The Impact of Antibiotics and Steroids on the Nasal Microbiome in Patients with Chronic Rhinosinusitis: A Systematic Review According to PICO Criteria.

BACKGROUND: The nasal microbiome represents the main environmental factor of the inflammatory process in chronic rhinosinusitis (CRS). Antibiotics and steroids constitute the mainstay of CRS therapies. However, their impact on microbial communities needs to be better understood. This systematic review summarizes the evidence about antibiotics' and steroids' impact on the nasal microbiota in patients with CRS. METHODS: The search strategy was conducted in accordance with the PRISMA guidelines for systematic reviews. The authors searched all papers in the three major medical databases (PubMed, Scopus, and Cochrane Library) using the PICO tool (population, intervention, comparison, and outcomes). The search was carried out using a combination of the key terms "Microbiota" or "Microbiome" and "Chronic Rhinosinusitis". RESULTS: Overall, 402 papers were identified, and after duplicate removal (127 papers), excluding papers off-topic (154) and for other structural reasons (110), papers were assessed for eligibility; finally, only 11 papers were included and summarized in the present systematic review. Some authors used only steroids, other researchers used only antibiotics, and others used both antibiotics and steroids. With regard to the use of steroids as exclusive medical treatment, topical mometasone and budesonide were investigated. With regard to the use of antibiotics as exclusive medical treatments, clarithromycin, doxycycline, roxithromycin, and amoxicillin clavulanate were investigated. Regarding the use of both antibiotics and steroids, two associations were investigated: systemic prednisone combined with amoxicillin clavulanate and topical budesonide combined with azithromycin. CONCLUSIONS: The impact that therapies can have on the nasal microbiome of CRS patients is very varied. Further studies are needed to understand the role of the nasal microbiome, prevent CRS, and improve therapeutic tools for personalized medicine tailored to the individual patient.

Kikuchi-Fujimoto Disease: A Distinct Pathological Entity but also an "Overlap" Autoimmune Syndrome: A Systematic Review.

BACKGROUND: The association between KFD and autoimmune diseases, not only with systemic lupus erythematosus, has been repeatedly described. OBJECTIVE: The aim of this review is to evaluate whether an overlap syndrome is present between KFD and autoimmune diseases, whether there is a chronological and a casual relationship between the pathologies. METHODS: The databases used for the overlap case search were Medline and Embase from which we extrapolated the studies of interest. The search queries used were: Kikuchi-Fujimoto Syndrome and juvenile idiopathic arthritis or systemic lupus erythematosus or Systemic Sclerosis or Antiphospholipid Syndrome or Sjogren's Syndrome. All study types were considered (n = 103). RESULTS: Total number of included studies are 43. We have shown that there is an "overlap" syndrome between KFD and other autoimmune diseases. The chronology of disease onset was variable; autoimmune disease may be "preceding" (n = 11 cases) or "simultaneous" (n = 20 cases) or "post" (n = 8 cases). Kikuchi-Fujimoto Syndrome. Also, the autoimmune disease can present with a complete clinical picture or only with the presence of autoantibodies. CONCLUSION: the different pathologies associated with KFD with different chronologies would suggest that there is an alteration of the immune system that allows the pathologies to occur in different temporal relationships.

Surgical Excision of Unusual Sacked Neck and Mediastinum Abscess of Odontogenic Origin.

The most common cause of neck infections is odontogenic abscesses that can often be life-threatening and require a surgical drain associated with antibiotic therapy. We present a case of the surgical management of an odontogenic sack-shaped and walled abscess arising from elements 3.6, 3.7 and 3.8 that reached the laterocervical spaces and anterior mediastinum in a 28-year-old healthy woman. Typical signs and symptoms of cervical complications of dental origin are fever, a neck mass, lymphadenopathy, trismus and odynophagia. The gold standard treatment in these situations is a multidisciplinary approach involving an oral surgeon, ENT specialist and thoracic surgeon to drain the infected material. To the best of our knowledge, this is the first described case report of a dental abscess enclosed in a sack in the deep space of the neck and in the anterior space of the mediastinum.

Hypertrophy of inferior turbinates: radiofrequency surgery.

Hypertrophy of the inferior turbinates can be treated by surgical reduction that seems to the most effective approach. Currently, several surgical techniques are performed, like turbinectomy, galvanic or laser cauterization, surgical submucosal decongestion and cryosurgery. In this study, we describe a procedure to reduce the hypertrophy of the inferior turbinates in 60 patients by radio frequency with electrosurgical equipment. The aim of this study is to show how to carry out this technique in the outpatient practice, that allows to face this pathology in an effective and rapid way.

Hipertrofia de los cornetes superiores: cirugía con radiofrequencia / Hypertrophy of inferior turbinates: radiofrequency surgery

La hipertrofia de los cornetes inferiores puede ser tratada con la reducción quirúrgica que parece el tratamiento más efectivo. Habitualmente se usan varias técnicas, como la turbinectomía, la cauterización con láser o galvánica, la descongestión submucosa quirúrgica y la criocirugía. En este estudio, describimos un método para reducir la hipertrofia de los cornetes inferiores en 60 pacientes con un equipo de radiofrecuencia electroquirúrgica. El objetivo de este estudio es mostrar como realizar esta técnica en la consulta externa, que permite afrontar esta patología de una forma efectiva y rápida (AU)

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Hipertrofia de los cornetes superiores: cirugia con radiofrecuencia / Hypertrophy of inferior turbinates: radiofrequency surgery

La hipertrofia de los cornetes inferiores puede ser tratada con la reducción quirúrgica que parece el tratamiento más efectivo. Habitualmente se usan varias técnicas, como la turbinectomía, la cauterización con láser o galvánica, la descongestión submucosa quirúrgica y la criocirugía. En este estudio, describimos un método para reducir la hipertrofia de los cornetes inferiores en 60 pacientes con un equipo de radiofrecuencia electroquirúrgica. El objetivo de este estudio es mostrar como realizar esta técnica en la consulta externa, que permite afrontar esta patología de una forma efectiva y rápida (AU)

No disponible

Vestibular compensation: analysis of postural re-arrangement as a control index for unilateral vestibular deficit.

Patients with an acute unilateral vestibular lesion show an impaired balance control. The initial presentation is vertigo followed by postural instability; but with time, the global balance functions can be completely restored by a process called vestibular compensation. The aim of our study was to evaluate short and long-term variations of postural parameters in 20 patients affected by vestibular neuritis (VN), and to compare these patients to 20 normal individuals using computerized static posturography (CSP) along with patient feedback throughout the spectral frequency analysis. This analysis showed in patients with no residual dizziness a frequency shift of body sway from low to middle frequencies as a probable expression of the compensatory strategies used by the central nervous system. On the other hand, patients with persistence of postural instability did not show any frequency shift. Our results seem to provide an early index of a proper occurring compensation so that we can adjust therapeutic protocols according to each patient's functional modifications.