Blood Basophils Relevance in Chronic Rhinosinusitis with Aspirin-Exacerbated Respiratory Disease.

Aspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and intolerance to cyclooxygenase-1 inhibitors. Interest is emerging in studying the role of circulating inflammatory cells in CRSwNP pathogenesis and its course, as well as their potential use for a patient-tailored approach. By releasing IL-4, basophils play a crucial role in activating the Th2-mediated response. The main aim of this study was to, first, investigate the level of the pre-operative blood basophils' values, blood basophil/lymphocyte ratio (bBLR) and blood eosinophil-to-basophil ratio (bEBR) as predictors of recurrent polyps after endoscopic sinus surgery (ESS) in AERD patients. The secondary aim was to compare the blood basophil-related variables of the AERD series (study group) with those of a control group of 95 consecutive cases of histologically non-eosinophilic CRSwNP. The AERD group showed a higher recurrence rate than the control group (p < 0.0001). The pre-operative blood basophil count and pre-operative bEBR were higher in AERD patients than in the control group (p = 0.0364 and p = 0.0006, respectively). The results of this study support the hypothesis that polyps removal may contribute to reducing the inflammation and activation of basophils.

Indications and timing for tracheostomy in patients with SARS CoV2-related.

BACKGROUND: The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial. PURPOSE: In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital. METHODS: 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. RESULTS: Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. CONCLUSION: In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.

Cervical mass as the first clinical manifestation of unsuspected metastatic seminoma.

The authors reported a case of a 27-year-old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients. Diagnostic delays are unfortunately common and may lead to metastatic spread and worse prognosis.

Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma.

Aims: The goal of the present study is to summarize our experience on surgical management of retraction pockets (RP) as a preventive tool against cholesteatomas. Methods: Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years (from 1 to 17 years). The sample presented a mean age of 47.56 ± 19.11 years (from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10 (40%) underwent tympanoplasty (TPL) type I, 14 (56%) TPL type II and 1 (4%) TPL type V. Results: Eleven ears (44%) showed cholesteatoma: all these cases were stage III according to Charachon staging, and stage IV or V according to Gersdorff classification. Twelve patients (48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage II or III RP (according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%. Conclusions: Surgical treatment of stages II and III RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP (stages IV and V, according to Gersdorff) are the real predictors of poor prognosis.

A genuine pediatric parapharyngeal abscess a year after uneventful adenotonsillectomy.

Brescia G, Pedruzzi B, Stramare R, Pendolino AL, Martini A, Marioni G. A genuine pediatric parapharyngeal abscess a year after uneventful adenotonsillectomy. Turk J Pediatr 2017; 59: 715-718. It is unusual for a parapharyngeal abscess (PA) to occur late after an adenotonsillectomy. We report herein a 13-year-old female patient who developed a PA a year after an uneventful adenotonsillectomy. The patient underwent 2 surgical explorations and was given intravenous antibiotic treatment. She was discharged in good general condition after spending 7 days in hospital. The potential pathophysiological mechanisms behind PA formation late after tonsillectomy or adenotonsillectomy, and rational treatments for PA are critically discussed.

Sinonasal polyposis in the elderly.

