A real world study of anti-IgE monoclonal antibody in the treatment of allergic united airway disease / 中华预防医学杂志

Objective: To investigate the clinical efficacy and safety of anti-IgE monoclonal antibody (omazumab) in the treatment of allergic united airway disease (UAD) in the real-wold. Methods: Retrospective cohort study summarizes the case data of patients with allergic united airway disease who were treated with anti IgE monoclonal antibody (omalizumab) for more than 16 weeks from March 1, 2018 to June 30, 2022 in the Peking University First Hospital.The allergic UAD is defined as allergic asthma combined with allergic rhinitis (AA+AR) or allergic asthma combined with chronic sinusitis with nasal polyps (AA+CRSwNP) or allergic asthma combined with allergic rhinitis and nasal polyps (AA+AR+CRSwNP). The control of asthma was evaluated by asthma control test (ACT), lung function test and fractional exhaled nitric oxide (FeNO). The AR was assessed by total nasal symptom score (TNSS). The CRSwNP was evaluated by nasal visual analogue scale (n-VAS), sino-nasal outcome test-22 (SNOT-22), nasal polyps score (TPS) and Lund-Mackay sinus CT grading system. The global evaluation of omalizumab for the treatment of allergic UADwas performed by Global Evaluation of Treatment Effectiveness(GETE).The drug-related side effects were also recorded. Matched t test and Wilcoxon signed-rank test were used to compare the score changes of IgE monoclonal antibody (omazumab) before and after treatment, and multivariate logistic regression analysis was used to determine the influencing factors of IgE monoclonal antibody (omazumab) response. Results: A total of 117 patients with UAD were enrolled, ranging in age from 19 to 77 years; The median age of patients was 48.7 years; Among them, 60 were male, ranging from 19 to 77 years old, with a median age of 49.9 years; There were 57 females, ranging from 19 to 68 years old, with a median age of 47.2 years. There were 32 cases in AA+AR subgroup, 59 cases in AA+CRSwNP subgroup, and 26 cases in AA+AR+CRSwNP subgroup. The total serum IgE level was 190.5 (103.8,391.3) IU/ml. The treatment course of anti IgE monoclonal antibody was 24 (16, 32) weeks. Compared with pre-treatment, omalizumab increased ACT from 20.0 (19.5,22.0) to 24.0 (23.0,25.0) (Z=-8.537, P<0.001), increased pre-bronchodilator FEV1 from 90.2 (74.8,103.0)% predicted value to 95.4 (83.2,106.0)% predicted value (Z=-5.315,P<0.001), increased FEV1/FVC from 80.20 (66.83,88.38)% to 82.72 (71.26,92.25)% (Z=-4.483,P<0.001), decreased FeNO from(49.1±24.8) ppb to (32.8±24.4) ppb (t=5.235, P<0.001), decreased TNSS from (6.5±2.6)to (2.4±1.9) (t=14.171, P<0.001), decreased n-VAS from (6.8±1.2) to (3.4±2.0)(t=14.448, P<0.001), decreased SNOT-22 from (40.0±7.9) to (21.3±10.2)(t=15.360, P<0.001), decreased TPS from (4.1±0.8) to (2.4±1.0)(t=14.718, P<0.001) and decreased Lund-Mackay CT score from (6.0±1.3) to (3.1±1.6)(t=17.012, P<0.001). The global response rate to omalizumab was 67.5%(79/117). The response rate in AA+AR (90.6%,29/32) was significantly higher than that in AA+CRSwNP (61.0%,36/59) and AA+AR+CRSwNP (53.8%,14/26) subgroups (χ2=11.144,P=0.004). Only 4 patients (3.4%,4/117) had mild side effects. Conclusion: The real-world study showed favorable effectiveness and safety of anti-IgE monoclonal antibody for treatment of allergic UAD. To provide basis for preventing the progress and precise treatment of allergic UAD.

Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps / Avaliação prospectiva da claritromicina na rinossinusite crônica com polipose nasossinusal recorrente

Abstract Introduction The antiinflammatory effects of macrolides, especially clarithromycin, have been described in patients with chronic rhinosinusitis without polyps and also other chronic inflammatory airway diseases. There is no consensus in the literature regarding the effectiveness of clarithromycin in patients with chronic rhinosinusitis with sinonasal polyposis and the national literature does not report any prospective studies on the efficacy of clarithromycin in chronic rhinosinusitis in our population. Objective To evaluate the effect of clarithromycin in the adjunctive treatment of recurrent chronic rhinosinusitis with sinonasal polyposis refractory to clinical and surgical treatment. Methods Open prospective study with 52 patients with chronic rhinosinusitis and recurrent sinonasal polyposis. All subjects received nasal lavage with 20 mL 0.9% SS and fluticasone nasal spray, 200 mcg / day, 12/12 h for 12 weeks; and clarithromycin 250 mg 8/8 h for 2 weeks and, thereafter, 12/12 h for 10 weeks. The patients were assessed by SNOT 20, NOSE and Lund-Kennedy scales before, immediately after treatment and 12 weeks after treatment. The patients were also evaluated before treatment with paranasal cavity computed tomography (Lund-Mackay) and serum IgG, IgM, IgA, IgE and eosinophil levels. The outcomes evaluated were: SNOT-20, NOSE and Lund-Kennedy. Results Most patients were women, aged 47 (15) years (median / interquartile range), and 61.5% (32/52) had asthma. All patients completed the follow-up after 12 weeks and 42.3% (22/52) after 24 weeks. Treatment resulted in a quantitative decrease in the SNOT-20 [2.3 (1.6) vs. 1.4 (1.6); Δ = −0.9 (1.1); p < 0.01]; NOSE [65 (64) vs. 20 (63); Δ = −28 (38), p < 0.01] and Lund-Kennedy [11 (05) vs. 07 (05); Δ = −2 (05); p < 0.01] scores. SNOT-20 showed a qualitative improvement (>0.8) in 54% (28/52, p < 0.04) of patients, a group that showed lower IgE level [108 (147) vs. 289 (355), p < 0.01]. The group of patients who completed follow-up 12 weeks after the end of treatment (n = 22) showed no worsening of outcomes. Conclusion Long-term adjuvant use of low-dose clarithromycin for chronic rhinosinusitis patients with recurrent sinonasal polyposis refractory to clinical and surgical treatment has resulted in improved quality of life and nasal endoscopy findings, especially in patients with normal IgE levels. This improvement persisted in the patient group evaluated 12 weeks after the end of the treatment.

