RESUMO
Antibacterial therapy in acute rhinosinusitis (ARS) is prescribed 4-9 times more often than recommended, while no >5 % of patients require such treatment. The main motive for the irrational antibiotic prescription is the presence of mucopurulent discharge and nasal congestion in combination with hyperthermia. The study objective was to determine the efficacy of hypertonic seawater solution in the technology of delayed antibiotic prescription in patients with ARS. METHODS: In a multicenter, randomized, open-label, comparative study, 100 children were randomized. 100 children with ARS aged 6-11 years, who received Aqua Maris Extra Strong irrigation therapy in addition to standard therapy or received standard therapy, completed the study. EVALUATION CRITERIA: decreased intensity of nasal congestion, rhinorrhea, postnasal drip, headache and facial pain, assessed by the physician using a 4-point scale at each visit compared to Visit 1, dynamics of self-scored symptoms using a 10-point visual analogue scale, frequency of antipyretic and antibiotic prescription. RESULTS: The use of hypertonic seawater solution in patients with ARS provides a clinically significant reduction in the severity of core or key symptoms: rhinorrhea, nasal congestion, postnasal drip and headache, assessed by the physician at V2 (p < 0.05). There are significant differences in the dynamics of these symptoms according to the patient's self-assessment from treatment Day 2 (p < 0.05). The use of irrigation therapy with Aqua Maris Extra Strong in the technology of delayed antibiotic prescription in patients with ARS allows to reduce the prescription of antibacterial drugs. No on-treatment side effects were observed in any patient. CONCLUSION: Hypertonic seawater solution Aqua Maris Extra Strong is a safe and effective medicinal product for the symptomatic treatment of acute rhinosinusitis in children aged 6-11 years/ It provides a significant therapeutic effect when prescribed in addition to standard therapy and helps to reduce the need for antibiotics.
RESUMO
OBJECTIVE: The aim: To explore the morphological changes of palatine tonsil at the levels of the epithelial layer and connective tissue; to determine the relative area of the connective tissue component in the tonsillar tissue (fibrosis) in patients with recurrent tonsillitis compared to the control. PATIENTS AND METHODS: Materials and methods: This study presents a morphological assessment of the palatine tonsils of 10 people. Tonsils' material with surrounding tissue was fixed in 10% formalin solution. The samples were dehydrated in increasing ethanol concentrations, cleared in xylol, impregnated with paraffin. Microscopy was then performed with samples stained beforehand. RESULTS: Results: In the samples of patients with recurrent tonsillitis pericapsular sclerosis was noted, along with thickening of interlobular septa and pronounced subepithelial fibrosis. A ratio of the dense connective tissue surface area to the total surface area of tonsil tissue was determined. The control group showed a statistically significant decrease in the degree of sclerosis of the tonsil stroma. CONCLUSION: Conclusions: Multiple changes were found in the tonsils of patients with recurrent tonsillitis at the level of the epithelial layer that manifested in structural alterations. Significant and irreversible changes were also observed in the connective stroma of the tonsil - pericapsular sclerosis, thickening of interlobular septa, and pronounced subepithelial fibrosis. A statistically significant increase in the relative surface area of the connective tissue component of the tonsil (fibrosis) by a factor of 1,26 was noted in patients with recurrent tonsillitis compared to the results of the control group of patients.