BACKGROUND/OBJECTIVE: The main end point of this investigation was to review our experience gained from 2009 to 2015 of treating chronic rhinosinusitis with nasal polyps (CRSwNP) in elderly patients (≥65 years old) with functional endoscopic sinus surgery. Secondary aims were to analyze the prognostic variables for CRSwNP in elderly patients and to compare the demographic, clinical, laboratory, histologic, and prognostic characteristics of CRSwNP in elderly versus young adult patients (20-40 years old). METHODS: Forty-three consecutive elderly patients and 71 consecutive young adult patients with CRSwNP were enrolled. RESULTS: Significant associations were found in the elderly group between CRSwNP recurrence and allergy (p = 0.037), CRSwNP recurrence and asthma (p = 0.017), and CRSwNP recurrence and acetyl salicylic acid (ASA) intolerance (p = 0.032) but not between recurrence and eosinophilic/noneosinophilic CRSwNP histology. Significant associations emerged in the young adult group between CRSwNP recurrence and asthma (p = 0.009), and ASA intolerance (p = 0.016), and serum eosinophil count (p = 0.02). The recurrence rate was also significantly higher for young adult patients with eosinophilic-type CRSwNP (p = 0.001). CRSwNP recurred less often in the elderly than in the young adult patients (p = 0.05). CONCLUSION: The present preliminary investigation found a lower recurrence rate after functional endoscopic sinus surgery for CRSwNP in elderly patients than in young adult patients. Further investigations on larger, prospective series are mandatory to support the hypothesis that, although eosinophilic-type CRSwNP is generally considered a variant at high risk of recurrence and that probably warrants stricter postoperative follow-up and adjuvant postoperative medical treatment, these considerations could not be applied to elderly patients.

Congenital Intratympanic Cholesteatoma in an Adult Patient: A Case Report and Review of the Literature.

Congenital cholesteatoma within the tympanic membrane is an uncommon entity, with only few cases being documented. The aetiopathogenesis of this lesion is still unknown; however, when cholesteatoma develops in subjects without any history of previous ear inflammation, as in the case we report here, an embryologic origin is deeply suspected. An acquired origin is hypothesized in patients with a previous history of an inflammatory process of the external or middle ear because of the proliferation of the basal cell layer of the tympanic membrane epithelium. We report a rare case of congenital cholesteatoma of the tympanic membrane in an adult patient and review the literature.

Are neutrophil-, eosinophil-, and basophil-to-lymphocyte ratios useful markers for pinpointing patients at higher risk of recurrent sinonasal polyps?

PURPOSE: Despite advances in the diagnosis and treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), their recurrence rate remains significant. There is a need for promptly-obtainable, inexpensive, minimally-invasive prognostic parameters to enable rhinologists to identify patients at higher risk of recurrent CRSwNP. The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR), previously discussed as potential markers of inflammation, has already been investigated in CRSwNP. The aim of the present study was to test the prognostic value of the NLR and ELR, and also of the basophil-to-lymphocyte ratio (BLR) (given the emerging role of basophils in CRSwNP) in a large series of CRSwNP. MATERIALS AND METHODS: The study concerned 240 patients who underwent FESS for CRSwNP from 2009 to 2014 and had a postoperative follow-up longer than 12months. We considered patients with recurrences as those with endoscopic evidence of at least grade I polyposis. RESULTS: In our series, the mean NLR, ELR and BLR were significantly higher in patients whose disease recurred than in those remaining recurrence-free (p=0.03, p=0.0001, and p=0.0002, respectively), but the discriminatory power of the NLR, ELR, or BLR in terms of disease recurrence was unacceptable (AUCs=0.600, 0.678, and 0.662, respectively). CONCLUSIONS: The heterogeneous prognostic role of NLR, ELR and BLR identified in the clinically and pathologically different sub-cohorts of CRSwNP considered supports the hypothesis that CRSwNPs with a similar clinical picture may differ considerably in terms of the biological and pathogenic mechanisms of polyp formation and growth.

Endoscopic surgery for recurrent undifferentiated nasopharyngeal carcinoma.

One of the biggest challenges for otolaryngologists is represented by the locally recurrent undifferentiated nasopharyngeal carcinoma (uNPC). Despite improvements in its treatment options, such as modern radiotherapy, chemotherapy, or external surgical approaches, the risk for severe complications, functional disabilities, and even death remains considerable. Over the years, advances in endoscopic surgery have led to a new alternative in the salvage surgery for recurrent uNPC: the nasopharyngeal endoscopic resection (NER). We retrospectively reviewed clinical records of 8 patients (6 men and 2 women), who underwent NER for recurrent T1 (rT1) locally recurrent uNPC between 2008 and 2011. Together with resections for subsequent recurrences, a total of 9 NERs were performed by a single surgeon with curative intent. Negative margins were obtained for the whole group of patients. After a mean follow-up period of 27 months (range, 16-54 mo), all the patients had no evidence of the disease. We had only 1 recurrence after 7 months. Two-year overall survival and disease-free survival rates were 100% and 88.9%, respectively. Only 1 patient presented with a complication, osteitis. Nasopharyngeal endoscopic resection can be considered a valid and promising treatment option for rT1 locally recurrent uNPC, showing encouraging short-term outcomes and complication rate. Long-term follow-up is needed to state the efficacy of NER, together with a larger number of patients.