Resumo Introdução Os efeitos anti-inflamatórios dos macrolídeos são reconhecidos, principalmente da claritromicina para os pacientes com rinossinusite crônica sem pólipos e outras doenças inflamatórias crônicas das vias aéreas em outras populações. Não existe consenso na literatura quanto a sua prescrição para os pacientes de rinossinusite crônica com polipose nasossinusal e a literatura nacional não dispõe de estudos prospectivos sobre a eficácia da claritromicina na rinossinusite crônica em nossa população. Objetivo Avaliar o efeito da claritromicina no tratamento adjuvante da rinossinusite crônica recorrente com polipose nasossinusal refratária ao tratamento clínico e cirúrgico. Método Estudo prospectivo aberto, com 52 pacientes, portadores de rinossinusite crônica com polipose nasossinusal recorrente. Todos os indivíduos receberam lavagem nasal com SF 0,9% 20 mL e fluticasona spray nasal, 200 mcg/dia, 12/12 horas por 12 semanas; e claritromicina 250 mg, de 8/8 horas, por 2 semanas e posteriormente 12/12 horas, por 10 semanas. Os pacientes foram avaliados através do SNOT 20, do NOSE e Lund-Kennedy antes, pós-tratamento imediato e 12 semanas após o tratamento. Os pacientes também foram avaliados antes do tratamento por tomografia computadorizada das cavidades paranasais (Lund-Mackay) e dosagem sérica de IgG, IgM, IgA, IgE e eosinófilos. Os desfechos avaliados foram: SNOT-20, NOSE e Lund-Kennedy. Resultados A maioria dos pacientes era mulher, idade de 47 (15) anos (mediana/intervalo interquartílico) e 61,5% (32/52) portadores de asma. Todos os pacientes completaram o seguimento após 12 semanas e 42,3% (22/52) após 24 semanas. O tratamento resultou em uma diminuição quantitativa do SNOT-20 [2,3 (1,6) vs. 1,4 (1,6); Δ = -0,9 (1,1); p< 0,01]; do NOSE [65 (64) vs. 20 (63); Δ = -28 (38), p< 0,01] e do Lund-Kennedy [11 (05) vs. 07 (05); Δ = -2 (05); p< 0,01]. O SNOT-20 mostrou uma melhoria qualitativa (> 0,8) em 54% (28/52, p< 0,04) dos pacientes, grupo que evidenciou menor nível de IgE [108 (147) vs. 289 (355), p< 0,01]. O grupo de pacientes que completou o seguimento 12 semanas após o término do tratamento (n = 22) não mostrou uma pioria dos desfechos. Conclusão O uso prolongado adjuvante da claritromicina em baixas doses para pacientes com rinossinusite crônica com polipose nasossinusal recorrente refratária ao tratamento clínico e cirúrgico resultou em melhoria na qualidade de vida e endoscopia nasal, principalmente em pacientes com níveis de IgE normal. Essa melhoria se sustentou no grupo de pacientes avaliado 12 semanas após o término do tratamento.

Short-term efficacy of anti-IgE monoclonal antibody in patients with recurrent chronic rhinosinusitis with nasal polyps combined with asthma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the short-term efficacy of anti-IgE monoclonal antibody (Omalizumab) in the treatment of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) complicated with asthma. Methods: Patients with recurrent CRSwNP and comorbid asthma in Beijing TongRen Hospital from May to December of 2020 were continuously recruited and received a 4-month therapy of stable background treatment plus Omalizumab. Results of visual analog scales (VAS) of nasal symptoms, sino-nasal outcome test-22 (SNOT 22) and nasal polyp scores were collected at baseline and post-treatment (1, 2, 3 and 4 months after treatment). Blood routine tests, total nasal resistances (TNR), minimum cross-sectional areas (MCA), total nasal cavity volumes (NCV), forced expiratory volumes in one second (FEV1)/forced vital capacity (FVC) and adverse events were collected at baseline and 4 months after treatment. All results were evaluated for short-term efficacy of Omalizumab. GraphPad Prism 8.2.1 was used for statistic analysis. Results: Ten patients were collected, including 3 males and 7 females, aged (41.13±12.64) years old (x¯±s). Compared to results at baseline, the VAS scores of nasal obstruction, rhinorrhea, hyposmia and headache after 4 months treatment were significantly decreased (1.80±1.48 vs 6.70±2.83, 2.40±1.27 vs 6.40±3.44, 2.70±2.91 vs 8.20±2.25, 0.60±1.08 vs 3.60±2.72, t value was 5.045, 4.243, 5.312, 3.402, respectively, all P<0.01). The scores of SNOT-22 (25.6±20 vs 61.3±33.32, t=4.127, P=0.002 6), nasal polyp scores (2.20±0.92 vs 4.60±0.84, t=9.000, P<0.01) and the count and percentage of eosinophils in peripheral blood were significantly decreased ((94.10±97.78)×109/L vs (360.00±210.80)×109/L, (32.90±27.06)% vs (64.40±20.73)%, t value was 3.678, 2.957, respectively, all P<0.05). NCV (0-5 cm and 0-7 cm) of patients were improved from baseline ((12.62±2.84) cm3 vs (10.40±2.09) cm3, (27.50±14.15) cm3 vs (16.81±6.40) cm3, t value was 2.371, 2.445, respectively, all P<0.05). Conclusions: The 4-month treatment of Omalizumab can significantly improve the nasal symptoms and quality of life of patients with recurrent CRSwNP complicated with asthma, shrink nasal polyps size and reduce the number of peripheral blood eosinophils. Omalizumab can be used as an alternative therapy for refractory CRSwNP patients in the future.

Terapia anti interleukina 5 para la rinosinusitis crónica con pólipos / Anti-interleukin 5 therapy for chronic rhinosinusitis with polyps

Resumen INTRODUCCIÓN: La rinosinusitis crónica es la inflamación de la mucosa nasosinusal de duración superior a 12 semanas. Se distinguen dos formas clínicas: rinosinusitis crónica con pólipos y sin pólipos. Los pacientes con rinosinusitis crónica con pólipos presentan niveles elevados de interleukina 5, la cual promueve la diferenciación y supervivencia de eosinófilos, por lo que se ha propuesto minimizar su circulación como una nueva estrategia de tratamiento. Sin embargo, no hay claridad respecto a su real efectividad. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron tres estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que los inhibidores de interleukina 5 podrían disminuir el puntaje de pólipos nasales. Si bien podrían asociarse a efectos adversos, estos serían poco frecuentes y de baja severidad. Sin embargo, la certeza de la evidencia es baja.

