Orbital complications of pediatric acute rhinosinusitis in the pneumococcal conjugate vaccine era.

OBJECTIVES: To evaluate the impact of the pneumococcal conjugate vaccines (PCVs) introduction on the orbital complications of acute rhino-sinusitis (OC-ARS). METHODS: A retrospective cohort study of all pediatric patients with OC-ARS during the period 2002-2019. Data included clinical, demographic, laboratory, and microbiology findings. Patients were divided into three groups: before PCV7 introduction (group 1), after PCV7 and before PCV13 (group 2), and after PCV13 (group 3). RESULTS: Of 265 enrolled patients, 117, 39, and 109 were assigned to groups 1, 2, and 3. During the study period, a significant decrease was recorded in the percentages of patients in Chandler classification severity category 1, with an increase in patients in category 3 (P = 0.011). The yearly incidence of OC-ARS decreased from 12.64 cases per 100,000 population in 2002 to 5.56 per 100,000 in 2008, and 2.99 per 100,000 in 2019 (P < 0.001). Patients aged 0-4 years showed a dramatic decrease from 29 cases per 100,000 population in 2002 to 4.27 per 100,000 in 2019 (P < 0.001). The pathogens retrieved from all cultures performed were Streptococcus pneumoniae (32.5%), non-typeable Haemophilus influenzae (27.5%), Streptococcus Species, (12.5%), and Staphylococcus aureus (20%), with no changes in distribution during the study periods. Surgery was performed in 28 (10.6%) patients. CONCLUSIONS: A significant decrease was seen in the overall incidence of OC-ARS, mainly attributable to the decrease in patients aged 0-4 years. An increase was recorded in the severity of the disease following PCVs introduction.

The effectiveness of evidence-based nursing intervention for nasal irrigation after endoscopic sinus surgery in patients with chronic rhinosinusitis: a randomized controlled trial.

OBJECTIVES: To evaluate its effect of an evidence-based nursing program for nasal irrigation after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). METHODS: A total of 66 patients with CRS were randomly divided into two groups, for which the experimental group received evidence-based nasal irrigation nursing, and the control group received conventional nursing. Differences in Sino-Nasal Outcome Test-20 (SNOT-20), visual analogue scale (VAS), Lund-Mackay CT, Endoscopic Lund Kennedy Score (LKES) and overall efficacy were assessed between the two groups. RESULTS: 2, 4 and 12 weeks after the intervention, the scores of SNOT-20, VAS, Lund-Mackay CT and LKES in the two groups were significantly lower than those before the surgery (P < 0.05). Compared with the control group, the scores were significantly lower in the experimental group (P < 0.05). 12 weeks after the intervention, the overall effective rate of treatment in the experimental group was 90.62%, while the control group was 16.43%, but the difference was not statistically significant in treatment effect (P > 0.05). CONCLUSIONS: The implementation of nasal irrigation evidence-based nursing program for patients with CRS after endoscopic sinus surgery can promote postoperative nasal mucosal recovery, improve treatment efficiency, and help improve patient comfort, quality of life and other subjective feelings. TRIAL REGISTRATION: The study was registered retrospectively with reference number ChiCTR2300075484 on 06/09/2023, available at: https://www.chictr.org.cn .

Risk Factors for Recurrence of Nasal Polyps after Endoscopic Sinus Surgery in Patients with Allergic Chronic Rhino Sinusitis.

