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1.
Braz. j. otorhinolaryngol. (Impr.) ; 86(6): 743-747, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142588

ABSTRACT

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


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


Subject(s)
Humans , Sinusitis/complications , Rhinitis/complications , Nasal Polyps/complications , Quality of Life , Chronic Disease , Cross-Sectional Studies , Epithelial Cells
2.
Arch. argent. pediatr ; 118(5): e491-e494, oct 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1122539

ABSTRACT

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente


Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient


Subject(s)
Humans , Female , Infant, Newborn , Nasal Polyps/diagnostic imaging , Resuscitation , Nasal Polyps/surgery , Nasopharyngeal Diseases , Cyanosis , Airway Obstruction , Intubation, Intratracheal , Neoplasms
3.
Article in English | WPRIM | ID: wpr-876439

ABSTRACT

@#Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods: Design: Quasi - Experimental Prospective Cohort Study Setting: Tertiary Government Training Hospital Participants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone. Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A. Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.


Subject(s)
Stents , Nasal Obstruction , Nasal Polyps , Sinusitis
4.
Article in Spanish | LILACS, COLNAL | ID: biblio-1102963

ABSTRACT

Introducción: la rinosinusitis crónica (RSC) es una de las enfermedades más prevalentes a nivel mundial. Los eosinófilos desempeñan un papel importante en la generación del proceso inflamatorio nasosinusal crónico secundario a la generación de una respuesta maladaptativa Th2 y cambios en la microbiota nasal. El objetivo del estudio es determinar si la eosinofilia periférica puede usarse como factor predictor de severidad tomográfica en pacientes que cursan con rinosinusitis crónica. Métodos: se realizó un estudio observacional de corte transversal con componente analítico en pacientes con diagnóstico de RSC quienes dispusieran en su registro de historia clínica un hemograma con recuento de eosinófilos. El tamaño de la muestra fue de 74 individuos. Resultados: la eosinofilia periférica se estableció como factor de severidad tomográfica, ya que se encontró que por cada incremento de 100 eosinófilos en sangre, aumentaría en un punto el puntaje total de la escala tomográfica Lund-Mackay. Este patrón fue similar en pacientes con pólipos y asma, en los que se encontró un incremento en los puntajes totales de 4 y 5 puntos, respectivamente, con respecto a los pacientes que no presentan estas patologías. Conclusión: la utilización de la eosinofilia periférica como predictor de severidad podría ser de gran utilidad para la comunidad médica. Este biomarcador puede resultar en un ahorro potencial de costos al eliminar la necesidad de tratamientos médicos repetidos en pacientes que de entrada tienen un riesgo incrementado de enfermedad nasosinusal severa.


Introduction: chronic rhinosinusitis (CRS) is one of the most prevalent diseases worldwide. Eosinophils play an important role in the generation of a chronic nasosinusal inflammatory process secondary to the generation of a Th2 maladaptive response and changes in the nasal microbiota. The objective of the study is to determine if peripheral eosinophilia can be used as a predictor of tomographic severity in patients with chronic rhinosinusitis. Methods: an observational cross-sectional study with an analytical component was performed in patients with a diagnosis of CSR who had an eosinophil count in their clinical record. The sample size was 74 individuals. Results: peripheral eosinophilia was established as a tomographic severity factor, finding that for each increase of 100 eosinophils in blood, the total score of the Lund-Mackay tomographic scale would increase by 1 point. This pattern was equally concordant in patients with polyps and asthma, with increases in total scores of 4 and 5 points respectively, with respect to patients who do not present these pathologies. Conclusion: the uses of peripheral eosinophilia as a predictor of severity could be very useful for the medical community. This biomarker can result in potential cost savings by eliminating the need for repeated medical treatments in patients who initially have an increased risk of severe nasosinusal disease.