Perfil socioeconômico e sociodemográfico de pacientes com tuberculose no sudeste do Brasil: uma revisão integrativa / Perfil socioeconómico y sociodemográfico de los pacientes con tuberculosis en el sureste de Brasil: una revisión integradora / Socioeconomic and sociodemographic profile of tuberculosis patients in southeastern Brazil: an integrative review

O objetivo desta revisão foi avaliar as evidências disponíveis na literatura sobre o perfil socioeconômico e sociodemográfico dos pacientes com tuberculose na região Sudeste do Brasil. Foi utilizado método descritivo, exploratório, do tipo bibliográfico, tendo sido realizada uma revisão integrativa. As áreas com piores níveis econômicos apresentam maiores incidências de tuberculose. A pobreza aumenta o risco de HIV/AIDS e Tuberculose, por promover maior exposição e vulnerabilidade às infecções, como também a capacidade diminuída para lidar com as consequências da doença, em razão da deficiência de acesso a serviços preventivos, diagnósticos e curativos. Pudemos observar que na região sudeste do Brasil, a tuberculose está relacionada com áreas mais carentes, os pacientes têm sua moradia em regiões suburbanas, possuindo baixa renda e baixa escolaridade, havendo necessidade de um olhar mais amplo e mais fixo dos serviços de saúde e dos serviços sociais, acerca das necessidades de saúde da referida população.

The objective of this review was to evaluate the evidence available in the literature on the socioeconomic and sociodemographic profile of patients with tuberculosis in Southeastern Brazil. This is a descriptive, exploratory, literature based kind of study, having been made ??an integrative review. The areas with the worst economic levels, have the highest incidences of tuberculosis. Poverty increases the risk of HIV / AIDS and tuberculosis by promoting greater exposure and vulnerability to infections, as well as a decreased ability to deal with the consequences of the disease, due to the difficult access to preventive, diagnostic and curative services. It was noted that in Southeastern Brazil, tuberculosis is related to poorer areas, patients have their home in suburban regions, having low education and low income, requiring a broader and steadier health and social service for the refered population.

Objetivo: evaluar las evidencias disponibles en la literatura sobre el perfil socioeconómico y sociodemográfico de los pacientes con tuberculosis en el Sureste de Brasil. Método: descriptivo, y exploratorio, del tipo bibliográfico. Se ha realizado una revisión integradora. Resultados: Las áreas con peores niveles económicos tienen una mayor incidencia de tuberculosis. La pobreza aumenta el riesgo de contraer VIH / SIDA y la tuberculosis, mediante la promoción de una mayor exposición y vulnerabilidad a las infecciones, así como una menor capacidad para manejar las consecuencias de la enfermedad, debido a la carencia de acceso a servicios de prevención, diagnóstico y curativos. Conclusión: en el Sureste de Brasil, la tuberculosis está relacionada con las zonas más pobres, teniendo su domicilio en regiones suburbanas, con baja renta y bajo nivel de educación , lo que requiere una mirada más amplia y más fija de los servicios de salud y sociales sobre las necesidades de salud de esa población.

In vivo emergence of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli.

Although resistance to tigecycline has been reported in surveillance studies, very few reports have described the emergence of resistance in vivo. We report two cases of patients with infections due to SHV-12-producing Klebsiella pneumoniae and K. pneumoniae carbapenemase-3 (KPC-3)-producing Escherichia coli, which developed tigecycline resistance in vivo after treatment. The reported limited experience underlines the risk of occurrence of a tigecycline MIC increase under treatment pressure.

