weeks, least squares mean difference in NPS of dupilumab treatment versus placebo was -2·06 (95% CI -2·43 to -1·69; p<0·0001) in SINUS-24 and -1·80 (-2·10 to -1·51; p<0·0001) in SINUS-52; difference in nasal congestion or obstruction score was -0·89 (-1·07 to -0·71; p<0·0001) in SINUS-24 and -0·87 (-1·03 to -0·71; p<0·0001) in SINUS-52; and difference in Lund-Mackay CT scores was -7·44 (-8·35 to -6·53; p<0·0001) in SINUS-24 and -5·13 (-5·80 to -4·46; p<0·0001) in SINUS-52. The most common adverse events (nasopharyngitis, worsening of nasal polyps and asthma, headache, epistaxis, and injection-site erythema) were more frequent with placebo. INTERPRETATION: In adult patients with severe CRSwNP, dupilumab reduced polyp size, sinus opacification, and severity of symptoms and was well tolerated. These results support the benefits of adding dupilumab to daily standard of care for patients with severe CRSwNP who otherwise have few therapeutic options. FUNDING: Sanofi and Regeneron Pharmaceuticals.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Pólipos Nasais/tratamento farmacológico , Sinusite/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Asma/tratamento farmacológico , Asma/epidemiologia , Doença Crônica , Feminino , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/epidemiologia , Pólipos Nasais/psicologia , Placebos/administração & dosagem , Qualidade de Vida , Índice de Gravidade de Doença , Sinusite/epidemiologia , Sinusite/psicologia , Resultado do Tratamento
3.
Otolaryngol Head Neck Surg ; 161(5): 877-880, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31500503

RESUMO

OBJECTIVES: Primary ciliary dyskinesia (PCD) is a genetic disorder characterized by abnormal respiratory cilia ultrastructure and/or function causing defective mucociliary clearance. We investigated the extent and severity of rhinosinusitis in a large cohort of children with PCD and explored associations among risk factors, including genotype and sinus disease. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary academic children's hospital. SUBJECTS AND METHODS: A review was conducted with a patient registry at the PCD Foundation Center at our institution. Demographic, imaging, clinical, and operative data were reviewed through the institutional electronic health record system. RESULTS: Fifty-four subjects were identified with mean and median age at diagnosis of 5.2 and 4.0 years. The male:female ratio was 35%:65%. Sinus symptoms were present in 46 (85%) subjects, 22 of whom had chronic rhinosinusitis. Nineteen (35%) subjects underwent operative intervention, consisting of endoscopic sinus surgery (ESS; 16 patients) and maxillary lavage (3 patients). Nineteen subjects underwent adenoidectomy for PCD-related indications. Five sinus-related admissions in 3 subjects were noted during the study period, and no complication of rhinosinusitis occurred in the cohort. Genetic test results were available in 27 subjects, in whom 23 (85%) had biallelic mutations in a PCD gene. Demographic factors, Lund-Mackay score, and PCD genotype were not found to be predictors for ESS or hospitalization in our cohort. CONCLUSION: While rhinosinusitis was common in our PCD cohort, most patients did not require ESS. Since complications of rhinosinusitis were uncommon, we recommend judicious surgical management tailored to the patient's symptoms.


Assuntos
Transtornos da Motilidade Ciliar/complicações , Rinite/epidemiologia , Sinusite/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Transtornos da Motilidade Ciliar/diagnóstico , Transtornos da Motilidade Ciliar/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Rinite/diagnóstico , Rinite/cirurgia , Fatores de Risco , Índice de Gravidade de Doença , Sinusite/diagnóstico , Sinusite/cirurgia
4.
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
5.
Allergol Int ; 68(4): 403-412, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402319

