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The Role of Dual Bronchodilation and the Conscientious Use of Inhaled Corticosteroid in COPD 双重支气管扩张和吸入皮质类固醇在慢性阻塞性肺病中的作用
Pub Date : 2022-08-05 DOI: 10.3390/sinusitis6020005
R. Figueiredo, Lucas F. Araujo, J. de Bessa Júnior
Chronic obstructive pulmonary disease (COPD) is a global public health burden that stands out as a leading cause of mortality around the world, especially in less developed countries. COPD treatment should be centered on the individual necessities of each patient, integrating pharmacological therapy, immunization, nutritional support, pulmonary rehabilitation and control of comorbidities. Combining a long-acting antimuscarinic (LAMA) with a long-acting beta2-agonist (LABA) bronchodilator has proven to be more effective than monotherapy with LABA or LAMA, in terms of the functional improvement of forced expiratory volume (FEV1), symptoms and life quality and may be helpful in patients with progressive dyspnea. The eosinophil blood count is a simple biomarker that could guide personalized treatment strategies by identifying patients with greater clinical benefits of inhaled corticosteroid (ICS) treatment. However, one critical concern is the increased risk of pneumonia in individuals treated with ICS.
慢性阻塞性肺疾病(COPD)是全球公共卫生负担,是世界各地,特别是欠发达国家的主要死亡原因。COPD治疗应以每位患者的个性化需求为中心,结合药物治疗、免疫、营养支持、肺部康复和合并症控制。在用力呼气量(FEV1)、症状和生活质量方面,长效抗uscarinic (LAMA)联合长效β 2激动剂(LABA)支气管扩张剂已被证明比LABA或LAMA单药治疗更有效,并可能对进行性呼吸困难患者有所帮助。嗜酸性粒细胞计数是一种简单的生物标志物,可以通过识别吸入皮质类固醇(ICS)治疗具有更大临床益处的患者来指导个性化治疗策略。然而,一个关键的问题是使用ICS治疗的个体患肺炎的风险增加。
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引用次数: 0
Promotion and Restoration of Health with the Amazing Mediterranean Diet versus an Increase in Childhood Pathology Due to the Disastrous Diet of ‘Western Civilisation’ 神奇的地中海饮食促进和恢复健康与“西方文明”灾难性饮食导致的儿童病理增加
Pub Date : 2022-07-15 DOI: 10.3390/sinusitis6020004
F. Calatayud-Sáez
‘Understand your honours that it is not so much that the traditional diet rooted in our homes has a miraculous character, as that the diet that modernity imposes on us is unhealthy and inadequate for the human intestines [...]
“尊敬的大人,请理解,与其说根植于我们家庭的传统饮食具有神奇的特性,不如说现代强加给我们的饮食是不健康的,对人体肠道是不适当的……”
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引用次数: 1
Allergic Rhinosinusitis and Airway Diseases 过敏性鼻窦炎和气道疾病
Pub Date : 2022-05-14 DOI: 10.3390/sinusitis6010003
S. Duong-Quy
The concept of united airway disease interaction, which comprises chronic rhinosinusitis and other lower airway disorders such as asthma, has been recognized for over a decade [...]
联合气道疾病相互作用的概念,包括慢性鼻窦炎和其他下气道疾病,如哮喘,已经被认可了十多年[…]
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引用次数: 0
Promoting Equity When Using the SNOT-22 Score: A Scoping Review and Literature Review 在使用SNOT-22分数时促进公平:范围回顾和文献回顾
Pub Date : 2022-01-16 DOI: 10.3390/sinusitis6010002
A. Weaver, Andrew Wood
It is established that non-white people experience worse health outcomes than white people within the same population. Equity addresses differences between patient subgroups, allowing needs-based distribution of resources. The use of quality-of-life (QoL) tools to assist clinical decision making such as the SNOT-22 for chronic rhinosinusitis promotes equality, not equity, as quality-of-life (QoL) tools provide the same criteria of symptom scoring across diverse populations. We considered the effects of ethnicity and race on SNOT-22 scores and whether these scores should be adjusted to improve equity. PubMed and MEDLINE provided papers for a scoping review. A combination of the following search terms was used: patient-reported outcome measures (PROM) (OR) quality of life; (AND) race (OR) ethnicity (OR) disparities; (AND) otolaryngology (OR) SNOT-22 (OR) sinusitis. The first study identified no evidence of ethnic variability in SNOT-22 scores. However, the study did not represent the local population, including 86% white people. Other studies identified baseline SNOT-22 disparities with respect to population demographics, gender, and age. Ethnic differences appear to exist in acute sinusitis symptomatology. In other fields both within and outside of otorhinolaryngology, ethnic differences exist with regard to QoL tools. This scoping review identified a paucity of data in rhinology. However, evidence implies some form of correction to QoL scores could help promote equity for non-white patients.