Prognostic value of virological and immunological responses after 6 months of antiretroviral treatment in adults with HIV-1 infection in sub-Saharan Africa.

BACKGROUND: HIV RNA monitoring is not available in most antiretroviral treatment (ART) programs in sub-Saharan Africa; switch to second-line therapy is mostly guided by clinical/immunological criteria. This may lead to unnecessary disease progression and drug resistance accumulation. We investigated the prognostic value of virological and immunological status 6 months after ART initiation with respect to death, loss to follow-up, and treatment switch. METHODS: We considered treatment-naive HIV-1-infected patients, starting ART with available 6-month visit and subsequent follow-up, enrolled in a prospective cohort comprising 5 ART sites in 3 sub-Saharan countries. Outcome measures included the time from 6-month visit to death for all causes, loss to follow-up, and switch to second line. RESULTS: Of 2539 patients, 62% were females, their median pre-ART CD4 count was 215 cells per microliter, median HIV RNA 4.6 Log10 copies per milliliter, 30% were on WHO stage 3/4. At 6 months, 85% had HIV RNA <1000 copies per milliliter. During 3112 person-years follow-up after the 6-month visit, 91 patients died. Death was predicted by 6-month HIV RNA ≥10,000 copies per milliliter, adherence, and 6-month CD4 <200 cells per microliter. The 2-year estimated probability of surviving ranged from 0.69 (with 6-month HIV RNA ≥10,000 and CD4 <200) to 0.95 (with HIV RNA <1000 and CD4 ≥200). Loss to follow-up (1.95 per 100 person-years follow-up) was predicted by the 6-month HIV RNA >10,000 copies per milliliter and adherence but not by CD4. Switch to second line (6.94 per 100 person-years follow-up) was predicted by 6-month HIV RNA and CD4. CONCLUSIONS: In patients starting ART in sub-Saharan Africa, 6-month HIV RNA independently predicts subsequent survival, retention to care, and switch to second-line therapy. This measure warrants further evaluation as specific time point monitoring option.

The complimentary role of diagnostic and therapeutic endoscopy in foreign body aspiration in children.

OBJECTIVE: To review the importance and benefits of flexible bronchoscopy and rigid bronchoscopy in airway foreign body inhalation in children. Prompt diagnosis will lead to safer outcomes when both types of endoscopy are employed within the operating room setting. METHODS: Retrospective review of all cases of foreign body inhalation seen and treated in our Department between July 1986 and December 2010. RESULTS: Three-hundred and ten children were admitted to our Department from Pediatric Emergency Room for a suspected foreign body inhalation. All patients with suspected FB inhalation underwent bronchoscopy. Of 310 evaluations of tracheobronchial tree performed at our Department, 104 were negative, while an airway FB were observed and removed in 206 cases. CONCLUSIONS: Rigid bronchoscopy under general anesthesia is an extremely accurate surgical technique to identify, localize and remove airway foreign body. In our experience, flexible bronchoscopy under total intravenous sedation and topical anesthesia is very useful in doubtful cases to absolutely exclude the presence of foreign body in upper airway tracheobronchial tree.

Conhecimento dos enfermeiros quanto aos riscos biológicos na enfermagem / Knowledge of nurses front biological risks in nursing / Conocimiento de los enfermeros con relación a los riesgos biológicos en la enfermería

O objetivo deste estudo foi identificar o conhecimento dos enfermeiros quanto aos riscos biológicos na enfermagemreferente à prevenção, pós-exposição e ações da educação permanente. Pesquisa exploratória-descritiva, comabordagem qualitativa. A coleta de dados foi realizada com sete enfermeiros do setor de Doenças Infecciosase Parasitárias do Hospital Universitário Antônio Pedro, Universidade Federal Fluminense. Observou-se que osprofissionais estão cientes da utilização dos Equipamentos de Proteção Individual (EPIs) como forma de prevenção.Conclui-se que os profissionais enfermeiros detêm o conhecimento quanto à utilização dos EPIs como forma deprevenção aos riscos biológicos, e a melhor maneira de prevenir os acidentes é a aderência completa de todas asmedidas de precaução padrão. A conduta após o acidente foi de amplo conhecimento entre os profissionais. Aatuação da Educação Permanente é efetiva, embora os profissionais não se referiram ao fato em seus relatos.

