Nasal irrigation with corticosteroids in Brazil: the clinical response of 1% compounded budesonide drops and betamethasone cream

Abstract Introduction: High-volume corticosteroid nasal irrigation is a treatment option in patients with chronic rhinosinusitis. In Brazil, alternatives are used to optimize its cost and popularize its use, such as 1% compounded budesonide drops or betamethasone cream, and it is necessary to study these treatment modalities. Objective: To evaluate the clinical response of nasal irrigation with 1% compounded budesonide drops or betamethasone cream compared to nasal sprays utilized in patients with chronic rhinosinusitis. Methods: This was a retrospective observational study with 257 patients. One hundred and eight patients using corticosteroid nasal irrigation (292 treatment cycles) and 149 using corticosteroid nasal spray (300 treatment cycles) were included. Evaluation of subjective improvement, adverse events, exacerbations, and objective assessments with SNOT-22 and Lund-Kennedy endoscopic score were performed, in addition to sub-analyses related to nasal polyps and previous surgery. Results: Corticosteroid nasal irrigation and corticosteroid nasal spray improved the Lund-Kennedy endoscopic score, with more adverse events in the corticosteroid nasal irrigation group. Previous surgery increased corticosteroid nasal irrigation improvement, with greater subjective improvement and fewer exacerbations. 1% compounded budesonide drops were better than betamethasone cream in the Lund-Kennedy endoscopic score, with fewer adverse events. A 1,000 μg dose of 1% compounded budesonide drops was more effective than 500 μg. Conclusion: Corticosteroid nasal irrigation was effective in improving the Lund-Kennedy endoscopic score in chronic rhinosinusitis, especially in patients with nasal polyps and previous surgery, in addition to promoting a higher rate of subjective improvement and fewer exacerbations than corticosteroid nasal spray, but with more adverse events. 1% compounded budesonide drops improved the Lund-Kennedy endoscopic score with fewer adverse events than betamethasone cream, particularly at higher doses (1000 μg).

Nova era no tratamento da hepatite C crônica em pacientes naïve / New era in the treatment of chronic hepatitis C virus in patients naïve

Estudos recentes com novos medicamentos para hepatite C crônica mostram altas taxas de resposta virológica sustentada (RVS). Esta revisão baseia-se nas novas diretrizes para o tratamento de pacientes naïve (virgens de tratamento) com infecção crônica pelo vírus da hepatite C (HCV), em seus diferentes genótipos.

Recent studies with new drugs for chronic hepatitis C show high sustained virologic response rates (SVR). This review is based on the new guidelines for the treatment of patients naïve with chronic infection by hepatitis C virus (HCV), in their different genotypes.

Tumefações cervicais / Cervical masses

Tumefações cervicais representam uma queixa freqüente nos consultórios médicos. A causa dessas tumefações abrange uma ampla lista de diagnósticos diferenciais. Elas podem ser a manifestação de uma simples adenite inflamatória reativa a uma infecção viral ou mesmo significar uma neoplasia metastática avançada. Cabe ao medico saber quando há necessidade de investigação adicional. Anamnese e exame físico cuidadoso são indispensáveis para um correto diagnóstico.

Cervical masses are a common symptom in a doctor´s office. The cause of these masses covers a huge list of diagnosis. They can represent a simple inflammatory lymphadenitis due to a viral infection or even they can mean an advanced metastatic disease. It is clinician´s role to evaluate them and to know when it is necessary further investigation. Anamnesis and a careful physical examination are indispensable for a correct diagnosis.