在相同的人群中,非白人的健康状况比白人差,这是确定的。公平解决了患者亚组之间的差异,允许基于需求的资源分配。使用生活质量(QoL)工具来辅助临床决策,如慢性鼻窦炎的SNOT-22,促进了平等,而不是公平,因为生活质量(QoL)工具在不同人群中提供了相同的症状评分标准。我们考虑了民族和种族对SNOT-22分数的影响,以及这些分数是否应该调整以提高公平性。PubMed和MEDLINE为范围审查提供了论文。使用了以下搜索词的组合:患者报告的结果测量(PROM) (OR)生活质量;(和)种族(或)民族(或)差异;(AND)耳鼻喉科(OR) SNOT-22 (OR)鼻窦炎。第一项研究没有发现SNOT-22分数存在种族差异的证据。然而,这项研究并没有代表当地人口,其中包括86%的白人。其他研究确定了基线SNOT-22在人口统计学、性别和年龄方面的差异。急性鼻窦炎的症状表现存在民族差异。在耳鼻喉科内外的其他领域,在生活质量工具方面存在民族差异。该范围审查确定了鼻科数据的缺乏。然而,有证据表明,对生活质量评分进行某种形式的修正可能有助于促进非白人患者的公平。
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引用次数: 1
Atopic Status in Children with Asthma and Respiratory Allergies—Comparative Analysis of Total IgE, ImmunoCAP Phadiatop/fx5 and Euroimmun Pediatric Immunoblot 哮喘和呼吸道过敏儿童的特应性状态——总IgE、ImmunoCAP Phadiatop/fx5和euroimmune儿科免疫印迹的比较分析
Pub Date : 2021-12-29 DOI: 10.3390/sinusitis6010001
S. Lazova, M. Baleva, S. Priftis, E. Naseva, T. Velikova
Introduction: An atopic status assessment (skin prick test or specific immunoglobulin (sIgE)) in asthmatic children is considered a milestone in identifying potential risk factors and triggers provoking loss of asthma control and asthma exacerbation. Objective: The study aims to perform a comparative analysis of different laboratory methods for a serological assessment of an atopic status in asthma and respiratory allergies in children. Material and methods: A total of 86 children were included, all of whom were diagnosed with bronchial asthma, aged from 5 to 17 years and screened for total IgE level using enzyme-linked immunosorbent assay (ELISA). In 48 randomly selected children, we performed a semi-quantitative serological in vitro assessment of the specific IgE antibodies against food and aeroallergen, using two different laboratory methods—Euroimmun Immunoblot and ImmunoCAP (Phadiatop/fx5). Results: In 70% of the children with a history of allergies, and 65.3% without clinically manifested allergies, multiscreen test ImmunoCAP Phadiatop/fx5 showed positivity and confirmed atopy. Our results showed a significant moderate to strong correlation between multiscreen ImmunoCAP Phadiatop/fx5, and Euroimmun specific IgE titers against aero-allergens—cats, mites, tree mix and food allergens—soy, wheat (р = 0.006), rice, р = 0.090), apple р = 0.007) and peanut. A sensitivity of 63% and specificity of 73.5% was observed for EUROIMMUN Pediatric (food allergens, IgE titer > 1) compared with the gold standard ImmunoCap/fx5. The mean value of total IgE is significantly higher in children with asthma and concomitant with allergic rhinitis compared to those without allergic rhinitis (mean 202.52 U/mL, IQR 102.50 (24.20–363.95) vs. 316.68, IQR 261.00 (109.20–552.50), p = 0.005). Conclusion: Establishing the spectrum of the most common respiratory and food allergens is an essential factor for maintaining asthma control, both through a strategy to avoid allergen exposure and by developing a recommendation plan. The immunoblotting technique is easily applicable in daily clinical and laboratory practice. It is also a cost-effective and reliable alternative to the “gold standard” ImmunoCAP Phadiatop/fx5 in diagnosing atopy in children.