Abstract INTRODUCTION: Chronic rhinosinusitis is the inflammation of sinonasal mucosa lasting longer than 12 weeks. Two clinical forms are distinguished: chronic rhinosinusitis with polyps and without polyps. Patients with chronic rhinosinusitis with polyps exhibit high levels of interleukin 5, which promotes differentiation and survival of eosinophils. So, minimizing their circulation has been proposed as a new treatment strategy. However, there is no clarity regarding its real effectiveness. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews included three primary studies overall, all corresponding to randomized trials. We concluded inhibitors of interleukin 5 might decrease nasal polyps score. Although they might be associated with adverse effects, these would be infrequent and of low severity. However, the certainty of the evidence is low.

Omalizumab para la rinosinusitis crónica / Omalizumab for chronic rhinosinusitis

Resumen INTRODUCCIÓN: La rinosinusitis crónica es una enfermedad inflamatoria crónica de alta prevalencia que compromete la mucosa de la cavidad nasal y senos paranasales. La inmunoglobulina E es un mediador inflamatorio que juega un rol etiopatogénico en esta condición, por lo que se ha planteado que omalizumab, un anticuerpo monoclonal anti-inmunoglobulina E, podría constituir una alternativa de tratamiento. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron cinco estudios primarios, de los cuales dos corresponden a ensayos controlados aleatorizados. Concluimos que en pacientes con rinosinusitis crónica, no está claro si omalizumab lleva a una mejoría en la escala de pólipos nasales, la calidad de vida, el bienestar general o los síntomas nasales porque la certeza de la evidencia es muy baja. Por otra parte, el uso de omalizumab probablemente se asocia a efectos adversos frecuentes.

Abstract INTRODUCTION: Chronic rhinosinusitis is a high prevalence chronic inflammatory disease that involves nasal mucosa and paranasal sinuses. Immunoglobulin E is an inflammatory mediator that plays an etiopathogenic role in this condition, so omalizumab, an anti-immunoglobulin E monoclonal antibody, might be a therapeutic alternative. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews that included five primary studies overall, of which two correspond to randomized trials. We concluded it is not clear whether omalizumab leads to an improvement in the nasal polyps scale, quality of life, general well-being or nasal symptoms in patients with chronic rhinosinusitis, because the certainty of the evidence is very low. On the other hand, omalizumab is probably associated with frequent adverse effects.

Nasal polyposis in cystic fibrosis: follow-up of children and adolescents for a 3-year period / Polipose nasal em fibrose cística: seguimento em crianças e adolescentes durante um período de 3 anos

Abstract Introduction: Nasal polyposis is often found in patients with cystic fibrosis. Objective: To assess the incidence of nasal polyposis, the response to medical treatment, recurrence and the need for surgical intervention in children and adolescents with cystic fibrosis during a three-year follow-up. Methods: Clinical symptoms (pulmonary, pancreatic insufficiency, malnutrition, nasal obstruction), two positive sweat chloride tests, and genotype findings in 23 patients with cystic fibrosis were analyzed. All patients underwent nasal endoscopy every 12 months from January 2005 to December 2007, to assess the presence and grade of Nasal Polyps. Nasal polyposis, when present, were treated with topical corticosteroids for 6-12 months, with progress being evaluated within the 3 years of follow-up. Results: In the first evaluation, nasal polyposis was diagnosed in 30.43% of patients (3 bilateral and 4 unilateral), recurrent pneumonia in 82.6%, pancreatic insufficiency in 87%, and malnutrition in 74%. The presence of nasal polyposis was not associated with chloride values in the sweat, genotype, clinical signs of severity of cystic fibrosis, or nasal symptoms. In the three-year period of follow up, 13 patients (56.52%) had at least one event of polyposis, with the youngest being diagnosed at 32 months of age. Only one patient underwent surgery (polypectomy), and there was one diagnosis of nasopharyngeal carcinoma. Conclusion: The study showed a high incidence of nasal polyposis. Monitoring through routine endoscopy in patients with cystic fibrosis, even in the absence of nasal symptoms, is highly recommended. The therapy with topical corticosteroids achieved good results. Thus, an interaction between pediatricians and otolaryngologists is necessary.

Resumo Introdução: A polipose nasal é frequentemente encontrada em pacientes portadores de fibrose cística. Objetivo: Avaliar a incidência de polipose nasal, a resposta ao tratamento clínico, a recorrência e a necessidade de intervenção cirúrgica em crianças e adolescentes com fibrose cística durante um seguimento de 3 anos. Método: Os sintomas clínicos (pulmonar, insuficiência pancreática, desnutrição, obstrução nasal), duas pesquisas de cloro no suor positivas e genótipo de 23 pacientes com fibrose cística foram descritos. Todos os pacientes foram submetidos à endoscopia nasal a cada 12 meses de janeiro de 2005 a dezembro de 2007, para avaliação de presença e grau de polipose nasal. A polipose nasal, quando presente, foi tratada com corticosteroide tópico de 6 a 12 meses e avaliada a evolução nos 3 anos de seguimento. Resultados: Na primeira avaliação, a polipose nasal foi diagnosticada em 30,43% dos pacientes (três bilaterais e quatro unilaterais), pneumonia recorrente em 82,6%, insuficiência pancreática em 87% e a desnutrição em 74%. A presença de polipose nasal não se associou aos valores de cloro no suor, genótipo, sinais clínicos de gravidade da fibrose cística ou sintomas nasais. Nos três anos de seguimento, 13 pacientes (56,52%) apresentaram pelo menos um evento de polipose, o mais jovem foi diagnosticado aos 32 meses. Apenas um paciente foi submetido à cirurgia (polipectomia) e houve um diagnóstico de carcinoma da nasofaringe. Conclusão: O estudo mostrou alta incidência de polipose nasal. O acompanhamento por meio de exames endoscópicos de rotina em pacientes fibrocisticos, mesmo na ausência de sintomas nasais, é altamente recomendado. A terapia com corticoide tópico mostrou bons resultados. Assim, faz-se necessária a interação entre pediatras e otorrinolaringologistas.