RESUMO

Eosinophilic chronic rhinosinusitis (ECRS) is a subgroup of chronic rhinosinusitis with nasal polyps (CRSwNP), which is associated with severe eosinophilic infiltration and intractable. Its symptoms include dysosmia, nasal obstruction, and visous nasal discharge. The cause of ECRS is not clear, although it is thought that Staphylococcus aureus and its enterotoxins are involved in stimulating the Th2 system to promote IgE production and eosinophil infiltration through various pathways. While, the coagulation system is activated and the fibrinolytic system is suppressed, leading to deposition of fibrinous networks in nasal polyps. Therefore, a fibrin-degrading agent could be a new treatment for ECRS. Genetic analysis of nasal polyp cells using next-generation sequencing has identified some of the factors involved in ECRS, including periostin, which can be used as a biomarker of this condition. A protease inhibitor could be a therapeutic agent for ECRS. Regarding the role of eosinophils, many researchers have been interested in the mechanism of ETosis. However, the mechanism leading to development of nasal polyps is unknown. In Japan (as well as in East Asia), the incidence of non-ECRS is decreasing and that of ECRS is increasing, but the reason is also unknown. Thanks to the development of biologics therapy, it is thought that there will be a shift to precision medicine in the future.


Assuntos
Eosinofilia/patologia , Rinite/diagnóstico , Rinite/etiologia , Sinusite/diagnóstico , Sinusite/etiologia , Biomarcadores , Doença Crônica , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Japão/epidemiologia , Rinite/epidemiologia , Rinite/terapia , Índice de Gravidade de Doença , Transdução de Sinais/efeitos dos fármacos , Sinusite/epidemiologia , Sinusite/terapia , Estados Unidos/epidemiologia
6.
Eur Arch Otorhinolaryngol ; 276(11): 3105-3111, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31352504

RESUMO

PURPOSE: Focal chronic inflammation or infection is thought to be one of the causes of psoriasis. Few reports on the association between chronic rhinosinusitis (CRS) and psoriasis exist, thus it is poorly defined. This study seeks to investigate the incidence of psoriasis in patients with CRS with reference to a matched control group. METHODS: This national cohort study relies on data from Korean Health Insurance Review and Assessment Service-National Sample Cohort (HIRA-NSC), which were entered from 2002 to 2013. A total of 34,219 patients with CRS without nasal polyps was matched with 136,976 controls. The Cox proportional hazard model was used to analyze the crude (simple) and adjusted hazard ratios (HRs) of psoriasis. For subgroup analysis, participants were grouped by age and sex. RESULTS: The risk of psoriasis was higher in the CRS group than in the control group (adjusted HR 1.28, 95% CI 1.12-1.47, P < 0.001). Children, adolescents below 19 years regardless of sex, and old adult men above 60 years are at significantly higher risk for subsequent psoriasis after CRS diagnosis. CONCLUSION: CRS may increase the risk of psoriasis.


Assuntos
Psoríase , Rinite , Sinusite , Adolescente , Fatores Etários , Estudos de Casos e Controles , Criança , Doença Crônica , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Psoríase/diagnóstico , Psoríase/epidemiologia , República da Coreia/epidemiologia , Rinite/diagnóstico , Rinite/epidemiologia , Fatores Sexuais , Sinusite/diagnóstico , Sinusite/epidemiologia
7.
Neumol. pediátr. (En línea) ; 14(2): 92-94, jul. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1015009

RESUMO

Primary Ciliary Diskinesia (PCD) is a heterogeneous, rare genetic disease that can be present in up to 5% of the patients with recurrent respiratory infections. The underlying pathogenesis is disrupted ciliary function which results in delayed mucus transportation leading to chronic inflammation in the upper and lower respiratory tract. Almost all PCD patients have otolaryngologic manifestations, characterized by recurrent ear and sinus infections, chronic inflammation at this level, sensorioneural and conductive hearing loss, and sleep-disordered breathing. This article reviews the diagnostic and therapeutic aspects of these manifestations.


La Disquinesia Ciliar Primaria (DCP) es una enfermedad genética heterogénea rara que puede estar presente en hasta un 5% de los pacientes que presentan infecciones respiratorias a repetición. La patogenia es secundaria a una alteración de la función ciliar que a su vez provoca una alteración del transporte de moco, resultando en una condición inflamatoria crónica en la vía aérea superior e inferior. Las manifestaciones clínicas de la esfera otorrinolaringológica en los pacientes portadores de DCP están presentes prácticamente en la totalidad de los mismos, y se caracterizan por infecciones recidivantes de oídos y cavidades perinasales, inflamación crónica a este nivel, hipoacusia neurosensorial y conductiva, y alteraciones respiratorias durante el sueño. En este artículo se revisarán los aspectos diagnósticos y terapéuticos de dicho compromiso.