Subject(s)
Humans , Sinusitis , Nasal Polyps , Eosinophilia , Eosinophils
5.
Article in English | WPRIM | ID: wpr-811062

ABSTRACT

PURPOSE: Th17-associated inflammation is increased in chronic rhinosinusitis with nasal polyp (CRSwNP), and is associated with disease severity and steroid resistance. Overexpressed interleukin (IL)-17A affects CRSwNP by tissue remodeling, eosinophilic accumulation, and neutrophilic infiltration. We aimed to identify the role of IL-17A in CRSwNP and to evaluate the effects of anti-IL-17A blocking antibody on nasal polyp (NP) formation using a murine NP model. Moreover, we sought to investigate whether the inhibition of mechanistic target of the rapamycin (mTOR) signal pathway could suppress IL-17A expression and NP formation.METHODS: Human sinonasal tissues from control subjects and patients with chronic rhinosinusitis (CRS) were analyzed using immunohistochemistry (IHC) and immunofluorescence staining. The effects of IL-17A neutralizing antibody and rapamycin were evaluated in a murine NP model. Mouse samples were analyzed using IHC, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay.RESULTS: IL-17A+ inflammatory cells were significantly increased in number in NP from patients with CRSwNP compared to that in uncinate process tissues from control subjects and patients with CRS without NP or CRSwNP. CD68+ M1 macrophages dominantly expressed IL-17A, followed by neutrophils and T helper cells, in NP tissues. Neutralization of IL-17A effectively reduced the number of NPs, inflammatory cytokines, and IL-17A-producing cells, including M1 macrophages. Inhibition of IL-17A via the mTOR pathway using rapamycin also attenuated NP formation and inflammation in the murine NP model.CONCLUSIONS: IL-17A possibly plays a role in the pathogenesis of CRSwNP, the major cellular source being M1 macrophage in NP tissues. Targeting IL-17A directly or indirectly may be an effective therapeutic strategy for CRSwNP.


Subject(s)
Animals , Antibodies, Neutralizing , Cytokines , Enzyme-Linked Immunosorbent Assay , Eosinophils , Fluorescent Antibody Technique , Humans , Immunohistochemistry , Inflammation , Interleukin-17 , Interleukins , Macrophages , Mice , Nasal Polyps , Neutrophils , Real-Time Polymerase Chain Reaction , Signal Transduction , Sinusitis , Sirolimus , T-Lymphocytes, Helper-Inducer
7.
Article in English | WPRIM | ID: wpr-785341

ABSTRACT

PURPOSE: Plasma cells and immunoglobulins (Igs) play a pivotal role in the induction and maintenance of chronic inflammation in nasal polyps. During secondary immune responses, plasma cell survival and Ig production are regulated by the local environment. The purpose of the present study was to investigate the presence of long-lived plasma cells (LLPCs) and specific survival niches for LLPCs in human nasal polyps.METHODS: Nasal mucosal samples were cultured with an air-liquid interface system and the Ig levels in culture supernatants were analyzed by enzyme-linked immunosorbent assay. The characteristics of LLPCs in nasal polyps were determined by immunohistochemistry and immunofluorescence. The expression of neurotrophins as well as their receptors was detected by quantitative real-time polymerase chain reaction, immunohistochemistry, immunofluorescence, and Western blotting.RESULTS: The numbers of CD138⁺ total plasma cells and BCL2⁺ plasma cells were increased in both eosinophilic and non-eosinophilic nasal polyps compared with those in normal tissues. The production of IgG, IgA, and IgE was detected in culture supernatants even after a 32-day culture of nasal polyps. Although the total numbers of plasma cells were decreased in nasal polyps after culture, the numbers of BCL2⁺ plasma cells remained stable. The expression of nerve growth factor (NGF) as well as tropomyosin receptor kinase (Trk) A, a high-affinity receptor for NGF, was upregulated in both eosinophilic and non-eosinophilic nasal polyps. In addition, BCL2⁺ plasma cell numbers were positively correlated with NGF and TrkA mRNA expression in nasal mucosal tissues. Polyp plasma cells had the expression of TrkA.CONCLUSIONS: Human nasal polyps harbor a population of LLPCs and NGF may be involved in their prolonged survival. LLPCs may be a novel therapeutic target for suppressing the local Ig production in nasal polyps.