Rhino sinusitis, is a common inflammatory disease that affects the nasal cavity and paranasal sinuses in millions of individuals. Chronic sinusitis patients complain of a combination of nasal obstruction, rhinorrhea, post nasal drip and facial pain. To identify the risk factors of the recurrence of nasal polyps in chronic rhino sinusitis patients after endoscopic sinus surgery. After a review of 60 patients with chronic rhino sinusitis with failed medical treatment requiring FESS presenting in Kasr Alainy Hospital in Cairo University and October 6 University Hospital from May 2022 to March 2023. All patients were subjected to history taking, clinical examination including endoscopy, subjective evaluation of symptoms and CT-scan. Of our patients, six patients (15%) were diagnosed with recurrence of nasal polyps with chronic rhino sinusitis and needed revision surgery. There are multiple risk factors related to the recurrence of nasal polyps including smoking followed by having a history of an asthma, the presence of an allergy, septal deviation, prior sinus surgery, and turbinate hypertrophy. Other factors, as proper medical treatment such as topical steroids and treatment of allergy had a significant role in decreasing the recurrence rate. Risk factors related to the recurrence of nasal polyps should be avoided before surgery. The avoidance of risk factors protects the patients from the recurrence of nasal polyps, the hazards of anaesthesia on surgical treatment, and the financial cost of surgery. Follow up is important in the prevention of recurrence of nasal polyps and improves the symptoms.

Multivariate analysis of clinical and radiological risk factors for revision endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps: can phenotype predict recurrence?

OBJECTIVE: This study aimed to analyse clinical and radiological features (phenotypes) to predict revision risk after functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. METHOD: Phenotype characteristics of the patients with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery were analysed retrospectively. RESULTS: The rates of asthma, aspirin sensitivity, smoking and a positive prick test result were significantly higher in revision functional endoscopic sinus surgery cases (p < 0.001, 0.001, < 0.001 and < 0.001, respectively). Multivariate analysis demonstrated that only gender, pre-operative nasal steroid use, pre-operative systemic steroid use, intra-operative systemic steroid use and smoking were significant risk factors for revision functional endoscopic sinus surgery (p = 0.034, 0.001, 0.010, 0.007 and 0.001, respectively). In addition, only eosinophilia and aspirin sensitivity were significant risk factors for multiple revision functional endoscopic sinus surgery procedures (p = 0.043 and 0.005, odds ratio = 2.4 and 5.2). CONCLUSION: Beyond the endotype of chronic rhinosinusitis with nasal polyps, defining clinical and radiological factors enables a valid prediction of patients at high risk of revision functional endoscopic sinus surgery.

A Rare Case of Complicated Sinonasal Meliodosis Mimicking Sinonasal Lymphoproliferative Disease.

Unilateral nasal obstruction with purulent nasal discharge is one of the presentations for sinonasal melioidosis. However, it may mimic nasal NK/T cell lymphoma. Both causing tissue destruction involving nasal septum, lateral nasal wall and palate. Here, we report a case of disseminated melioidosis involving sinonasal mimicking nasal lymphoma in a 32-year-old immunocompetent lady. She presented with prolonged fever, unilateral nasal blockage, painful facial swelling and knee pain. Clinical findings revealed extensive necrotic tissue and crusting involving right lateral wall of nasal cavity. Tissue and blood culture and sensitivity (C + S) grew Burkholderia pseudomallei. Recovery was complete after surgery and antibiotics.

Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors / Rinosinusitis fúngica invasiva asociada con COVID-19: cambios clínicos y predictores de pronóstico

Background This study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes. Methods It was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022. We included sixty-six patients who suffered from AIFRS associated with confirmed COVID-19. We observed the prognosis of all included patients with a six-month follow-up. We correlated the prognosis with many factors, such as demographic data, medical conditions, blood investigations, the features of fungal infections, and management. Results Forty-two patients (64%) survived after the AIFRS associated with COVID-19, and twenty-two patients (36%) died. High doses of corticosteroids with prolonged use were the main factors that affected the behavior of the AIFRS associated with COVID-19. HbA1c was a good predictor of the prognosis; a level less than 9.35% may indicate survival with 87.5% sensitivity. Conclusions According to this multi-center study, the mortality of the AIFRS associated with COVID-19 was high. The behavior was affected by glycemic control, the type of fungal species, and the type of antifungal therapy. Early surgical debridement, a combination of Amphotericin B with Voriconazole, and anticoagulants helped improve the prognosis. (AU)

