New Ringer's lactate gel formulation on nasal comfort and humidification / Nova formulação de Ringer lactato gel no conforto e umidificação nasal

Abstract Introduction: The use of saline irrigation for nasal washes is a well established procedure in the treatment of sinonasal inflammation and infection. In addition to saline solutions, Ringer's lactate is also an efficient option for nasal washes and humidification. Objective: To assess the comfort, humidification and tolerance regarding stinging sensation, provided by sodium chloride nasal gel at the concentrations of 4.5 mg/g and 6.0 mg/g through questionnaires answered by the patients. Methods: A total of 60 patients, 56 females, aged between 22 and 66 years old (mean age of 47) and 4 males, aged between 36 and 66 years (mean age of 49), were included in the study for a period of 17 days (±2 days) treatment. The patients were monitored by a general practitioner throughout the study period. They were instructed to apply each product in both nostrils twice a day during a 7-day period (±2 days). The patients were evaluated prior to the use of the first product at visit 0 (V0), after 7 days of treatment (±2 days) at visit 1 (V1), after 3 days of product discontinuation at visit 2 (V2) and after 7 days (±2 days) of treatment with the second product, in visit 3 (V3). Results: A significant difference (5% significance) was observed regarding comfort and stinging sensation between the two different concentrations; comfort was higher and stinging was lower with the 6.0 mg/g concentration gel. No difference in humidification was observed between the two treatments. Conclusion: Ringer's lactate at the concentration of 6.0 mg/g was superior to that at 4.5 mg/g for parameters comfort and stinging sensation. No statistical difference was observed between the two products regarding nasal humidification.

Resumo Introdução: O uso de soluções salinas para lavagem nasal está consagrado no tratamento de quadros inflamatórios e infecciosos nasossinusais. Além das soluções salinas, o ringer lactato é uma importante opção tanto para lavagem quanto para a hidratação nasal. Objetivo: Avaliar a tolerabilidade (ardência e conforto) e umidificação do produto gel nasal cloreto de sódio 4,5 mg/g em relação ao ringer lactato 6,0 mg/g, por meio de questionários respondidos pelos pacientes. Método: Foram incluídos 60 pacientes, 56 mulheres (22-66 anos; média: 47 anos) e quatro homens (36-66 anos; média: 49 anos) foram incluídos no estudo de 17 dias (± 2 dias) de tratamento. Os pacientes foram supervisionados por um clínico geral durante todo o período do estudo. Os pacientes usaram os produtos com uma borrifada em cada narina duas vezes ao dia, durante sete dias (± 2 dias). As formulações foram avaliadas antes do uso do primeiro produto na visita 0 (V0), após sete dias (± 2 dias) de tratamento na visita 1 (V1), após três dias de interrupção do primeiro tratamento na visita 2 (V2) e após sete dias (± 2 dias) de uso do segundo produto na visita 3 (V3). Resultados: Foi observada diferença significante para o conforto das vias nasais, (significância de 5%), na comparação entre os tratamentos nos atributos de conforto e ardência. O conforto das vias nasais foi superior e a ardência inferior para o gel nasal ringer lactato 6,0 mg/g em comparação ao gel cloreto de sódio 4,5 mg/g. Não foi observada diferença significante para a umidificação entre os tratamentos. Conclusão: O gel ringer lactato 6,0 mg/g foi superior ao produto gel cloreto de sódio 4,5 mg/g nos quesitos conforto e ardência. Não foi observada diferença estatisticamente significante entre os tratamentos em relação à umidificação das vias nasais.