Evaluation of the improvement of quality of life with Azithromycin in the treatment of eosinophilic nasal polyposis / Avaliação da melhora da qualidade de vida com o uso de Azitromicina no tratamento da polipose nasossinusal eosinofílica

ABSTRACT INTRODUCTION: The Sino-Nasal Outcome Test 22 (SNOT-22) is an important tool in assessing the quality of life (QoL) of patients with chronic rhinosinusitis with a validated version in Brazil. The eosinophilic nasal polyposis (ENP) represents most of the cases of nasal polyposis (85-90%) and belongs to the group of chronic rhinosinusitis. It is a chronic inflammatory disease that impacts the QoL of patients, not only causing localized symptoms, but also resulting in a general malaise. The standard treatments (corticosteroids and nasal endoscopic surgery) lead to partial control of symptoms, but relapses are frequent. Macrolide acting as an immunomodulator is a promising tool for more effective control of this disease. Studies are still lacking to assess the real impact on the QoL in patients treated with macrolides. OBJECTIVE: To evaluate the improvement of QL, evaluated using SNOT-22, in patients with PNSE treated with immunomodulatory dose azithromycin. METHODS: This is a paired experimental study in patients with ENP. Comparison of pre-treatment and post-treatment with azithromycin was performed. Patients completed the SNOT-22 questionnaire before the start of treatment and returned for evaluation after eight weeks of treatment. Azithromycin was prescribed at a dose of 500 mg, orally, three times a week, for 8 weeks. RESULTS: SNOT-22 score decreased 20.3 points on average. There was a significant decrease in the SNOT-22 (difference greater than 14 points) in 19 patients (57.6%). There was no significant difference in improvement in SNOT in subgroups with or without asthma/aspirin intolerance. CONCLUSION: Azithromycin resulted in significant improvement of QoL, assessed by SNOT-22, in the studied population.

RESUMO INTRODUÇÃO: O Sino-Nasal Outcome Test 22 (SNOT-22) está entre os principais instrumentos na avaliação da qualidade de vida dos pacientes com rinossinusite crônica, com versão validada no Brasil. A polipose nasossinusal eosinofílica (PNSE) representa a maioria dos casos de polipose nasossinusal (85% a 90%) e pertence ao grande grupo das rinossinusites crônicas. É uma doença inflamatória crônica que impacta sobremaneira a qualidade de vida (QV) dos pacientes, não só pelos sintomas locais, mas também por resultarem em um quadro de mal-estar geral. Os tratamentos padronizados (corticosteroides e cirurgia endoscópica nasal) levam ao controle parcial dos sintomas e as recidivas são frequentes. Os macrolídeos usados como imunomoduladores são uma promissora ferramenta para um controle mais eficaz dessa doença. Ainda faltam estudos para avaliar o real impacto na QV dos pacientes tratados com macrolídeos. OBJETIVO: Avaliar a melhora da QV do paciente portador de PNSE tratado com azitromicina em dose imunomoduladora baseando-se questionário SNOT-22. MÉTODO: Trata-se de estudo experimental autopareado em pacientes com PNSE. Foi realizada a comparação dos pacientes pré-tratamento e pós-tratamento com azitromicina. Os pacientes preencheram o questionário SNOT-22 antes do início do tratamento e no retorno após as oito semanas de tratamento. Foi prescrita azitromicina na dose de 500 mg, VO, três vezes por semana, durante 8 semanas. RESULTADOS: O valor do índice SNOT-22 dos pacientes reduziu 20,3 pontos, em média. Houve diminuição significativa do SNOT-22 (diferença maior que 14 pontos) em 19 pacientes (57,6%). Não houve uma diferença significativa na melhora do SNOT nos subgrupos com ou sem asma/intolerância à aspirina. CONCLUSÃO: A azitromicina resultou em melhora significativa da QV, avaliada pelo questionário SNOT-22, na população estudada.

Efectividad y seguridad del corticosteroide nasal mometasona comparado con beclometasona, budesonida, ciclesonida y fluticasona para el tratamiento de pólipos nasales en adultos y niños / Effectiveness and safety of nasal corticosteroid mometasone compared to beclomethasone, budesonide, ciclesonide and fluticasone for the treatment of nasal polyps in adults and children

Introducción: los pólipos nasales son una manifestación de la inflamación crónica de la mucosa nasal y senos paranasales. Generalmente surgen desde la mucosa que rodea al meato medio y muchas veces causan bloqueo nasal y restricción al flujo de aire a través de las fosas nasales. Su prevalencia ha sido reportada entre un 0.5% y un 4% en la población general. El principal objetivo del tratamiento de la poliposis nasal es aliviar los síntomas nasales debido a la eliminación o reducción en el tamaño del pólipo. Debido a sus propiedades antiinflamatorias, los corticoesteroides son el pilar del tratamiento de la poliposis nasal. Objetivo: esta evaluación de tecnología tiene como objetivo examinar los beneficios y riesgos del uso del corticosteroide tópico nasal Mometasona en comparación con otros corticoesteroides nasales para el tratamiento de poliposis nasal. Metodología: se realizó una búsqueda sistemática y exhaustiva de literatura. Todo el proceso se acogió a los estándares de calidad internacional utilizados por la Colaboración Cochrane. Resultados: de las búsquedas, se obtuvieron 166 referencias, de las que, luego de tamización de título y resumen, se obtuvieron 5 para evaluar en texto completo, y de las cuáles se excluyeron 3, para incluir dos en éste reporte. Las razones por las cuales fueron excluidas las anteriores referencias se describen a continuación: 1) versión anterior de una de las RSL incluidas en los resultados del reporte, 2) la población no respondía a los criterios de inclusión, y 3) un reporte era un resumen de conferencia. Conclusiones: no se encontró evidencia directa, ni indirecta, que permitiera conocer las diferencias entre mometasona y el resto de los CEN. En general, los corticoesteroides nasales son mejores que el placebo en efectividad sobre casi todos los desenlaces clínicos importantes y críticos. En general todos los CEN presentaron más efectos adversos que el placebo, aunque todos fueron leves. No se encontró evidencia de diferencias en cuanto a eventos adversos entre los CEN entre sí.(AU)

Apoptose em pólipos nasais eosinofílicos submetidos in vitro ao tratamento com mitomicina C / Apoptosis in eosinophilic nasal polyps treated in vitro with mitomycin C