Antecedentes Durante el periodo de la pandemia de COVID19, ha habido un aumento en la tasa de casos de rinosinusitis fúngica invasiva aguda (RSFIA), siendo cada vez más evidente la asociación entre ambas entidades. EL objetivo de este estudio ha sido analizar la evolución de los pacientes con rinosinusitis fúngica invasiva aguda asociado con la infección por COVID-19, analizando los factores determinantes en la evolución y pronóstico de la enfermedad. Métodos Fue un estudio observacional retrospectivo que incluyó casos de cuatro instituciones de referencia de tercer nivel entre noviembre de 2020 y febrero de 2022. Se incluyeron sesenta y seis pacientes que padecían RSFIA asociado a COVID-19 confirmado. Observamos el pronóstico de todos los pacientes incluidos con un seguimiento de seis meses. Correlacionamos el pronóstico con muchos factores, como los datos demográficos, las condiciones médicas, las investigaciones de sangre, las características de las infecciones fúngicas y el manejo. Resultados Cuarenta y dos pacientes (64%) sobrevivieron después de la RSFIA asociada a COVID-19, y veintidós pacientes (36%) fallecieron. Las dosis altas de corticoides con uso prolongado fueron los principales factores que afectaron el comportamiento de la RSFIA asociada a la COVID-19. HbA1c fue un buen predictor del pronóstico; un nivel inferior al 9,35 % puede indicar supervivencia con una sensibilidad del 87.5%. Conclusiones Según este estudio multicéntrico, la mortalidad de la RSFIA asociada a la COVID-19 fue alta. El comportamiento se vio afectado por el control glucémico, el tipo de especie fúngica y el tipo de terapia antifúngica. El desbridamiento quirúrgico temprano, una combinación de Amphotericin B con Voriconazole y anticoagulantes ayudaron a mejorar el pronóstico. (AU)

TNF-α Regulates the Glucocorticoid Receptor Alpha Expression in Human Nasal Epithelial Cells Via p65-NF-κb and p38-MAPK Signaling Pathways.

Background: Tumor necrosis factor (TNF)-α induces changes in the glucocorticoid receptor (GR) isoforms' expression in human nasal epithelial cells (HNECs) in chronic rhinosinusitis (CRS). Objective: However, the underlying mechanism of TNF-α induced GR isoforms' expression in HNECs remains unclear. Here, we explored changes in inflammatory cytokines and glucocorticoid receptor alpha isoform (GRα) expression in HNECs. Materials and Methods: To explore the expression of TNF-α in nasal polyps and nasal mucosa of CRS, fluorescence immunohistochemical analysis was employed. To investigate changes in inflammatory cytokines and GRα expression in HNECs, RT-PCR and western blotting were performed following the cells' incubation with TNF-α. Cells were pretreated with the nuclear factor-κB gene binding (NF-κB) inhibitor QNZ, the p38 inhibitor SB203580, and dexamethasone for one hour, then a TNF-α. Western blotting, RT-PCR, and immunofluorescence had been utilized for the cells' analysis and the ANOVA for the data analysis. Results: The TNF-α fluorescence intensity was mainly distributed in nasal epithelial cells of nasal tissues. TNF-α prominently inhibited the expression of GRα mRNA from 6 to 24 h in HNECs. GRα protein was decreased from 12 to 24 h. Treatment with QNZ, SB203580, or dexamethasone inhibited the TNF-α and interleukin (IL)-6 mRNA expression and increased the GRα levels. Conclusion: TNF-α induced changes in the GR isoforms' expression in HNECs, and it was mediated through p65-NF-κB and p38-MAPK signal transduction pathways, which could be considered a promising neutrophilic CRS treatment.

Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors.