Nasal polyposis: more than a chronic inflammatory disorder-a disease of mechanical dysfunction - the São paulo position

Introduction: The importance of our study lies in the fact that we have demonstrated the occurrence ofmechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective: To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data: Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion: The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP (AU)

What is the impact of positive airway pressure in nasal polyposis? An experimental study

Introduction: It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective: To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods: Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE-Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results: The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE (p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR (p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly (p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened (p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size (p = 0.04). Conclusions: Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, asmeasured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms (AU)

The Effect of Propolis in Healing Injured Nasal Mucosa: An Experimental Study

Abstract Introduction Mechanical trauma to the nasal mucosa increases the risk of synechia formation, especially after chronic rhinosinusitis and nasal surgeries. Objective This study was carried to assess the effect of propolis administration in healing injured nasal mucosa in rats. Methods We randomly divided eighteen rats into three equal experimental groups: (1) non-treated group; (2) gum tragacanth (suspending agent for propolis) treated group; and (3) propolis treated group. The non-treated group received no treatment for 15 days. The second group received gum tragacanth administration (5 ml/kg, orally) once daily for 15 days. The third group received propolis suspension orally at a dose of 100 mg/kg once daily for 15 days. At the beginning of this study, we induced unilateral mechanical nasal trauma on the right nasal mucosa of all rats in the three groups using a brushing technique. A pathologist stained tissue samples using hematoxylin and examined eosin by using a light microscope. Results The severity of inflammation wasmilder with the absence of ulcerations in the propolis treated group compared with the non-treated and gum tragacanth groups. Goblet cell and ciliated cell loss was substantially lower in patients treated with propolis compared with groups without treatment and those treated with gum tragacanth. Conclusion Propolis decreased inflammation and enhanced healing of wounds of the nasal mucosa in rats.

Prevalence of rhinitis symptoms among textile industry workers exposed to cotton dust

Introduction: The respiratory tract is one of the main points of entry of foreign substances into the body. Because of its location, the respiratory tract is heavily exposed to harmful agents, such as gases, vapors, or aerosols. Aim: Our objective was to evaluate the symptoms of occupational rhinitis in workers exposed to cotton dust. Method: The prospective study population consisted of workers from the "Nova Esperança" Cooperative of Nova Odessa (Sao Paulo), who were studied between September and December 2008. Data were collected through an individually and privately answered questionnaire designed by the author considering the clinical criteria for rhinitis. Results: Using the questionnaire, we evaluated a total of 124 workers. Among these patients, 63.7% complained of nasal obstruction, 57.2% of nasal itching, 46.7% of rhinorrhea, and 66.1% of sneezing. Of the patients considered to have very serious symptoms, 9% had nasal obstruction; 9%, itching; 4%, rhinorrhea; and 6.4%, sneezing. Discussion: Aerosol agents in the environment can clearly aggravate and even initiate rhinitis. From the standpoint of pathogenesis, the mechanisms of classical allergic airway inflammation involving mast cells, IgE, histamine, eosinophils, and lymphocytes may be responsible for the development of rhinitis after exposure to high molecular weight allergens such as proteins derived from animals and plants. This study showed a strong relationship between the occupational exposures associated with work in the cotton textile industry and the symptoms of rhinitis. Conclusion: Analysis of the data clearly showed the occurrence of rhinitis symptoms in these patients, demonstrating that the prevention and treatment of this condition in the workplace is extremely important...

Diferença de potencial nasal: um novo teste para diagnóstico de fibrose cística / Nasal potential difference: a new test for cystic fibrosis diagnosis