Subject(s)
Blotting, Western , Enzyme-Linked Immunosorbent Assay , Eosinophils , Fluorescent Antibody Technique , Humans , Immunoglobulin A , Immunoglobulin E , Immunoglobulin G , Immunoglobulins , Immunohistochemistry , Inflammation , Mucous Membrane , Nasal Polyps , Nerve Growth Factor , Nerve Growth Factors , Phosphotransferases , Plasma Cells , Plasma , Polyps , Real-Time Polymerase Chain Reaction , RNA, Messenger , Tropomyosin
8.
Article in English | WPRIM | ID: wpr-785339

ABSTRACT

PURPOSE: Osteitis refers to the development of new bone formation and remodeling of bone in chronic rhinosinusitis (CRS) patients; it is typically associated with eosinophilia, nasal polyps (NPs), and recalcitrant CRS. However, the roles of ossification in CRS with or without NPs remain unclear due to the lack of appropriate animal models. Thus, it is necessary to have a suitable animal model for greater advances in the understanding of CRS pathogenesis.METHODS: BALB/c mice were administered ovalbumin (OVA) and staphylococcal enterotoxin B (SEB). The numbers of osteoclasts and osteoblasts and bony changes were assessed. Micro computed tomography (micro-CT) scans were conducted to measure bone thickness. Immunofluorescence, immunohistochemistry, and quantitative polymerase chain reaction were performed to evaluate runt-related transcription factor 2 (RUNX2), osteonectin, interleukin (IL)-13, and RUNX2 downstream gene expression. Gene set enrichment analysis was performed in mucosal tissues from control and CRS patients. The effect of resveratrol was evaluated in terms of osteogenesis in a murine eosinophilic CRS NP model.RESULTS: The histopathologic changes showed markedly thickened bones with significant increase in osteoblast numbers in OVA/SEB-treated mice compared to the phosphate-buffered saline-treated mice. The structural changes in bone on micro-CT were consistent with the histopathological features. The expression of RUNX2 and IL-13 was increased by the administration of OVA/SEB and showed a positive correlation. RUNX2 expression mainly co-localized with osteoblasts. Bioinformatic analysis using human CRS transcriptome revealed that IL-13-induced bony changes via RUNX2. Treatment with resveratrol, a candidate drug against osteitis, diminished the expression of IL-13 and RUNX2, and the number of osteoblasts in OVA/SEB-treated mice.CONCLUSIONS: In the present study, we found the histopathological and radiographic evidence of osteogenesis using a previously established murine eosinophilic CRS NP model. This animal model could provide new insights into the pathophysiology of neo-osteogenesis and provide a basis for developing new therapeutics.


Subject(s)
Animals , Computational Biology , Core Binding Factor Alpha 1 Subunit , Enterotoxins , Eosinophilia , Eosinophils , Fluorescent Antibody Technique , Gene Expression , Humans , Immunohistochemistry , Interleukin-13 , Interleukins , Mice , Models, Animal , Mucous Membrane , Nasal Polyps , Nose , Osteitis , Osteoblasts , Osteoclasts , Osteogenesis , Osteonectin , Ovalbumin , Polymerase Chain Reaction , Sinusitis , Transcription Factors , Transcriptome
10.
Article in English | WPRIM | ID: wpr-762184