BACKGROUND: This study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes. METHODS: It was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022. We included sixty-six patients who suffered from AIFRS associated with confirmed COVID-19. We observed the prognosis of all included patients with a six-month follow-up. We correlated the prognosis with many factors, such as demographic data, medical conditions, blood investigations, the features of fungal infections, and management. RESULTS: Forty-two patients (64%) survived after the AIFRS associated with COVID-19, and twenty-two patients (36%) died. High doses of corticosteroids with prolonged use were the main factors that affected the behavior of the AIFRS associated with COVID-19. HbA1c was a good predictor of the prognosis; a level less than 9.35% may indicate survival with 87.5% sensitivity. CONCLUSIONS: According to this multi-center study, the mortality of the AIFRS associated with COVID-19 was high. The behavior was affected by glycemic control, the type of fungal species, and the type of antifungal therapy. Early surgical debridement, a combination of Amphotericin B with Voriconazole, and anticoagulants helped improve the prognosis.

Safety of day-case endoscopic sinus surgery in England: An observational study using an administrative dataset.

INTRODUCTION: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for endoscopic sinus surgery (ESS). The aim of this study was to investigate the safety of day-case ESS in England. DESIGN: Secondary analysis of administrative data. METHODS: We extracted data from the Hospital Episodes Statistics database for the 5 years from 1 April 2014 to 31 March 2019. Patients undergoing elective ESS procedures aged ≥17 years were included. Exclusion criteria included malignant neoplasm, complex systemic disease and trans-sphenoidal pituitary surgery. The primary outcome was readmission within 30 days post-discharge. Multilevel, multivariable logistic regression modelling was used to compare outcomes for those operated on as day-cases and those with an overnight stay after adjusting for demographic, frailty, comorbidity and procedural covariates. RESULTS: Data were available for 49 223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 20.6% to 100%. Nationally, rates of day-case surgery increased from 64.0% in the financial year 2014/2015 to 78.7% in 2018/2019. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). Outcomes for patients operated on in trusts with ≥80% day-case rates compared with patients operated on in trusts with <50% rates of day-case surgery were similar. CONCLUSIONS: Our data support the view that ESS can safely be performed as day-case surgery in most cases, although it will not be suitable for all patients. There appears to be scope to increase rates of day-case ESS in some hospital trusts in England.

Non-Mucormycetes Causes of Fungal Rhino Sinusitis With Periocular Swelling in COVID-19 With Delta Variant.

OBJECTIVE:  To highlight fungi other than mucormycetes as causative agents of rhinosinusitis with periocular swelling in coronavirus (COVID-19) infection caused by Delta variant of SARS-CoV-2 virus and identify the presenting features, risk factors, intervention, and outcomes. METHODS AND ANALYSIS: A retrospective interventional study of 96 patients with fungal rhinosinusitis and periocular swelling was done in patients with concurrent or recovered COVID-19 infection with the Delta variant (B.1.617.2) of SARS-CoV-2 virus in India. All patients with mucormycetes infection were excluded. Clinical presentation, medical history, blood reports, and imaging were analyzed. Management was by intravenous (IV) liposomal amphotericin B and functional endoscopic sinus surgery (FESS) with paranasal sinus debridement. Limited orbital debridement with or without transcutaneous retrobulbar liposomal amphotericin B (TRAMB) was done in patients with orbital involvement. Postoperative antifungal therapy was decided on the basis of the causative fungi. RESULTS: Four cases of Aspergillus and one each of Fusarium, Curvularia, and Penicillium-associated fungal rhinosinusitis with periocular swelling were seen. Signs of orbital involvement on MRI were present in all four of them. Two of these showed partial third-nerve palsy while one case with aspergillosis suffered cavernous sinus thrombosis. Proptosis was not witnessed in any case. History of diabetes and use of steroids was seen in all patients. All patients had mild to moderate COVID-19 with oxygen supplementation needed in one. No mortality, acute vision loss, or exenteration took place. CONCLUSION:  Aspergillus, Fusarium, Curvularia, and Penicillium were non-mucormycetes causes of fungal rhinosinusitis with periocular swelling in COVID-19 infection with the Delta variant (B.1.617.2) of SARS COV-2 virus. Few cases showed orbital and intracranial involvement.