A etiopatogênese da polipose nasal eosinofílica ainda não foi esclarecida. Os eosinófilos constituem as principais células do infiltrado inflamatório e estão relacionados com a perpetuação do processo inflamatório na rinossinusite crônica com pólipos nasais. OBJETIVO: Avaliar a ação in vitro da mitomicina no índice apoptótico de pólipos nasais eosinofílicos. MATERIAL E MÉTODO: Estudo prospectivo experimental autopareado com amostra de biópsia de 15 pacientes com polipose nasal eosinofílica. Cada fragmento foi dividido em dois grupos. No grupo experimental aplicou-se mitomicina por cinco minutos, na dosagem de 400 µg/ml. O grupo controle foi submetido às mesmas manipulações, mas utilizando-se somente meio de cultura. Os fragmentos contidos nos dois primeiros compartimentos, controle e experimento, foram imediatamente submetidas ao preparo para histopatologia. O outro par de amostra, contendo controle e experimento, foi incubado por 12 horas. Após 12 horas, os fragmentos foram retirados para exame histopatológico. O índice apoptótico foi determinado pela morfometria na coloração hematoxilina-eosina e pela análise da fragmentação do DNA. RESULTADO: A comparação do dois grupos demonstrou diferença significativa (p < 0,001) no índice apoptótico das culturas incubadas por 12 horas. CONCLUSÃO: A mitomicina induz in vitro o aumento do índice apoptótico dos eosinófilos dos pólipos nasais eosinofílicos.

The etiopathogenesis of eosinophilic nasal polyps is yet to be explained. Eosinophils are key components in the inflammatory infiltrate and are related to the perpetuation of the inflammatory process in chronic rhinosinusitis with nasal polyps. OBJECTIVE: This paper aims to evaluate the in vitro action of mitomycin upon the apoptotic index of nasal polyps. MATERIALS AND METHODS: This is a self-paired prospective experimental study using biopsy fragments from 15 patients with eosinophilic nasal polyps. Biopsy fragments were divided into two groups. In the case group, the fragments were treated with 400 µg/ml of mitomycin for five minutes. The control group fragments were treated with culture medium. The pair of fragments contained in the two first compartments - control and case - were immediately sent to the histopathologist. The other pair of samples containing control and case fragments was incubated for 12 hours. The fragments were then taken to the histopathologist for testing. The apoptotic index was determined by the morphometry in hematoxylin and eosin staining and DNA fragmentation analysis (TUNEL reaction). RESULTS: The comparison between the two groups showed a statistically significant difference (p < 0,001) in the apoptotic index of the 12-hour incubated cultures. CONCLUSION: Mitomycin acts in vitro upon the eosinophilic nasal polyps inducing the rise of the eosinophilic apoptotic index.

In vitro effect of glucocorticoids on nasal polyps / Efeito in vitro de glicocorticosteróides sobre pólipos nasais

Glucocorticoids are considered the main treatment option for nasal polyps, but their effect is only recently being understood. AIM: To evaluate whether fluticasone propionate (FP) inhibits the inflammatory process induced by TNF-alpha in vitro, and to assess if NF-kappaB is associated to this inhibition. STUDY DESIGN: Experimental in vitro study. MATERIALS AND METHODS: Nasal polyp fibroblasts were cultured during 24 hours. Three different concentrations of FP (1, 10 and 100 nM, added to TNF-alpha) were compared to negative (without additive) and positive (TNF-alpha) controls. Gene expression (RTQ-PCR) and protein concentration (ELISA) of VCAM-1, ICAM-1, eotaxin and RANTES were measured, as well as the nuclear translocation of NF-kappaB. RESULTS: TNF-alpha significantly increased protein concentration and RNA expression of all the studied molecules, as well as the nuclear translocation of NF-kappaB, when compared to the negative control. FP decreased these parameters in a dose-dependent manner, statistically different from positive control up to 100nM. CONCLUSIONS: FP extensively inhibited inflammatory recruiters, at both protein and RNA levels, confirming the ability of glucocorticoids to modulate the inflammatory process in nasal polyps. This inhibition was associated to decreased NF-kappaB nuclear translocation, demonstrating that this is an important mechanism of glucocorticoids action for nasal polyps.

Glicocorticoides são considerados a principal opção terapêutica para polipose nasossinusal, mas seus efeitos estão sendo descobertos apenas recentemente. OBJETIVO: Avaliar se proprionato de fluticasona (FP) inibe in vitro o processo inflamatório induzido por TNF-alfa, e se NF-kappaB está associado a esta inibição. FORMA DE ESTUDO: Experimental in vitro. MATERIAIS E MÉTODOS: Fibroblastos de pólipos nasais foram cultivados por 24 horas. Três concentrações diferentes de FP (1, 10 e 100nM, além do TNF-alfa) foram comparados a controles negativo (sem aditivo) e positivo (TNF-alfa). Expressão gênica (RTQ-PCR) concentração proteica (ELISA) de VCAM-1, ICAM-1, eotaxin e RANTES foram medidos, assim como a translocação nuclear de NF-kappaB. RESULTADOS: TNF-alfa aumentou significativamente a concentração proteica e expressão gênica de todas molé¬culas estudadas, assim como a translocação nuclear de NF-kappaB, quando comparado ao controle negativo. O FP diminuiu estes parâmetros numa forma dose-dependente, diferente estatisticamente do controle positivo até 100nM. CONCLUSÕES: O FP extensivamente inibiu os recrutadores inflamatórios, em níveis proteicos e gênicos, confirmando a habilidade dos glicocorticoides em modular o processo inflamatório na polipose nasossinusal. Esta inibição esteve associada à diminuição da translocação nuclear de NF-kappaB, demonstrando que este é um importante mecanismo de ação dos glicocorticoide na polipose nasossinusal.