ABSTRACT

PURPOSE: Various immune cells, including eosinophils and neutrophils, are known to contribute to the development of chronic rhinosinusitis with nasal polyps (CRSwNP). However, the current understanding of the role of neutrophils in the development of CRSwNP still remains unclear. Therefore, we investigated risk factors for refractoriness of CRSwNP in an Asian population. METHODS: Protein levels of 17 neutrophil-related mediators in nasal polyps (NPs) were determined by multiplex immunoassay, and exploratory factor analysis using principal component analysis was performed. Immunofluorescence analysis was conducted to detect human neutrophil elastase (HNE) or myeloperoxidase (MPO)-positive cells. Tissue eosinophilic nasal polyp (ENP) and tissue neutrophilia (Neu(high)) were defined as greater than 70 eosinophils and 20 HNE-positive cells, otherwise was classified into non-eosinophilic nasal polyp (NENP) and absence of tissue neutrophilia (Neu(low)). RESULTS: In terms of disease control status, NENP-Neu(low) patients showed the higher rate of disease control than NENP-Neu(high) and ENP-Neu(high) patients. Linear by linear association demonstrated the trend in refractoriness from NENP-Neu(low) to NENP-Neu(high) or ENP-Neu(low) to ENP-Neu(high). When multiple logistic regression was performed, tissue neutrophilia (hazard ratio, 4.38; 95% confidence interval, 1.76-10.85) was found as the strongest risk factor for CRSwNP refractoriness. Additionally, exploratory factor analysis revealed that interleukin (IL)-18, interferon-γ, IL-1Ra, tumor necrosis factor-α, oncostatin M, and MPO were associated with good disease control status, whereas IL-36α and IL-1α were associated with refractory disease control status. In subgroup analysis, HNE-positive cells and IL-36α were significantly upregulated in the refractory group (P = 0.0132 and P = 0.0395, respectively), whereas MPO and IL-18 showed higher expression in the controlled group (P = 0.0002 and P = 0.0009, respectively). Moreover, immunofluorescence analysis revealed that IL-36R⁺HNE⁺-double positive cells were significantly increased in the refractory group compared to the control group. We also found that the ratio of HNE-positive cells to α1 anti-trypsin was increased in the refractory group. CONCLUSIONS: Tissue neutrophilia had an influence on treatment outcomes in the Asian CRSwNP patients. HNE-positive cells and IL-36α may be biomarkers for predicting refractoriness in Asians with CRSwNP. Additionally, imbalances in HNE and α1 anti-trypsin may be associated with pathophysiology of neutrophilic chronic rhinosinusitis.


Subject(s)
Asian Continental Ancestry Group , Biomarkers , Eosinophils , Fluorescent Antibody Technique , Humans , Immunoassay , Interleukin 1 Receptor Antagonist Protein , Interleukin-18 , Interleukins , Leukocyte Elastase , Logistic Models , Nasal Polyps , Necrosis , Neutrophils , Oncostatin M , Peroxidase , Principal Component Analysis , Rhinitis , Risk Factors , Sinusitis
11.
Braz. j. otorhinolaryngol. (Impr.) ; 85(6): 780-787, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055519

ABSTRACT

Abstract Introduction: Chronic rhinosinusitis can lead to poor sleep quality in affected individuals. Endoscopic nasal surgery has been indicated for patients with chronic rhinosinusitis, resulting in improved quality of life, but it is still unknown if there is a similar improvement in sleep quality after the surgical procedure. Objective: To estimate the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery. Methods: The literature search was conducted in the indexed databases PubMed, Embase, Lilacs, SciELO, Google Scholar, Web of Science, Scopus, Database of Thesis and Dissertations of CAPES, Cochrane Library, Clinical Trials and in the grey literature. It included studies that reported the sleep quality of patients with chronic rhinosinusitis after undergoing endoscopic sinus surgery based on questionnaires assessing quality of life. Two researchers independently conducted the study selection and extraction. The random effects model was chosen to conduct the meta-analysis that was performed using the statistical package STATA, version 11. Results: Overall, 4 studies and 509 subjects were included in the systematic review. Improved sleep quality was observed in 90% of the patients. There was an improvement (on average, from 57% to 67%) in each of the five symptoms related to sleep quality. The results of the meta-analysis revealed high heterogeneity. Conclusions: This review shows that a large percentage of patients report improved sleep quality after endoscopic sinus surgery.