Mixed etiology COVID-19 associated acute rhinosinusitis caused by two Aspergillus species.

INTRODUCTION: Acute invasive fungal rhino-sinusitis (AIFR) is a life-threatening infection that is mostly found in immunocompromised patients with serious morbidity and mortality. Recently, reports of AIFR have also emerged among SARS-CoV-2 infected patients. CASE PRESENTATION: A 50-year-old diabetic woman, previously diagnosed with COVID-19 pneumonia, was presented to the hospital with left facial pain on day 12 after discharge. Paranasal sinuses computed tomography was performed and according to the mucosal thickening in both maxillary sinuses and ethmoidal air cells, the patient underwent functional endoscopic sinus surgery (FESS) and necrosis were observed. The histopathologic examination revealed mycelium with septation suspected to Aspergillus and the culture was consistent with Aspergillus flavus and also Aspergillus niger . We reported a case of COVID-19 associated AIFR with two combined Aspergillus species from Iran. The patient received liposomal amphotericin B, which then switched to voriconazole combined with aggressive surgical debridement of necrotic tissues with a clinically favorable outcome. CONCLUSION: Mixed etiology AIFR can influence the outcome. However, further investigation is required upon this new threat.

A Case of Gastric Mucormycosis in a 21-Year-Old Patient With Hemophagocytic Lymphohistiocytosis.

Mucormycosis is an angioinvasive, opportunistic infection. Diabetes Mellitus and immunosuppression are the most common risk factors for fungal infection. Without prompt treatment, the infection can be fatal. A 21-year-old male patient presented with gastritis-like symptoms refractory to proton pump inhibitor (PPI) therapy. He recently received treatment for Hemophagocytic Lymphohistiocytosis (HLH), confirmed by bone marrow biopsy and fungal sinusitis. Esophagogastroduodenoscopy (EGD) revealed extensive gastric involvement by Mucormycosis. The patient was given antifungal drugs and a resection of necrotic stomach tissue. Gastric mucormycosis is a rare presentation of the angioinvasive fungus. The patient's young age and lack of distinguishing risk factors such as diabetes or immunosuppression are also unusual. Furthermore, the patient's unique presentation with gastric mucormycosis compounded by a recent diagnosis of Hemophagocytosis lymphohistiocytosis produces a valuable case study in management.

Effects of the Traditional Mediterranean Diet in Patients with Otitis Media with Effusion.

INTRODUCTION: Otitis media with effusion (OME) is common in pediatric primary care consultations. Its etiology is multifactorial, although it has been proven that inflammation factors mediate and that immunity is in a phase of relative immaturity. The objective of this study was to assess the effects of the Traditional Mediterranean Diet (TMD) modulating inflammation and immunity in patients diagnosed with OME. MATERIALS AND METHODS: A analysis as a single-group pre-test/post-test was conducted on 40 girls and 40 boys between 18 months and 5 years old. Tympanometry normalization was the main test to control the benefit of diet. Clinical and therapeutic variables were studied through evaluation questionnaires, a quality test of the diet, as well as various anthropometric parameters. RESULTS: At the end of one year, tympanometry had normalized in 85% of patients. The remaining 15% had normal audiometry and/or associated symptoms had decreased. Likewise, episodes of recurrent colds decreased from 5.96 ± 1.41 to 2.55 ± 0.37; bacterial complications of 3.09 ± 0.75 to 0.61 ± 0.06 and persistent nasal obstruction of 1.92 ± 0.27 to 0.26 ± 0.05. The degree of satisfaction of the families with the program was very high. CONCLUSIONS: The application of the Traditional Mediterranean Diet could have promising effects in the prevention and treatment of otitis media with effusion.

Explaining heterogeneity of individual treatment causal effects by subgroup discovery: An observational case study in antibiotics treatment of acute rhino-sinusitis.