Assuntos
Humanos , Criança , Adulto , Otite Média/epidemiologia , Sinusite/epidemiologia , Rinite/epidemiologia , Síndrome de Kartagener/epidemiologia , Otite Média/terapia , Rinite/terapia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
9.
Rhinology ; 57(4): 303-312, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31120456

RESUMO

INTRODUCTION: Pharmacological salicylates are known to trigger respiratory exacerbations in patients with Non-Steroidal Exacerbated Respiratory Disease (N-ERD), a specific phenotype of Chronic Rhinosinusitis (CRS) and asthma. The impact of dietary sources of salicylates across subgroups of CRS is not well understood. The hypothesis is that in patients with nasal polyps present, there is likely to be a higher incidence of symptom exacerbation due to dietary salicylates regardless of any known response to pharmacological salicylate. METHODS: The Chronic Rhinosinusitis Epidemiology Study (CRES) was a questionnaire-based case-control study which sought to characterise the UK CRS population in terms of sociological, economic and medical factors. Using specific questions to examine participant responses relating to symptom exacerbation from food groups thought to be high in salicylate content, this analysis of the CRES database sought to compare an estimate of the prevalence of dietary sensitivity due to food with higher potential salicylate content across patients with CRS with (CRSwNPs) and without nasal polyposis (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). RESULTS: The CRSwNPs group were significantly more likely than controls to report symptom exacerbation due to ingestion of food groups with higher potential dietary salicylate content. The same trend was observed amongst CRSsNPs participants to a lesser degree. Reported response to the individual specific food groups wine, nuts, spicy foods, fruit and vegetables demonstrated that a statistically significant proportion of CRSwNPs and AFRS participants reported sensitivity to wine. CONCLUSIONS: This analysis suggests that there is an association between symptom exacerbation in response to food products with higher potential salicylate content, specifically wine, in CRS patients both with and without nasal polyposis when compared to controls, but especially in the CRSwNPs and AFRS phenotypes. Further studies are needed to detail if this relationship represents a causal relationship to dietary salicylate. The data present the possibility that a wider group of CRS patients may elicit salicylate sensitivity than those with known N-ERD.


Assuntos
Pólipos Nasais , Rinite , Salicilatos , Sinusite , Estudos de Casos e Controles , Doença Crônica , Dieta , Estudos Epidemiológicos , Humanos , Rinite/complicações , Rinite/epidemiologia , Salicilatos/efeitos adversos , Sinusite/complicações , Sinusite/epidemiologia , Reino Unido/epidemiologia
11.
Eur Arch Otorhinolaryngol ; 276(7): 1975-1980, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30929057

RESUMO

OBJECTIVE: Fungal rhinosinusitis occurs in different forms depending on race and region. While allergic fungal rhinosinusitis is common in Caucasians, fungal ball (FB) is more common in Asians. However, most cases are reported as unilateral, and clinical data on bilateral FB (BFB) are rare. Therefore, the purpose of this study was to analyze and to compare the clinical characteristics of BFB and unilateral FB (UFB) in Koreans. METHODS: We retrospectively analyzed medical records and computed tomography (CT) images of 434 patients diagnosed with FB. The patients were divided into two groups: BFB and UFB. Demographic data, multiple allergen simultaneous test including total or specific immunoglobulin E (IgE) levels, symptoms, CT findings, treatment, and outcomes were analyzed. RESULTS: Among the patients, 26 had BFB and 408 had UFB. Hypertension was noted in 61.5% of the BFB and 39% of the UBF individuals (p = 0.023). While total IgE levels were similar between the two groups, Dermatophagoides pteronyssinus (p = 0.004), Cladosporium (p = 0.017), and Aspergillus-specific IgE positivity (p = 0.025) were significantly higher in the BFB than in the UFB group. Not only symptoms such as postnasal drip (p = 0.013), mucopurulent rhinorrhea (p = 0.009), and foul odor (p = 0.037), but also sphenoid sinus involvement on CT images were more common in the BFB than in the UFB group (p = 0.011). CONCLUSION: Patients with BFB in Korea showed more common hypertension and symptoms of foul odor, mucopurulent rhinorrhea, and postnasal drip with allergy positivity compared to those with UFB. Therefore, understanding clinical characteristics of BFB will allow clinicians to approach BFB more appropriately.