Expressão dos genes que codificam as proteínas anexina-1 e galectina-1 nos pólipos rinossinusais e sua modulação pelo glicocorticoide / Expression of genes that encode the annexin-1 and galectin-1 proteins in nasal polyposis and their modulation by glucocorticoid

A fisiopatologia da polipose rinossinusal não é totalmente compreendida, apesar de várias hipóteses em relação ao seu processo inflamatório. OBJETIVOS: Estudo prospectivo da expressão dos genes das proteínas, anexina-1 e a galectina-1, que têm ação anti-inflamatória, e sua modulação pelo glicocorticoide. MATERIAL E MÉTODOS: Onze pacientes portadores de polipose rinossinusal tiveram biopsiados seus pólipos em dois momentos: na ausência de glicocorticoide sistêmico, e na sua presença. Nas duas amostras, foi avaliada a expressão desses genes e comparada com a expressão na mucosa nasal normal do meato médio. RESULTADOS: Verificou-se que a média de expressão dos genes que codifica a anexina-1 e galectina-1 estava predominantemente aumentada, independente do uso do glicocorticoide em relação à mucosa nasal controle. Entretanto, nos pólipos sem uso de corticoide, a média de expressão do gene da anexina-1 foi significativamente maior do que nos pólipos que estavam sob uso de glicocorticoide. Com relação à galectina-1 não houve diferença significativa entre as médias de expressão antes e após o uso de glicocorticoide sistêmico. CONCLUSÃO: Os genes apresentaram um aumento da expressão na mucosa nasal polipoide, independente do uso do glicocorticoide, porém a relação destes dois genes das proteínas anti-inflamatórias com o glicocorticoide não ocorreu da mesma maneira.

Rhinosinusal polyps physiopathology is not fully understand, despite numerous hypotheses regarding its inflammatory process. AIMS: a prospective study regarding the gene expression of proteins: anexin-1 and galectin-1, which has an anti-inflammatory action and is modulated by steroids. MATERIALS AND METHODS: eleven patients with rhinosinusal polyps suffered a biopsy of their polyps at two moments: in the absence of systemic steroids and during its use. In the two samples we assessed the expression of these genes and compared it to the normal nasal mucosa in the middle meatus. RESULTS: We noticed that the mean expression of the genes which code anexin-1 and galectin-1 was predominantly increased, regardless of the use of steroids in relation to the control nasal mucosa. Notwithstanding, in polyps without the use of steroids, the mean gene expression of anexin-1 was significantly higher than in the polyps which were under the use of steroids. Regarding galectin-1, there was no significant difference between the expression mean values before and after the use of systemic steroids. CONCLUSION: The genes present an expression increase in the polyp mucosa, regardless of the use of steroids; nonetheless, the relationship of these two genes of anti-inflammatory proteins with steroids did not happen the same way.

Management of recurrence in nasal polypi

To investigate the incidence of recurrence in nasal polypi and assess the efficacy of various modalities of the treatment currently available to prevent the recurrence. This study was carried out in the ENT and Head and Neck Surgery Department, B.V. Hospital Bahawalpur from January 2006 to December 2007. A total of 160 cases were included in the study. Most of the cases were between the ages 11-30 years. The youngest patient was of 5 years age while the eldest was of 70 years. Mean age was 24 years. The disease is most prominent in males. Out of 160, male patients were 98 and female were 62. Male to female ratio is 1.6:1. Nasal polypi are mostly bilateral [75%] while 25% were unilateral. 14% were right sided and 11% were left sided. About 60% of the patients were having symptoms for less than one year, 26% presented in 1-3 years period and only 16% presented after 3.years. Out of 160 cases, 56 [35%] patients were recurrent i.e. they had undergone already operative procedures, mostly nasal polypectomy. Nasal polypectomy was performed in 67.5% of the cases and ethmoidectomy in 32.5%. Ethoidectomy is better than nasal polypectomy and has lesser recurrence rate but a great care must be observed as the ethmoid is very close to the orbit and brain. External erthmoidectomy is the best of all surgical procedure to prevent the recurrence. Use of topical steroids after nasal polypectomy also prevents the patient from recurrence of nasal polypi

Reprodutibilidade do estadiamento endoscópico tridimensional da polipose nasal / Reproducibility of the three-dimensional endoscopic staging system for nasal polyposis

A polipose nasossinusal é um processo inflamatório crônico da mucosa nasal, caracterizado pela presença de pólipos nasais múltiplos e bilaterais. Vários tipos de medicações têm sido usados no seu tratamento. Para estudar o resultado de diferentes formas de tratamento, é preciso alguma forma de estadiamento. OBJETIVOS: Apresentar um novo método endoscópico de estadiamento, baseado na endoscopia nasal e na avaliação tridimensional dos pólipos, comparar sua reprodutibilidade entre outros dois métodos já difundidos. Forma de estudo: Estudo de coorte histórica com corte transversal. Material e método: Três examinadores avaliaram exames de 20 pacientes portadores de polipose nasossinusal em diferentes momentos, antes e 15 e 30 dias após o início de um tratamento com prednisona, na dose de 1 mg/kg/dia por 7 dias. Foi avaliado o grau de concordância entre os examinadores para cada método, utilizando-se o Kappa múltiplo para análise estatística. Resultados: Os três métodos mostraram-se reprodutíveis, sendo que o método proposto apresentou menor concordância entre os examinadores. Conclusão: O estadiamento proposto mostrou-se reprodutível, apesar de apresentar menor concordância do que os outros dois estadiamentos.

Nasal Polyposis is a chronic inflammatory process of the nasal mucosa, characterized by multiple and bilateral nasal polyps. Different drugs have been used in its treatment. In order to study the results of different treatment modalities it is necessary to have some kind of staging. AIM: to present a new endoscopic staging method, based on nasal endoscopy and on the three-dimensional nasal polyp assessment; and compare its reproducibility with that from two other systems already established in the literature. Study design: Cohort study. Material and methods: Three experts assessed the exams of 20 patients with nasal polyposis at different times, before, at 15 and at 30 days after the start of oral prednisone, 1 mg/kg/day, during 7 days. We assessed the agreement rate among the experts, using Kappa for statistic analysis. Results: The three methods were reproducible, and the method hereby proposed had the least agreement among the examiners. Conclusions: the three-dimensional staging system proposed proved reproducible, despite showing less agreement among the examiners than the other as the other two methods.

Mecanismos de ação dos corticosteróides na polipose rinossinusal: [revisão] / Mechanism of action of glucocorticoids in nasal polyposis: [review]

Os glicocorticóides (GC) são drogas de escolha no tratamento clínico da polipose nasossinusal conforme recomendação da literatura. Entretanto, seus mecanismos de ação nas regressões dos sintomas clínicos e dos pólipos não são totalmente compreendidos. Sabe-se que a administração tópica e ou sistêmica dos glicocorticóides leva a variações na expressão de citocinas, quimiocinas e linfocinas, além das alterações celulares. Assim, os GC suprimem a expressão de citocinas pró-inflamatórias, de quimiocinas, de moléculas de adesão, além de estimular a transcrição de citocinas antiinflamatórias. Citocinas pró-fibróticas como a IL-11, fator básico de crescimento do fibroblasto (b-FGF) e fator de crescimento endotelial vascular (VEGF), relacionados com o crescimento do pólipo, também são suprimidos pela ação do GC. Tal ação depende fundamentalmente da interação com os seus receptores (GR), pois alguns indivíduos apresentam algum grau de resistência celular ao seu efeito, que parece estar relacionada com a presença da isoforma b do GR. Genes envolvidos nas fases de produção de imunoglobulinas, apresentação e processamento do antígeno também sofrem ação dos GC de forma variada. OBJETIVOS: Fazer uma revisão da literatura sobre os mecanismos de ação do GC na PNS. CONCLUSÃO: A compreensão desses mecanismos implicará no desenvolvimento de drogas mais eficazes na sua terapêutica.