The objective of this study was to identify the knowledge of nurses regarding the biological hazards in nursing, withrespect to prevention, treatment and continuing education. This is an exploratory descriptive research of qualitativeapproach. The data collection was performed with seven nurses of the sector of Infectious Diseases, at the UniversityHospital Antônio Pedr at Universidade Federal Fluminense. It was observed that the professionals are aware ofthe use of Personal Protective Equipment (EPI) as a means of prevention. It can be concluded that all nurses holdknowledge about the use of EPI in order to prevent biological risks and the best way to prevent accidents is thecomplete adherence to all standard precautionary measures. The conduct after accidents was widely known amongprofessionals. Continuing Education is effective, although the professionals did not refer to it in their reports.

El objetivo de este estudio fue identificar la percepción de los enfermeros con relación a los riesgos biológicos enla enfermería, referentes a la prevención, postexposición y las acciones de la formación continua. Investigaciónexploratoria descriptiva, con enfoque cualitativo. La recolecta de datos se realizó con siete enfermeros del sector deEnfermedades Infecciosas y Parasitarias del Hospital Universitario Antonio Pedro, Universidad Federal Fluminense.Se observó que los profesionales son conscientes de la utilización de los Equipos de Protección Individual (EPI) comomedio de prevención. Se concluye que los enfermeros detienen el conocimiento sobre el uso de los EPI como formade prevención de los riesgos biológicos y, la mejor forma de prevenir los accidentes es la adhesión completa a todas las medidas de precaución estándar. La conducta entre los profesionales, después del accidente, fue de amplioconocimiento. La actuación de la formación continua es eficaz, a pesar de que en sus informes, los profesionales nose hayan referido a este hecho.

Endoscopic treatment of tracheocele in pediatric patients.

Acquired tracheal pouch known also as tracheocele is a rare air-filled diverticulum of tracheal pars membranacea. This disease may be due to esophageal or tracheal surgery, orotracheal intubation, or increased intralunimal pressure through a weak area of tracheal wall. When symptomatic and medical therapy is insufficient, this disorder must be treated surgically. Several surgical methods ranging from open neck or thoracic surgery to endoscopic managements have been reported. We report the case history of a 7-year-old boy affected by recurrent pneumonia due to tracheal pouch. The patient underwent successful brushing of tracheocele plus fibrin glue application by rigid tracheobroncoscopy. Furthermore, particular emphasis on endoscopic treatments of tracheal diverticulum is also presented.

Antimicrobial prevention and therapy for travelers' infection.

International journeys are increasing and more than 70 million people from industrialized countries cross the borders of tropical countries every year. More than 50% of them will suffer from some form of infectious illness, ranging from mild travelers' diarrhea to severe dengue fever to fatal malaria, with a wide spectrum of microbiological entities. Travel-related respiratory infections, including TB, and sexually transmitted infections are also increasingly reported. Awareness of travel-related risk is not always adequate among international travelers. Specific training on travel medicine-related issues, as well as better diagnostic facilities for imported diseases, is crucial for physicians and nurses in industrialized countries.

Penetrating foreign body mimicking supraglottic carcinoma.

Penetrating trauma to the neck is a rare observation. We report the first case of laryngeal myofibroblastic tumor due to a persistent splinter of glass in the preepiglottic space, which presented with recurrent mild hemoptysis and cough, and mimicked supraglottic carcinoma. The clinical and imaging evaluations are herein reported. Finally, medical and surgical options in the management of this unusual observation are discussed.