Resumo Introdução: A rinossinusite crônica pode levar a uma má qualidade do sono nos indivíduos afetados. A cirurgia endoscópica nasal tem sido indicada para pacientes com rinossinusite crônica, resulta em melhoria da qualidade de vida, mas ainda não se sabe se há melhoria semelhante na qualidade do sono após o procedimento cirúrgico. Objetivo: Estimar a qualidade do sono em pacientes com rinossinusite crônica após serem submetidos à cirurgia endoscópica nasossinusal. Método: A busca na literatura foi feita nas bases de dados indexadas PubMed, Embase, Lilacs, SciELO, Google Scholar, Web of Science, Scopus, Banco de Teses e Dissertações da Capes, Cochrane Library, Clinical Trials e na literatura cinzenta. Foram incluídos estudos que relataram a qualidade do sono de pacientes com rinossinusite crônica após ser submetidos à cirurgia endoscópica nasossinusal, com base em questionários que avaliaram a qualidade de vida. Dois pesquisadores conduziram independentemente a seleção e extração dos estudos. O modelo de efeitos aleatórios foi escolhido para conduzir a meta-análise que foi feita com o pacote estatístico STATA, versão 11. Resultados: No total, 4 estudos e 509 indivíduos foram incluídos na revisão sistemática. Melhora na qualidade do sono foi observada em 90% dos pacientes. Houve melhora (em média, de 57% a 67%) em cada um dos cinco sintomas relacionados à qualidade do sono. Os resultados da meta-análise apresentaram alta heterogeneidade. Conclusões: Esta revisão mostra que uma grande porcentagem de indivíduos relata melhoria na qualidade do sono após a cirurgia endoscópica nasossinusal.


Subject(s)
Humans , Sinusitis/surgery , Sleep/physiology , Rhinitis/surgery , Endoscopy/methods , Quality of Life , Nasal Polyps/surgery , Chronic Disease , Surveys and Questionnaires , Nasal Surgical Procedures
12.
Braz. j. otorhinolaryngol. (Impr.) ; 85(6): 760-765, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055517

ABSTRACT

Abstract Introduction: Chronic rhinosinusitis with nasal polyps is a heterogeneous disease and appropriate diagnostic algorithms in individual cases are necessary for effective medical treatment. Objective: The purpose of this study was to clarify the relationship between the pendrin expression of nasal polyps and clinical and pathological characteristic features of eosinophilic chronic rhinosinusitis. Methods: A total of 68 patients were classified into eosinophilic chronic rhinosinusitis or non-eosinophilic chronic rhinosinusitis groups according to the degree of eosinophilic infiltration into the nasal polyps. Clinical, hematological, and immunohistochemical analyses were performed and statistically compared between both groups. Results: Thirty-eight were classified into eosinophilic chronic rhinosinusitis and 30 into non-eosinophilic chronic rhinosinusitis groups. There were no significant differences in age distribution, sex ratio, prevalence of asthma, or any other complications between the groups. The mean Lund-Mackay score and the number of serum eosinophils was significantly higher in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. The pendrin expression was more frequently detected in the epithelial surface layer of nasal polyps in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. In addition, mucin 5AC was more widely expressed in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis. Conclusion: Increased expression of pendrin and mucin 5AC in the nasal polyps would be associated with development of eosinophilic chronic rhinosinusitis. This finding could allow the development of a novel therapeutic agent targeted specifically to patients with eosinophilic chronic rhinosinusitis.


Resumo Introdução: A rinossinusite crônica com pólipos nasais é uma doença heterogênea e algoritmos diagnósticos apropriados em casos individuais são necessários para um tratamento médico eficaz. Objetivo: O objetivo deste estudo foi esclarecer a relação entre a expressão da pendrina de pólipos nasais e propriedades clínicas e patológicas características da rinossinusite crônica eosinofílica. Método: Um total de 68 pacientes foram classificados como tendo rinossinusite crônica eosinofílica ou rinossinusite crônica não eosinofílica de acordo com o grau de infiltração eosinofílica nos pólipos nasais. Análises clínicas, hematológicas e imunohistoquímicas foram realizadas e comparadas estatisticamente entre os dois grupos. Resultados: Entre os pacientes, 38 apresentavam rinossinusite crônica eosinofílica e constituíram o grupo 1; 30 tinham rinossinusite crônica não eosinofílica e constituíram o grupo 2. Não houve diferenças significantes na distribuição etária, razão entre os sexos, prevalência de asma ou qualquer outra complicação entre os grupos. O escore médio de Lund-Mackay e o número de eosinófilos séricos foram significantemente maiores no grupo com rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. A expressão da pendrina foi mais frequentemente detectada na camada epitelial superficial dos pólipos nasais na rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. Além disso, mucina 5AC foi mais amplamente expressa na rinossinusite crônica eosinofílica do que na rinossinusite crônica não eosinofílica. Conclusão: O aumento da expressão da pendrina e mucina 5AC nos pólipos nasais estaria associado ao desenvolvimento de rinossinusite crônica eosinofílica. Esse achado pode permitir o desenvolvimento de um novo agente terapêutico voltado especificamente para pacientes com rinossinusite crônica eosinofílica.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Sinusitis/metabolism , Rhinitis/metabolism , Nasal Polyps/metabolism , Eosinophilia/metabolism , Sulfate Transporters/metabolism , Asthma/etiology , RNA, Messenger , Chronic Disease , Cytokines/metabolism , Eosinophilia/etiology
13.
Arch. argent. pediatr ; 117(6): 670-675, dic. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1046729