Introdução: Fibrose Cística (FC) é uma doença cujo diagnóstico é essencialmente clínico, confirmada por dosagem de cloro no suor acima de 60 mEq/L e/ou identificação das mutações do CFTR causadoras da doença nos dois alelos. Casos atípicos necessitam ser investigados através do exame da diferença de potencial nasal (DPN). Na FC a DPN é mais negativa, há maior despolarização com o amiloride e pouca resposta ao isoproterenol. Objetivo: Determinar os valores da DPN para portadores de FC e grupos controle. Métodos: A DPN foi medida em 24 portadores de FC, 19 portadores de outras doenças não FC e 18 sadios e foram determinadas a média e desvio-padrão da DPN máxima, 8 amil, 8ØCl, 8iso, 8Cl, 8amil+iso e index DPN. Resultados: A média da DPN máxima foi -32 mV no grupo FC, -14 mV no grupo Não FC e -16 mV no grupo Sadio (P<0,0001). No grupo FC a média do 8 amil foi -18 mV, no grupo Não FC -6 mV e no grupo Sadio -7mV (P<0,0001). No grupo FC a média do 8Cl foi 4mV, 17mV no grupo Não FC e 11mV no grupo Sadio. A média do index 8 amil + iso foi - 16mV e o index DPN foi 0,85 no grupo FC, comparado com -0,6 mV e 0,26 no grupo Não FC e -2mV e 0,23 no grupo Sadio. Conclusões: O teste da DPN pode claramente diferenciar o grupo FC, com valores semelhantes aos descritos na literatura, possibilitando seu emprego futuro como teste diagnóstico complementar nos casos atípicos de FC.

Cystic Fibrosis (CF) is a disease whose diagnosis is essentially clinical, confirmed by measurement of sweatchloride above 60mEq / L and / or identification of CFTR mutations that cause disease in two alleles. Atypical cases need to be investigated by the nasal potential difference test (NPD). In CF the NPD is more negative, there is increased depolarization with amiloride (Eamil ) and a poor response to the isoproterenol (Eiso). Aim: To determine the values of NPD for CF patients and control groups. Methods: DPN was measured in 24 CF patients, 19 carriers of other diseases non-CF and 18 healthy and the mean plus standard deviation of NPD maximum, E amyl, EØCl, Eiso, ECl, E amil+iso and index NPD were determined. Results: NPD maximum in the FC group was -32 mV, -14 mV In the non-CF and-16mV in healthy group (p <0.0001). In the CF group the mean Eamil was - 18mV, -6mV in the non-FC group and -7mV in healthy (p <0.0001). The ECl mean was 4mV in CF group, 17mV in non-CF and 11mV in healthy. The average of the index E amil+iso was-16mV and DPN index was 0.85 in FC group compared with -0.6 mV and 0.26 in non-CF and -2mV, and 0.23 in healthy. Conclusions: The test of DPN can clearly distinguish the CF group, with values similar to those described in the literature, enabling their future use as a complementary diagnostic test in atypical cases of CF.

respiratory nasal mucosa after endoscopic sphenopalatine artery coagulation. A histological and histochemical study

Epistaxis is regarded as the commonest emergency requiring admission to the otolaryngology departments. Endoscopic coagulation of sphenopalatine artery is indicated in patients with posterior epistaxis unresponsive to nasal packing. Although many studies dealt with the efficacy of the procedure in controlling severe Epistaxis, few studied its effect on the nasal structure and functions. The aim of the present work was to study the effect of sphenopalatine artery coagulation on the secretory activities as well as the histological and histochemical changes of the nasal mucosa. The study was performed on 20 adult patients suffering from persistent or recurrent posterior epistaxis. Punch biopsies from the inferior turbinate were stained with hematoxylin and eosin and PAS alcian blue for histological examination while histochemical examination was done for the activity of succinic dehydrogenase, alkaline phosphatase and cholinesterase enzymes. Histologically; the nasal mucosa showed marked decrease in the size of both the seromucinous acini and blood sinusoids in the subendothelial connective tissue stroma in the post operative biopsies. Hitochemically; all enzymatic activities showed noticeable decrease in the postoperative biopsies. No degenerative changes were noticed in any postoperative biopsy. Sphenopalatine artery coagulation is an effective method in controlling recurrent or persistent posterior nasal bleeding that affects to some extent the secretory functions of the nasal mucosa on short term with no long term harmful effects

Does nasal breathing cause frictional trauma in allergic rhinitis?