Assuntos
Fungos , Hipertensão/epidemiologia , Micoses , Rinite , Sinusite , Adulto , Comorbidade , Gerenciamento Clínico , Feminino , Fungos/classificação , Fungos/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/microbiologia , Micoses/terapia , República da Coreia/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Rinite/microbiologia , Rinite/terapia , Fatores de Risco , Sinusite/epidemiologia , Sinusite/microbiologia , Sinusite/cirurgia , Sinusite/terapia , Tomografia Computadorizada por Raios X/métodos
12.
Int Arch Allergy Immunol ; 179(3): 209-214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970360

RESUMO

BACKGROUND: Nasal polyps are a common health problem that can significantly impact the quality of life. OBJECTIVE: To analyze the impact of allergy and peripheral eosinophils (EOS) on the morbidity of chronic rhinosinusitis with nasal polyps (CRSwNP) in Northwest China. METHODS: A retrospective cohort of 323 patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis without nasal polyps (CRSsNP) and CRSwNP in Xijing Hospital was studied between January 5, 2011, and January 4, 2015. All of the patients underwent an allergen skin prick test and peripheral blood EOS inspection. Detailed information regarding the impact of allergy and EOS on the morbidity of CRSwNP was collected. Potential risk factors associated with nasal polyps were explored using logistic regression analysis. Multivariate logistic regression was performed to identify independent risk factors. RESULTS: The results revealed that EOS is an important risk factor for nasal polyps. In the univariate analysis, the adjusted OR was 2.01 (95% CI 1.08-3.72; p = 0.027). In the multivariate analysis, the adjusted OR was 2.02 (95% CI 1.08-3.76; p = 0.027). Compared to allergic rhinitis and normal EOS levels, nonallergic rhinitis and elevated EOS levels constituted a risk factor for CRSwNP (OR = 2.70; 95% CI 1.32-5.50). Compared to allergen-positive and EOS-normal status, allergen-negative and elevated-EOS status constituted a risk factor for CRSwNP (OR = 2.95; 95% CI 1.38-6.33). CONCLUSION: EOS is a significant factor related to the morbidity of CRSwNP in Northwest China. Elevated EOS levels occurring in the context of nonallergic rhinitis constitute a risk factor for CRSwNP. Similarly, elevated EOS levels occurring in the context of allergen-negative rhinitis are also an important risk factor for morbidity of CRSwNP.


Assuntos
Eosinófilos/imunologia , Hipersensibilidade/imunologia , Pólipos Nasais/imunologia , Rinite/imunologia , Sinusite/imunologia , Adulto , China , Doença Crônica , Feminino , Humanos , Hipersensibilidade/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade , Pólipos Nasais/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Fatores de Risco , Sinusite/epidemiologia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-30959865