ABSTRACT

El compromiso orbitario es la complicación más frecuente de la rinosinusitis aguda en pediatría, y el etmoides es el seno más afectado. La recurrencia es infrecuente. Existen solo tres casos publicados en la literatura. Una anomalía anatómica del proceso unciforme o un mucocele podrían ser factores predisponentes, que pueden obstruir el drenaje normal de los senos junto con la presencia de etmoiditis.La tomografía computada y la resonancia magnética orientan el diagnóstico. El tratamiento quirúrgico está indicado ante la falta de respuesta al tratamiento instaurado luego de 48 horas o disminución de la agudeza visual o recurrencias sin patología tumoral de base.Se presenta a un paciente de 4 años de edad que consultó por un cuadro compatible con etmoiditis complicada recurrente. Presentó celulitis preseptal en seis oportunidades y un episodio de absceso subperióstico, desde los 3 meses de edad. Evolucionó favorablemente luego de la operación quirúrgica.


Orbital infection is the most frequent complication of ethmoiditis. Recurrent periorbital cellulitis is a very rare complication of rhinosinusitis with only three reports in the literature describing this pathological process.This complication can be favored by an anatomical abnormality of the uncinate process or mucocele obstructing the normal drainage pathway, in addition to ethmoidal sinusitis.Computed tomography and magnetic resonance guide the diagnosis. The treatment is based on antibiotics, corticosteroids and local decongestants. Surgical treatment is indicated in the absence of response to treatment established after 48 hours or decrease in visual acuity or recurrent orbital complications without underlying tumor pathology. In this report, we present a case of orbital complication of rhinosinusitis in a 4 year-old-child with six episodes of unilateral periorbital cellulitis and one episode of subperiosteal orbital abscess since the age of 3 months. There was a complete resolution with no recurrence after the surgical intervention


Subject(s)
Humans , Male , Child, Preschool , Ethmoid Sinusitis/diagnosis , Orbital Cellulitis/diagnostic imaging , Ethmoid Sinusitis/drug therapy , Nasal Polyps , Ethmoid Sinus/surgery , Orbital Cellulitis/surgery
14.
Rev. fac. cienc. méd. (Impr.) ; 16(1): 28-33, ene.-jun. 2019.
Article in Spanish | LILACS | ID: biblio-1024430

ABSTRACT

La poliposis nasosinusal, es una entidad caracterizada por un proceso inflamatorio de la mucosa nasosinusal, con sintomatología obstructiva, para su diagnóstico es necesario la exploración endoscópica y la tomografía computarizada, siendo la cirugía endoscópica nasosinusal, el tratamiento recomendado. Objetivo:recopilar información actualizada acerca de la poliposis nasosinusal con respecto a su fisiopatología, diagnóstico y tratamiento. Material y Métodos: se realizó la búsqueda de artículos en las bases de datos como HINARI, SciELO, Biblioteca Cochrane, PubMed, con las palabras clave rinosinusitis polipoide y poliposis nasosinusal, en inglés y español; se encontraron varios artículos, de los cuales se seleccionaron 20, de revistas biomédicas publicadas en los últimos 5 años y según su importancia de los conceptos básicos de esta entidad. Conclusión: existe debate en la fisiopatología de la poliposis nasosinusal, aunque se acepta la teoría alérgica y la reacción inflamatoria como las causas. Además, el manejo medicamentoso, no es un tratamiento definitivo, teniendo que recurrir al tratamiento quirúrgico para mejorar la sintomatología, donde el tratamiento recae principalmente, en la cirugía endoscópica nasosinusal...(AU)