Glucocorticoids (GC) are the drugs of choice for the clinical treatment of nasal polyposis, according to the medical literature. Its mechanism of action in the regression of clinical symptoms and polyps, however, is not fully understood. The topical and/or systemic use of glucocorticoids lead to variable expression of cytokines, chemokines and lymphokines, as well as changes in cells. It is known that GC suppresses the expression of pro-inflammatory cytokines, chemokines and adhesion molecules such as ICAM-1 and E-selectin; GC also stimulate the transcription of anti-inflammatory cytokines such as TGF-b. GC suppress pro-fibrotic cytokines related to polyp growth, such as IL-11, the basic fibroblast growth factor (b-FGF), and the vascular endotelial growth factor (VEGF). The action of GC depends fundamentally on their interaction with receptors (GR); certain subjects have a degree of resistance to its effect, which appears to be related with the presence of a b isoform of GR. GC also act variably on the genes involved in immunoglobulin production, presentation, and antigen processing. AIM: We present a review of the literature on the mechanisms of GC action in nasal polyosis. CONCLUSION: Understanding the mechanism of action of GC in nasal polyposis will aid in the development of new, more efficient, drugs.

Efeito da mitomicina C em polipose nasossinusal eosinofílica, in vivo: dosagem de IL5 e GM-CSF, RT-PCR / Effect of mitomocin C in eosinophilic nasal polyposis, in vivo: concentration of IL5 and GM-CSF, RT-PCR

A polipose nasossinusal eosinofílica (PNS) é manifestação de uma doença inflamatória crônica na mucosa do nariz e nos seios paranasais caracterizada por infiltração de granulócitos eosinófilos. O fator responsável pela eosinofilia e manutenção dessas células com a perpetuação do processo inflamatório e formação polipóide é objeto constante de estudos. As citocinas como IL5 (interleucina 5) e GM-CSF (fator estimulador de colônia granulócito macrófago) aumentam a sobrevida dos eosinófilos e prolongam a sua presença no tecido polipóide, diminuindo o índice de apoptose eosinofílica. OBJETIVO: Avaliar o efeito da mitomicina C - MMC - por meio de aplicação tópica em pacientes portadores de PNS eosinofílica quanto à presença de IL5 e GM-CSF. CASUÍSTICA E MÉTODOS: Quinze pacientes portadores de PNS eosinofílica foram submetidos à aplicação tópica de MMC na concentração de 0,5mg/ml, 1ml, durante cinco minutos, na cavidade nasal direita, e submetidos à biópsia para RT-PCR 24hs após. O grupo-controle foi a cavidade nasal esquerda. O perfil de citocinas foi analisado para IL5 e GM-CSF. RESULTADOS: A comparação dos resultados de GM-CSF pré e pós-uso de MMC quando usamos o teste t pareado apresenta p=0,041. A comparação para IL5 resulta em p < 0,001. CONCLUSÃO: O uso de MMC em pacientes com PNS mostra redução com significância estatística par GM-CSF e importante significância para IL5.

Eosinophilic nasosinusal polyposis is a chronic inflammatory infection with elevated infiltration of eosinophils, which presents high rate of recurrence after surgical treatment. The continuous inflammatory process that leads to the formation of polyps requires constant clinical treatment. Contributing to the maintenance of eosinophilia are cytokines IL5 (interleukin-5) and GM-CSF (granulocyte macrophages colony-stimulating factor), which show up in elevated concentrations. These oligoproteins diminish the rate of apoptosis and prolong the survival of eosinophils. AIM: By diminishing these cytokines, the action of Mitomycin C (MMC), an antineoplasic drug which inhibits the synthesis of DNA, was studied. In a recent study the power of this drug to cause apoptosis in eosinophils, in vitro, of nasal polyps was verified. METHODOLOGY: A biopsy of the nasal polyps was undertaken in 15 patients carriers of eosinophilic nasosinusal polyposis 24 hours after applying 0.5 mg/ml of MMC during five minutes. RT-PCR (reverse transcription of polymerase chain reaction) for IL5 and GM-CSF was the method used to obtain the results. RESULTS: The comparison of the results of GM-CSF pre- and post-application of MMC, when the paired T-test was used, showed p=0.041 and for IL5 we found p<0.001. CONCLUSION: Topic use of MMC in patients with eosinophilic nasosinusal polyposis shows statistically significant reduction for GM-CSF and significant and important reduction for IL5.

Expression of glucocorticoid receptor mRNAs in glucocorticoid-resistant nasal polyps

Glucocorticoids (GCs) are the most effective group of medications available to treat inflammation. Although most patients with inflammation respond to GC, a small group of patients exhibit persistent GC-resistance with prolonged inflammation. Previously, it was proposed that the GC-resistance is caused by low amount of human GC receptor (hGR alpha) and/or excessive presence of a GC receptor isoform, hGR beta that was generated from alternative splicing of the hGR message. We have tested this hypothesis by investigating correlation between the expression pattern of hGR mRNAs in patients with inflammatory nasal polyps and the effectiveness of GC treatment.? We have performed reverse transcription PCR analysis of mRNAs coding each hGR alpha and hGR beta in nasal tissues.? hGR alpha mRNA was more expressed in patients with nasal polyps than in normal subjects. However, the elevated hGR alpha mRNA expression was decreased after GC treatment. Compared with hGR alpha mRNA expression, level of hGR beta mRNA expression was very low in all groups. In patients, hGR beta mRNA was expressed at a similar level regardless of GC efficacy, indicating that there is no correlation between the GC sensitivity and the expression level of hGR beta mRNA. Thus, persistent GC-resistance is not associated with low expression of hGRa or over- expression of hGR beta.

Invasive aspergillosis involving multiple paranasal sinuses--a case report.