OBJECTIVES: Frictional stress on the walls of a tube increases with increased air flow and as the diameter of the tube is reduced. High values of frictional stress may occur in the nose during nasal obstruction which could damage the nasal mucosa particularly when the mucosa is inflamed and fragile as in allergic rhinitis. The effect of nasal airflow induced frictional stress on the nasal mucosa was studied in patients with allergic rhinitis. METHODS: We studied nasal peak flow rate in eight patients with allergic rhinitis and nasal obstruction comparing the change in peak expiratory flow after they breathed for 30 minutes through an obstructed and a patent nostril. Patients were studied in the right and left lateral decubitus positions to increase and decrease the resistance in the lower and upper nostril respectively and thus minimize any effects of cyclical changes in nasal resistance. Subjects breathed for 30 minutes through the upper patent nostril (schedule 1) and for a further 30 minutes through the lower obstructed nostril (schedule 2). Nasal peak expiratory flow rate was measured in both nostrils separately in both positions after each schedule. RESULTS: There was a significant reduction in mean (SD) nasal peak flow rate (-12.8 (4.06) L/min) after subjects had breathed for 30 minutes through the obstructed nostril. There was no significant change in nasal peak flow rate after subjects had breathed through the patent nostril, or in the nostril that had no flow for 30 minutes. CONCLUSIONS: These findings are compatible with the hypothesis that frictional stress due to airflow through an obstructed nostril induces trauma and swelling of the nasal mucosa of patients with allergic rhinitis.

Citologia nasal en fumadores, fumadores pasivos y no fumadores / Nasal cytology in smokers, passive smokers and non-smokers

El objetivo del estudio fue investigar la citopatología nasal en pacientes fumadores, fumadores pasivos y no fumadores. Se estudiaron 60 pacientes divididos en grupos de 20 cada uno. En el 95 por ciento de los fumadores (Grupo 1) se encontró algún tipo de metaplasia o displasia; en los fumadores pasivos (Grupo 2) solo en el 55 por ciento se encontró alteración citológica y solo en el 15 por ciento de los no fumadores (Grupo 3). El estudio concluye que el riesgo de tener cambios citológicos en los fumadores pasivos es de aproximadamente la mitad en relación a los fumadores. La citología nasal es un método barato, sencillo y muy adecuado para el diagnóstico de los cambios histológicos de la mucosa nasal

Rinitis iatrogénica / Iatrogenic rhinitis

Hablar de rinitis iatrogénica es valorar las causas que ocasionan la inflamación de la mucosa nasal, donde el médico es responsable. No existe en la literatura una clasificación de ello, por lo cual propongo como causas dos conceptos importantes: a) Mala relación humana del médico. b) Desconocimiento por parte del médico de la enfermedad. El término rinitis iatrogénica permite que el profesionista tenga presente durante el tiempo que permanece con el paciente que la medicina es un arte y una ciencia y que sólo con cultura y educación es posible que el término iatrogénico quede fuera de las clasificaciones generales de rinitis

Effect of heavy smoking on nasal respiratory mucosa

Thirty heavy smokers and 20 non-smokers were chosen to study the effect of heavy smoking on nasal respiratory mucosa. For each subject active anterior rhino manometry was performed together with saccharine clearance time and light microscopic examination of tissues from inferior turbinate. A statistically significant increase in nasal resistance and prolongation in saccharine clearance time were found. Also, marked chronic inflammatory changes were noted

Fisiopatología de la rinosinusitis crónica / chronic rhinosinusitis fisiopatology

La respuesta inflamatoria de las vías aéreas superiores, ocasionada por infecciones virales y/o bacterianas, constituye la causa más común de consulta médica y la rinosinusitis una complicación frecuente. Las alteraciones en los mecanismos de inmunidad local y sistémica son factores que favorecen el desarrollo de la rinosinusitis. La participación de mediadores derivados del eosinófilo es también un factor importante en la fisiopatología de la inflamación de la mucosa nasal