Subject(s)
Humans , Nasal Obstruction/complications , Nasal Polyps/diagnosis , Sinusitis , Tomography, X-Ray Computed
15.
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 101-103, Jan.-Mar. 2019. graf
Article in English | LILACS | ID: biblio-1002176

ABSTRACT

Abstract Introduction Eosinophilic chronic rhinosinusitis (ECRS) is characterized by an eosinophilic inflammation driven by Th2-type cytokines. Glucocorticosteroids are the most common first-line treatment for ECRS with nasal polyps. Objective We have evaluated the long-term treatment with double-dose intranasal corticosteroids in refractory ECRS nasal polyps resistant to the conventional dose and assessed the risk of adverse systemic effects Methods Sixteen subjects were enrolled in this study. All subjects had ECRS after endoscopic sinus surgery that resulted in recurrentmild andmoderate nasal polyps and were undergoing a postoperative follow-up application of mometasone furoate at a dose of 2 sprays (100 μg) in each nostril once a day (200 μg). All the patients were prescribed mometasone furoate, administered at a dose of 2 sprays (100 μg) in each nostril twice a day (400 μg) for 6 months. Results The average scores of the symptoms during the regular dose of intranasal steroid treatment were 5.2 ± 2.2, but 6 months after the high-dose application, they had significantly decreased to 2.5 ± 1.4 (p < 0.05). The polyp size showed an average score of 1.38 during the regular dose which was significantly reduced to 0.43 (p < 0.01) by the double dose. Glycated hemoglobin (HbA1c) showed normal ranges in all the patients tested. The cortisol plasma concentration was also normal. Conclusion Doubling the dose of the nasal topical spray mometasone furoate might be recommended for the treatment of recurrent nasal polyps in the postoperative follow-up of intractable ECRS. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sinusitis/drug therapy , Rhinitis/drug therapy , Mometasone Furoate/administration & dosage , Mometasone Furoate/adverse effects , Postoperative Care , Sinusitis/surgery , Administration, Intranasal , Rhinitis/surgery , Nasal Polyps/physiopathology , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Endoscopy , Nasal Sprays
16.
Article in Korean | WPRIM | ID: wpr-760153

ABSTRACT

Chronic rhinosinusitis (CRS) is divided into CRS with nasal polyp (CRSwNP) and CRS without nasal polyp (CRSsNP) according to the presence of a nasal polyp. Some of the CRSwNP patients are relatively well managed without recurrences while others are difficult due to recurrence and refractoriness after surgical or medical treatment. Thus CRSwNP is not a single disease but is rather considered as a disease that has a variety of disease spectrum. Various biomarkers have been proposed to distinguish endotypes of CRSwNP. CRSwNP with high tissue eosinophil infiltration with robust type 2 inflammation (e.g., IL-5) is usually associated with comorbid asthma and is likely to recur. This type of CRSwNP is relatively common in Western countries. However, in Asian countries, CRSwNP is often presented as a heterogeneous disease comprising a mixture of type 1 (e.g., IFN-γ), type 2 and type 3 (e.g., IL-17) inflammation. In Asians, up-regulation of IL-8, IFN-γ and associated neutrophilic inflammation is prone to have disease refractoriness. Different underlying inflammatory profile indicates different underlying pathogenesis. Therefore, in the era of precision medicine, treatment should be based upon according to endotype.