RESUMO

Background: World Trade Center (WTC) dust-exposed subjects have multiple comorbidities that affect sleep. These include obstructive sleep apnea (OSA), chronic rhinosinusitis (CRS), gastroesophageal-reflux disorder (GERD) and post-traumatic stress disorder (PTSD). We examined the impact of these conditions to sleep-related outcomes. Methods: Demographics, co-morbidities and symptoms were obtained from 626 WTC (109F/517M), 33⁻87years, BMI = 29.96 ± 5.53 kg/m²) subjects. OSA diagnosis was from a 2-night home sleep test (ARESTM). Subjective sleep quality, sleep-related quality of life (QOL, Functional Outcomes of Sleep Questionnaire), excessive daytime sleepiness (Epworth Sleepiness Scale), sleep duration and sleep onset and maintenance complaints were assessed. Results: Poor sleep quality and complaints were reported by 19⁻70% of subjects and average sleep duration was 6.4 h. 74.8% of subjects had OSA. OSA diagnosis/severity was not associated with any sleep-related outcomes. Sleep duration was lower in subjects with all conditions (p < 0.05) except OSA. CRS was a significant risk factor for poor sleep-related QOL, sleepiness, sleep quality and insomnia; PTSD for poor sleep-related QOL and insomnia; GERD for poor sleep quality. These associations remained significant after adjustment for, age, BMI, gender, sleep duration and other comorbidities. Conclusions: Sleep complaints are common and related to several health conditions seen in WTC responders. Initial interventions in symptomatic patients with both OSA and comorbid conditions may need to be directed at sleep duration, insomnia or the comorbid condition itself, in combination with intervention for OSA.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Qualidade de Vida , Rinite/epidemiologia , Ataques Terroristas de 11 de Setembro , Sinusite/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Doença Crônica , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Fatores de Risco , Inquéritos e Questionários
14.
Ear Nose Throat J ; 98(5): 279-282, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30939913

RESUMO

The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 had diagnosis of CRS. When purulent rhinorrhea was present with facial pain, CRS was statistically more prevalent than chronic adenoiditis (P = .017). Symptoms including cough (P = .022), rhinorrhea (P = .27), and facial pressure (P = .98) were not predictive of one diagnosis over the other. Past medical history of asthma or allergy was similar in both groups. Smoke exposure was associated with CT scores >5 (odds ratio 2.4, 95% confidence interval, 0.799-7.182). We conclude that purulent rhinorrhea in the presence of facial pain is more indicative of CRS versus chronic adenoiditis. For all other children, an adenoidectomy without the need for a CT scan can be entertained.


Assuntos
Adenoidectomia/métodos , Tonsila Faríngea , Doenças Linfáticas , Rinite , Sinusite , Avaliação de Sintomas/métodos , Tonsila Faríngea/diagnóstico por imagem , Tonsila Faríngea/patologia , Tonsila Faríngea/fisiopatologia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Diagnóstico Diferencial , Dor Facial/diagnóstico , Dor Facial/etiologia , Feminino , Humanos , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/epidemiologia , Doenças Linfáticas/fisiopatologia , Masculino , Pediatria/métodos , Pediatria/estatística & dados numéricos , Prevalência , Rinite/diagnóstico , Rinite/epidemiologia , Rinite/fisiopatologia , Sinusite/diagnóstico , Sinusite/epidemiologia , Sinusite/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Estados Unidos
15.
Int J Pediatr Otorhinolaryngol ; 121: 50-54, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30861428

RESUMO

OBJECTIVES: The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS: This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS: A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS: Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.


Assuntos
Abscesso/epidemiologia , Celulite Orbitária/epidemiologia , Doenças Orbitárias/epidemiologia , Rinite/epidemiologia , Sinusite/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Admissão do Paciente/tendências , Vacinas Pneumocócicas , Estudos Retrospectivos , Rinite/microbiologia , Rinite/terapia , Sinusite/microbiologia , Sinusite/terapia , Suécia/epidemiologia , Vacinas Conjugadas
16.
Ann Otol Rhinol Laryngol ; 128(7): 608-613, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30832483