OBJECTIVES: Individuals may respond differently to the same treatment, and there is a need to understand such heterogeneity of causal individual treatment effects. We propose and evaluate a modelling approach to better understand this heterogeneity from observational studies by identifying patient subgroups with a markedly deviating response to treatment. We illustrate this approach in a primary care case-study of antibiotic (AB) prescription on recovery from acute rhino-sinusitis (ARS). METHODS: Our approach consists of four stages and is applied to a large dataset in primary care dataset of 24,392 patients suspected of suffering from ARS. We first identify pre-treatment variables that either confound the relationship between treatment and outcome or are risk factors of the outcome. Second, based on the pre-treatment variables we create Synthetic Random Forest (SRF) models to compute the potential outcomes and subsequently the causal individual treatment effect (ITE) estimates. Third, we perform subgroup discovery using the ITE estimates as outcomes to identify positive and negative responders. Fourth, we evaluate the predictive performance of the identified subgroups for predicting the outcome in two ways: the likelihood ratio test, and whether the subgroups are selected via the Akaike Information Criterion (AIC) using backward stepwise variable selection. We validate the whole modelling strategy by means of 10-fold-cross-validation. RESULTS: Based on 20 pre-treatment variables, four subgroups (three for positive responders and one for negative responders) were identified. The log likelihood ratio tests showed that the subgroups were significant. Variable selection using the AIC kept two of the four subgroups, one for positive responders and one for negative responders. As for the validation of the whole modelling strategy, all reported measures (the number of pre-treatment variables associated with the outcome, number of subgroups, number of subgroups surviving variable selection and coverage) showed little variation. CONCLUSIONS: With the proposed approach, we identified subgroups of positive and negative responders to treatment that markedly deviate from the mean response. The subgroups showed additive predictive value of the outcome. The modelling approach strategy was shown to be robust on this dataset. Our approach was thus able to discover understandable subgroups from observational data that have predictive value and which may be considered by the clinical users to get insight into who responds positively or negatively to a proposed treatment.

Effects of head tilt on squeeze-bottle nasal irrigation - A computational fluid dynamics study.

Nasal irrigation is a widely recognized treatment for several sinonasal diseases. However, there is a lack of clear evidence-based guidelines for optimal irrigation delivery to improve lavage and topical drug delivery. This study uses computational fluid dynamics (CFD) to assess the effects of different head tilt positions on sinonasal coverage, residence time and shear stresses in squeeze-bottle nasal irrigation. A sinonasal cavity computational model was constructed from a high-resolution CT scan of a healthy, 25-year-old Asian female. The Volume of Fluid method was used to track the interface between the two immiscible fluids (air and water). The direction of gravity was varied to simulate different head tilt-positions (0° Straight, 45° Forward, 45° Left, 45° Right and 45° Backward) during nasal irrigation with 150 mL liquid via a squeeze bottle through the left nostril for 2 s with a 0.1 s acceleration/deceleration time. The results showed that the 45° backward head tilt position was the most effective in delivering irrigation to the ethmoid, frontal and sphenoid sinuses. Altering head tilt had minimal impact on irrigation delivery to the maxillary sinuses. Maximum wall shear stresses seen in localized areas of the sinus mucosa varied significantly with different head tilt angles. However, the difference in mean wall shear stress on the sinus surfaces was marginal with changing head tilt position. The findings suggest that an optimized head tilt position can be identified to improve liquid irrigation to targeted sinuses, as per treatment requirements (lavage and topical drug delivery).

A Case of Fatal Rhino-Orbital Mucormycosis Associated With New Onset Diabetic Ketoacidosis and COVID-19.

Mucormycosis is an invasive fungal infection, often acute and extremely severe, occurring in patients with an underlying condition. Coinfection in patients with coronavirus disease 2019 (COVID-19) has been reported, often bacterial. A 24-year-old female is presented with acute fatal rhino-orbital mucormycosis and COVID-19. We report one of the first cases of rhino-orbital mucormycosis and COVID-19. With this case, we highlight the importance of considering mycotic coinfection in COVID-19 patients with diabetes.