Subject(s)
Asian Continental Ancestry Group , Asthma , Biomarkers , Eosinophils , Humans , Inflammation , Interleukin-8 , Nasal Polyps , Neutrophils , Precision Medicine , Recurrence , Sinusitis , Up-Regulation
17.
Article in Korean | WPRIM | ID: wpr-760132

ABSTRACT

BACKGROUND AND OBJECTIVES: Manuka honey has anti-microbial, anti-inflammatory, and anti-proliferative action with a high concentration of methylglyoxal compound. It is also effective in killing Staphylococcus aureus biofilm and effective for the acute exacerbation of chronic rhinosinusitis. The aim of this study was to determine the anti-fibrotic effect of manuka honey in nasal polyp fibroblasts. MATERIALS AND METHOD: Primary nasal fibroblasts were isolated from nasal polyps and treated with transforming growth factor-beta 1 (TGF-β1). To determine the anti-fibrotic effect of manuka honey, fibroblasts were pre-treated with various concentration of the honey. Reverse transcription-polymerase chain reaction and western blot analysis were then performed to determine α-smooth muscle actin (α-SMA), collagen type I, and matrix metalloproteinase-9 (MMP-9) messenger ribonucleic acid (mRNA) expression and protein production in nasal polyp fibroblasts. Phosphorylated Smad (pSmad) 2/3 and phosphorylated adenosine monophosphate-activated protein kinase (pAMPK) were then determined by western blotting. RESULTS: TGF-β1 stimulation increased α-SMA, collagen type I, and MMP-9 mRNA expression and protein production in nasal polyp fibroblasts. Manuka honey effectively suppressed α-SMA, collagen type I, and MMP-9 mRNA expression and protein production. Its inhibitory role on TGF-β1 induced myofibroblast differentiation and its extracellular matrix production was associated with Smad2/3 and AMPK pathway. CONCLUSION: Manuka honey can inhibit TGF-β1 induced myofibroblast differentiation, collagen type I, and MMP-9 production in nasal fibroblasts. These results suggest that manuka honey might be a useful candidate for the inhibition of nasal polyp formation if further studies in vivo were accompanied.


Subject(s)
Actins , Adenosine , AMP-Activated Protein Kinases , Biofilms , Blotting, Western , Collagen Type I , Extracellular Matrix , Fibroblasts , Homicide , Honey , Matrix Metalloproteinase 9 , Methods , Myofibroblasts , Nasal Polyps , Protein Kinases , Pyruvaldehyde , RNA , RNA, Messenger , Staphylococcus aureus , Transforming Growth Factor beta , Transforming Growth Factors
18.
Article in Korean | WPRIM | ID: wpr-760110

ABSTRACT

Woakes' syndrome is a group of disease which include recurrent nasal polyps resulting in the broadening of the nasal pyramid, the onset of hypoplasia of frontal sinus and bronchiectasis, as well as the production of mucous discharge. Children and young adults are mostly susceptible to Woakes' syndrome due to the plasticity of the bone. Even though the exact etiology is unknown, genetic factor is thought to be influential because it is often diagnosed in siblings. Otolaryngologically, the mainstream method of removing nasal polyp by endoscopic sinus surgery as well as topical or systemic treatment can be helpful. We report two siblings who visited our clinic both complaining of nasal obstruction. The patients presented with recurrent nasal polyps and showed signs of bronchiectasis, which led to the diagnosis of Woakes' syndrome. These rare cases are presented here with a review of related literature.


Subject(s)
Bronchiectasis , Child , Diagnosis , Fibrinogen , Frontal Sinus , Humans , Methods , Nasal Obstruction , Nasal Polyps , Plastics , Siblings , Young Adult
19.
Article in Korean | WPRIM | ID: wpr-760096

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study. SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications. RESULTS: Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis. CONCLUSION: CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.


Subject(s)
Adult , Aged , Comorbidity , Epistaxis , Heart Arrest , Humans , Incidence , Medical Records , Methods , Nasal Polyps , Nasal Surgical Procedures , Orbit , Pneumonia , Quality of Life , Retrospective Studies , Risk Factors , Stroke
20.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 241-249, 2019. ilus, tab
Article in English | LILACS | ID: biblio-1015650

ABSTRACT

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)


Subject(s)
Humans , Nasal Polyps/physiopathology , Nasal Polyps/pathology , Inflammation/physiopathology , Sinusitis/physiopathology , Biomechanical Phenomena , Brazil , Flow Mechanics , Chronic Disease , Edema/physiopathology , Extracellular Matrix/pathology , Hydrostatic Pressure , Nasal Mucosa/physiopathology , Nasal Mucosa/pathology
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