A case of invasive multiple paranasal sinus aspergillosis with bony involvement is reported. A young immunocompetent lady presented with bilateral nasal obstruction due to polyps. Radiologically and histopathologically a fungal cause was kept a possibility, and the diagnosis of Aspegillus fumigatus was established by demonstration of acute angle branching septate hyphae on direct wet mount and repeated isolation in culture. Patient responded favourably to surgical excision of polyps and oral itraconazole post operatively.

Role of allergy in the therapeutic response of nasal polyps.

The objective of this study was to determine whether the allergy factor affects therapeutic response of nasal polyps. A total of 68 patients were enrolled between 1 October 1999 and 1 January 2002 at the Allergy and Rhinology Clinic, Faculty of Medicine, Songklanagarind Hospital. Allergy skin prick test was performed in order to divide patients into a positive skin test group and a negative skin test group. Their medical history was recorded including age, sex, nasal symptoms, concomitant diseases and medications. Patients in both groups were treated over a 6 week period with Budesonide nasal spray. Nasal symptoms, polyp size, nasal and oral expiratory peak flow were evaluated at each visit. Overall assessment of treatment efficacy was evaluated by patients at 3 and 6 weeks after treatment. The mean value of these variables during treatment and a baseline period were compared within and between groups. After 3 and 6 weeks of treatment of nasal polyps with topical Budesonide nasal spray, nasal symptoms, polyp size, nasal and oral expiratory peak flow index and overall response to treatment were improved within both groups. Comparing the two groups, there were greater improvements in the negative skin test group compared to the positive skin test group in all variables. These differences in variable scores between groups showed a tendency to increase overtime after treatment was terminated. The results demonstrate that nasal polyps with positive allergen skin test had less improvement compared to nasal polyps with negative allergen skin test in all nasal signs and symptoms and these differences in improvement showed a tendency to increase over time after treatment.

Frecuencia de pansinusitis en el postoperatorio de polipectomía endoscópica nasosinusal con la utilización de esteroide tópico nasal / Pansinsitis incidence in post-operative endoscopic nasosinusual polypectomy with the use of a topic nasal steroid

Introducción. El uso del propinato de fluticasona para el tratamiento de la rinitis, independientemente de la causa, así como su empleo como auxiliar en el tratamiento de las poliposis nasosinusales ha sido probado desde hace al menos 10 años; durante este tiempo ha mostrado buena seguridad y tolerancia. Uno de los problemas más complejos para el otorrinolaringólogo es el tratamiento de las poliposis sinusales, por su alta tasa de recurrencia. El tratamiento es múltiple, incluyendo la cirugía para mejorar la calidad de vida, ventilación por vía nasal y disminuir el volumen de la mucosa para que los medicamentos tópicos puedan llegar hasta el sitio donde se localiza la patología. Además de la cirugía se han utilizado antihistamínicos, esteroides tópicos y sistémicos, antibióticos y recientemente se ha inciado el estudio de antileucotrienos, así como el de antilinfocinas (se encuentran en fase II de investigación). Pese a la larga experiencia de la mayoría de los cirujanos en el manejo posoperatorio de la polipectomía por vía endoscópica, sólo existe un estudio, el efectuado por Mostapha en 1996, en el que se informa una mayor incidencia de pansinusitis durante el postoperatorio mediato de popectomía por vía endoscópica, con el uso del propionato de fluticasona. Aunque citado en forma reiterada por otros autores, el trabajo no ha sido reproducido, Material y métodos. Estudio prospectivo, abierto, comparativo, experimental y longitudinal, que incluyó 20 pacientes, 13 hombres y siete mujeres, con poliposis nasosinusal a los que se les efectuó resección de estas lesiones por vía endoscópica. Los sujetos fueron distribuidos en dos grupos similares. Uno de éstos (grupo control) lo integraron pacientes que no recibieron esteroides tópicos y que fueron manejados exclusivamente con los lavados nasales: El segundo grupo lo conformaron enfermos a quienes se aplicaron 200 µg propionato de fluticasona dos veces al día posteriores a lavados nasales con solución salina. Resultados. No se encontraron diferencias estadísticamente significativas entre uno y otro grupos ni en cuanto a frecuencia de presentación de infecciones o de recurrencias. Conclusiones. Los reusltados obtenidos en este estudio muestran que si se realiza un adecuado proceso de curaciones y control en el posoperatorio inmediato y mediato de las cavidades, no se presentarán cuadros de infecciones agudas, se utilice o no esteroides tópicos nasales, lo cual contradice lo notificado por Mostapha en 1996

Recidiva de poliposis nasal luego de tratamiento con beclometasona dipropionato en aerosol 50 µg y 250 µg tres veces por día / Recidivation nasal polyposis after the treatment with beclomethasone dipropionate 50 µg y 250 µg every 8 hours

Se estudiaron 16 pacientes con poliposis nasal crónica. Los pacientes fueron divididos al comienzo del estudio en tres grupos clínicos, según la poliposis estuviera acompañada de asma y atopia (IgE > 200 kU/l), fuera unilateral o bilateral. Los grupos fueron: Grupo I, poliposis nasal bilateral, asma e IgE > 200 kU/l (7 pacientes); Grupo II, poliposis nasal bilateral (5 pacientes) y Grupo III, poliposis nasal unilateral (4 pacientes). Todos los pacientes fueron sometidos a un tratamiento oral de 20 mg de metilprednisolona cada 12 horas durante 3 días, cada 24 horas durante 3 días y cada 48 horas durante 5 días. Posteriormente fueron divididos en dos grupos terapéuticos (Grupos A y B) que contenían cantidades similares de pacientes de los grupos clínicos. El Grupo A recibió 50 µg de beclometasona dipropionato en aerosol cada 8 horas durante 6 meses, y el Grupo B, 250 mg de beclometasona dipropionato en aerosol cada 8 horas durante 6 meses. Se examinó la evolución de los pacientes según un score de síntomas que incluían bloqueo nasal, hidrorrea y/o secreción nasal, estornudos e hipoosmia. Los análisis estadísticos se realizaron con el estudio de la tendencia y la diferencia de medias de los valores promedios mensuales entre ambos grupos terapéuticos. El resultado es una diferencia significativa (p<0.01) entre ambos grupos, lo cual expresa la menor recidiva de los síntomas de pólipos nasales al utilizar por vía tópica nasal 250 µg. de dipropionato de beclometasona