Perfil de inmunoglobulinas (Ig) séricas e inmunoglobulinas A secretora (IgA) en pacientes con bloqueo nasal crónico total y permanente (B.N.C.T.y P.) / Profile of serical immunoglobulin (Ig) and secretoral A immunoglobulin (IgA) in patients with total and permanent chronic nasal blockage (TPCNB)

Objetivo: determinar Igs en suero y secreciones de pacientes con bloque nasal crónico total y permanente (B.N.C.T. y P.)a fin de correlacionar estos datos con los hallazgos clínicos y anatomopatológicos. Material y métodos: Se estudiaron 17 pacientes de ambos sexos de 11 a 30 años. Se realizó estudio anatomopatológico de biopsias de mucosa nasal. Resultados: IgG: 11,76 por ciento disminuida. IgA sérica: normal en todos los pacientes, IgA en saliva: 64,7 por ciento disminuida y en un caso, no detectable. IgA en moco nasal: 35,3 por ciento muy disminuida y en 7 casos, no detectable. La IgE fue elevada en el 35,3 por ciento de los casos. Conclusiones: De los resultados obtenidos, se infiere que los pacientes con B.N.C.T. y P., tienen un perfil de IgA en saliva y moco nasal deficitario debido a las alteraciones de la mucosa nasal en distintos estadíos evolutivos que conducen al B.N.C.T. y P., hecho que se correlaciona con los hallazgos anatomopatológicos

A preliminary study of nasal mucociliary clearance in smokers, sinusitis and allergic rhinitis patients.

Mucocillary clearance of nasal mucosa was evaluated with the saccharin test. A total of 140 subjects was divided into 4 groups: smokers, allergic rhinitis patients, sinusitis patients, and a normal control group. The mean mucociliary transit time for the normal control group (n = 40) was 12 minutes, while allergic rhinitis patients (n = 40) had a mean of 14.6 minutes. The smoker group (n = 40) could be further divided into the following subcategories: (a) those who had been smoking for less than 5 years (n = 10) had a mean of 15.2 minutes, (b) those who had been smoking for more than 5 years at less than one-pack a day (n = 11) had a mean of 14 minutes, and (c) those who had been smoking for more than 5 years at more than one-pack a day (n = 19) had a mean of 16.5 minutes. For the sinusitis patients (n = 20) the mean was 16.6 minutes. The study shows that sinusitis patients, along with those smokers who had been smoking for more than 5 years at more than one-pack a day, had a mucocillary transit time that was considered to be prolonged when compared to the normal control group (p < 0.05).

Autoinmunidad en rinitis alérgica / Autoimmunity and allergic rhinitis

Con objeto de identificar fenómenos de autoinmunidad en la alergia respiratoria seleccionamos 68 pacientes, 30 con diagnóstico de rinitis alérgica perenne (RAP) y 38 con rinitis alérgica perenne mas asma bronquial (RA+AB) a quienes se les cuantificó anticuerpos antinucleares y antimúsculo liso por técnica de inmunofluorescencia indirecta, encontrándolos negativos en todos los casos

Leishmanaiasis mucocutanea (MCL) en Bolivia, epidemiologia de las lesiones mucosas / Mucocutaneous leishmaniasis in Bolivia, epidemiology of the mucosal lesions

Entre los anos 1980 y 1990 se realiza este estudio con un promedio significativo del numero de localizaciones anatomicas que fue de 2,5. No encontramos asociacion entre el numero de localizaciones y el lugar de infeccion. Informacion publicada de areas de pie de monte cercanas a los Andes, muestran lesiones de mayor intensidad. Nuestros casos mucosos, en sus antecedentes previos no habian recibido tratamiento especifico completo, mientras que nuestros casos cutaneos que recibieron un tratamiento completo no mostraron ni lesiones mucosas ni recaidas, demostrando la efectividad del Glucantine en nuestra area