RESUMO

OBJECTIVES: Data on health care disparities by socioeconomic status for chronic rhinosinusitis (CRS) are lacking, and the available literature shows mixed results. The aim of this study was to evaluate several indicators of disease complexity in patients with CRS undergoing endoscopic sinus surgery between a private and a public hospital to determine if there are any disparities in the severity of disease presentation or in access to care. METHODS: Two hundred patients with CRS who underwent endoscopic sinus surgery from 2015 to 2017 were retrospectively reviewed. Demographics, disease-specific data, and pre- and postoperative management were collected. RESULTS: Public hospital patients (n = 100) were significantly more likely to be non-Caucasian (73.0% vs 25.0%, P < .0001) and to have Medicaid or no insurance (86.0% vs 4.0%, P < .0001). Patients from the public hospital were more likely to have CRS with nasal polyposis (85.0% vs 60.0%, P < .0001) and to have longer wait times for surgery (68 vs 45 days, P < .0001) and were more likely to be lost to follow-up (26.0% vs 16.0%, P = .031). Patients at the public hospital had CRS symptoms 21% longer ( P = .0206), and if a patient carried a diagnosis of asthma, he or she had on average more severe asthma ( P = .0021). CONCLUSIONS: This study suggests that patients of lower socioeconomic status had a longer duration of disease prior to surgery, more often had nasal polyposis, and had decreased access to care, as indicated by increased surgical wait times and being lost to follow-up. Acting as a foundation for further investigation, the ultimate intent of this study is to improve care for all patients.


Assuntos
Endoscopia , Grupos Étnicos/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Nasais , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Asma/epidemiologia , Asma/fisiopatologia , Doença Crônica , Comorbidade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hospitais Privados , Hospitais Públicos , Humanos , Seguro Saúde/estatística & dados numéricos , Perda de Seguimento , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Pólipos Nasais/epidemiologia , Rinite/epidemiologia , Índice de Gravidade de Doença , Sinusite/epidemiologia , Classe Social , Tempo para o Tratamento/estatística & dados numéricos , Estados Unidos/epidemiologia
17.
Iran J Allergy Asthma Immunol ; 18(1): 27-37, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30848571

RESUMO

The effects of comorbidities on systemic inflammation markers in stable asthmatics and the consequences of such effects have not been well evaluated. We aimed to evaluate the effect of comorbidities on clinical manifestations and systemic inflammation in asthmatic patients under control. The study group consisted of asthmatic patients who applied to our pulmonology outpatient clinic and volunteered to participate. 120 clinically stable asthma patients (71 females and 49 males) and 35 healthy controls (19 females and 16 males) with similar age, gender, and body mass index distributions were admitted to the study. The levels of osteopontin, interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 13 (IL-13), eosinophilic cationic protein, adiponectin, and high-sensitivity C-reactive protein of the individuals were evaluated using commercial ELISA kits by taking venous blood samples. Of 120 asthmatic subjects, 47 (39, 2%) had comorbidities and allergic rhinitis (15%) coexisted most frequently. Other comorbidities associated with asthma were gastroesophageal reflux, sinusitis, hypertension, diabetes, gastritis, and peptic ulcus respectively. There was no physician-diagnosed comorbidity in the control group. The levels of IL-6 and IL-8 were found higher in asthma group with comorbidities when compared to those with no comorbidities (p were 0.032 and 0.046, respectively). Comorbidities interfere with the diagnosis and treatment of asthma, besides affecting the disease control. Our findings suggest the possibility of the impact of comorbidities on systemic inflammation markers, especially IL-6 and IL-8. To evaluate the impact of comorbidities on asthma control and systemic markers, further studies are needed.


Assuntos
Asma/sangue , Asma/epidemiologia , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Adolescente , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Comorbidade , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Gastrite/sangue , Gastrite/epidemiologia , Refluxo Gastroesofágico/sangue , Refluxo Gastroesofágico/epidemiologia , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Rinite/sangue , Rinite/epidemiologia , Sinusite/sangue , Sinusite/epidemiologia , Adulto Jovem
19.
Chest ; 155(2): 375-383, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30739642