Role of microRNAs in inflammatory upper airway diseases.

MicroRNAs (miRNAs) are a conserved family of small endogenous noncoding RNA molecules that modulate post-transcriptional gene expression in physiological and pathological processes. miRNAs can silence target mRNAs through degradation or inhibition of translation, showing their pivotal role in the pathogenesis of many human diseases. miRNAs play a role in regulating immune functions and inflammation and are implicated in controlling the development and activation of T and B cells. Inflammatory chronic upper airway diseases, such as rhinitis and rhinosinusitis, are spread all over the world and characterized by an exaggerated inflammation involving a complex interaction between immune and resident cells. Until now and despite allergy, little is known about their etiology and the processes implicated in the immune response and tuning inflammation of these diseases. This review highlights the knowledge of the current literature about miRNAs in inflammatory chronic upper airways diseases and how this may be exploited in the development of new clinical and therapeutic strategies.

Allergic Fungal Rhinosinusitis in Saudi Arabia: A Review of Recent Literature.

Allergic fungal rhinosinusitis (AFRS) has been considered an enigma since it was first described four decades ago. Previous research has found that AFRS has multiple definitions and a poorly understood pathogenesis because it overlaps with other conditions and necessitates meticulous work and multiple diagnostic modalities to confirm the diagnosis. However, despite the expansion of medical and surgical treatments, recurrence still occurs. In this review, the recent literature on AFRS cases in Saudi Arabia with relevance to its epidemiology, diagnosis, and management was studied and compared with international data. PubMed, Google Scholar, and Cochrane Library were searched for original research and review articles with local data. There is an evident paucity and contradiction between local studies regarding the epidemiology, diagnostic methods, and management of AFRS. Hence, well-defined randomized controlled trials (RCTs) are needed for the treatment of this chronic recurrent disease.

Role of Dupilumab in Approved Indications of COVID-19 Patient: an Efficacy-Based Nonsystematic Critical Analysis.

With many drugs being tried in the management and treatment of COVID-19, dupilumab is one such monoclonal antibody that has come under the limelight for its possible role as an adjunct therapy in COVID-19 position. There are isolated case reports and series that document a milder course of COVID-19 infection in patients who have already been on dupilumab therapy for treatment of conditions such as atopic dermatitis and chronic rhino-sinusitis with nasal polyp. There is also an ongoing debate regarding the continuation of biologicals in the COVID patient. In this article, a non-systematic critical analysis of dupilumab was performed to delve into this hypothesis further.

Fungal Rhinosinusitis: Prevalence and Spectrum in Singapore.

Background Fungal involvement of the paranasal sinuses has been described more than two centuries ago. In the current article, it is referred to as fungal rhinosinusitis (FRS) which is a general term that is used to describe a spectrum of pathologically, immunologically, and clinically different disease entities affecting the paranasal sinuses where fungus is thought to be the major potential etiology. Objective To determine the incidence and spectrum of FRS in Singapore and to compare our findings with international figures through literature review. Methods A retrospective review of the clinical charts, radiological and laboratory results, and operative reports of all patients who underwent endoscopic sinus surgery at an ENT department of a tertiary referral hospital in Singapore over five-year period. Results Out of 533 functional endoscopic sinus surgeries performed during the period of the study for management of chronic rhinosinusitis, 44 (8.4%) were found to fit the criteria for diagnosis of FRS. Twenty (45.5%) were eosinophilic FRS and 24 (54.5%) were fungal balls. Invasive FRS has not been encountered. Clinical presentation, investigations, and management of both groups of patients are discussed. Conclusion Fungal rhinosinusitis is not uncommon in Singapore. Fungal ball and eosinophilic mucin fungal rhinosinusitis are among the most common forms encountered in this part of the world.