RESUMO

BACKGROUND: Many respiratory conditions have been attributed to toxic dust and fume exposure in World Trade Center (WTC) rescue and recovery workers, who frequently report symptoms of OSA. We examined the prevalence of new-onset OSA and tested if the prevalence and severity of OSA are related to the presence of chronic rhinosinusitis (CRS). METHODS: A total of 601 subjects (83% men; age, 33-87 years; BMI, 29.9 ± 5.5 kg/m2) enrolled in the WTC Health Program, excluding those with significant pre-September 11, 2001, snoring or prior CRS, underwent two nights of home sleep testing. OSA was defined as Apnea Hypopnea Index 4% ≥ 5 events/h or respiratory disturbance index of ≥ 15 events/h. CRS was assessed using nasal symptom questionnaires. RESULTS: The prevalence of OSA was 75% (25% no OSA, 46% mild OSA, 19% moderate OSA, and 10% severe OSA), and the prevalence of CRS was 43.5%. Compared with no CRS, new and worsening CRS was a significant risk factor for OSA with an OR of 1.80 (95% CI, 1.18-2.73; P = .006) unadjusted and 1.76 (95% CI, 1.08-2.88; P = .02) after adjustment for age, BMI, sex, gastroesophageal reflux disorder, and alcohol use. CONCLUSIONS: The high prevalence of OSA in WTC responders was not explained fully by obesity and sex. Possible mechanisms for the elevated risk of OSA in subjects with CRS include increased upper airway inflammation and/or elevated nasal/upper airway resistance, but these need confirmation.


Assuntos
Socorristas/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Rinite/epidemiologia , Ataques Terroristas de 11 de Setembro , Sinusite/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Exposição Ocupacional , Prevalência , Fatores de Risco
20.
Eur Arch Otorhinolaryngol ; 276(5): 1355-1365, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30739177

RESUMO

PURPOSE: The sino-nasal outcomes test-22 (SNOT-22) represents the reference questionnaire to assess patients with chronic rhinosinusitis (CRS). As weak correlations between objective CRS parameters and SNOT-22 total score have been observed, factor analyses have aimed to identify underlying factorial structures. However, ambiguous factor loadings and problematic item-domain assignments have resulted. Moreover, such factor analyses have mainly been performed in non-European CRS patients, while European data remain sparse. This study thus sought to address these issues. METHODS: Principal component analysis and confirmatory factor analysis were performed from SNOT-22 questionnaires completed by European CRS patients. Goodness of fit, internal consistencies, and factor loadings were calculated. Item-domain assignment was based on statistical grounds and clinical meaningfulness. Additionally, this study investigated correlations between SNOT-22 domains and external reference criteria, including Lund-Mackay score, Lund-Naclerio score and the brief symptom inventory 18 (BSI-18). RESULTS: One hundred and thirty-four European CRS patients were included. Principal component analysis proposed four SNOT-22 domains ("nasal symptoms", "otologic symptoms", "sleep symptoms", "emotional symptoms"), which explained 63.6% of variance. Observed item-domain-assignment differed from previously proposed item-domain assignments. All factor loadings were > 0.5, except "cough" (0.42) and "facial pain or pressure" (0.49). For confirmatory factor analysis, satisfactory goodness of fit (RMSEA = 0.66; CFI = 0.92; TLI = 0.90) and internal consistencies (Cronbach-α: total score = 0.93; domains = 0.75-0.91) were observed. Significant positive correlations were found between the "nasal symptoms" domain and both the Lund-Mackay score (r = 0.48; p < 0.001) and the Lund-Naclerio score (r = 0.27, p < 0.01). Significant positive correlations were also identified between "emotional symptoms" and BSI-18 total score (r = 0.64, p < 0.001). CONCLUSIONS: Principal component analysis performed for SNOT-22 questionnaires completed by European CRS patients indicated a different item-domain-assignment than previously reported. Confirmatory factor analysis suggested acceptable and clinically plausible psychometric properties for the resulting factorial structure. Significant correlations between the "nasal symptoms" and the "emotional symptoms" domains were observed with objective CRS parameters. The resulting factorial structure with different item-domain assignments may thus be more suitable for European CRS patients.


Assuntos
Pólipos Nasais/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Adulto , Doença Crônica , Europa (Continente)/epidemiologia , Dor Facial , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/epidemiologia , Pólipos Nasais/fisiopatologia , Análise de Componente Principal , Rinite/epidemiologia , Rinite/fisiopatologia , Sinusite/epidemiologia , Sinusite/fisiopatologia , Inquéritos e Questionários , Avaliação de Sintomas/métodos
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