哮喘儿童的特应性状态评估(皮肤点刺试验或特异性免疫球蛋白(sIgE))被认为是识别潜在危险因素和引发哮喘控制丧失和哮喘加重的一个里程碑。目的:本研究旨在对不同的实验室方法进行比较分析,以评估儿童哮喘和呼吸道过敏的特应性状态。材料和方法:共纳入86例儿童,均为支气管哮喘,年龄5 ~ 17岁,采用酶联免疫吸附试验(ELISA)筛查总IgE水平。在48名随机选择的儿童中,我们使用两种不同的实验室方法——euroimmune Immunoblot和ImmunoCAP (Phadiatop/fx5),对针对食物和空气过敏原的特异性IgE抗体进行了半定量的体外血清学评估。结果:在70%有过敏史的儿童和65.3%无临床表现过敏的儿童中,免疫cap Phadiatop/fx5多屏试验呈阳性,证实为特应性反应。我们的研究结果显示,multiscreen ImmunoCAP Phadiatop/fx5与针对空气过敏原(猫、螨虫、树木混合物)和食物过敏原(大豆、小麦(0.006)、大米(0.090)、苹果(0.007)和花生)的euroimmune特异性IgE滴度之间存在显著的中至强相关性。与金标准ImmunoCap/fx5相比,EUROIMMUN儿科(食物过敏原,IgE滴度> 1)的敏感性为63%,特异性为73.5%。哮喘合并变应性鼻炎患儿总IgE均值明显高于非变应性鼻炎患儿(平均202.52 U/mL, IQR 102.50 (24.20-363.95) vs. 316.68, IQR 261.00 (109.20-552.50), p = 0.005)。结论:通过制定避免过敏原暴露的策略和制定推荐计划,建立最常见的呼吸道和食物过敏原谱是维持哮喘控制的重要因素。免疫印迹技术在日常临床和实验室实践中易于应用。它也是诊断儿童特异反应的“金标准”ImmunoCAP Phadiatop/fx5的一种经济可靠的替代方法。
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引用次数: 2
Clearance of Bone Substitute in Gel Form Accidentally Dispersed into the Sinus Cavity during Transcrestal Maxillary Sinus Floor Elevation: Two-Case Report 经瓣上颌窦底提升过程中意外分散到窦腔的凝胶状骨替代物清除:2例报告
Pub Date : 2021-10-27 DOI: 10.3390/sinusitis5020014
F. Bernardello, T. Lombardi, C. Stacchi
Sinus membrane perforation is the most frequent intraoperative complication occurring during maxillary sinus floor elevation. Although numerous techniques for perforation management are present, grafting material dissemination may still occur, representing a potential trigger factor leading to acute or chronic sinusitis. This case report describes two cases of xenogeneic bone substitute in gel form accidentally dispersed into the sinus cavity during maxillary sinus floor elevation with a transcrestal approach. In both cases, immediately postoperative radiographic imaging showed an important amount of gel graft dislodged into the sinus cavity as a consequence of hidden perforations that remained undetected during surgery. Patients were monitored for 6 months after surgery and reported no signs or symptoms related to possible sinus disease. Control radiographs showed no sinus membrane hypertrophy and/or presence of residual disseminated gel, confirming complete clearance of the accidentally dispersed graft through the ostiomeatal complex. In order to minimize postoperative complications, bone substitutes in gel form could represent an interesting alternative to granular grafts for their easier clearance from the maxillary sinus cavity in case of accidental dissemination during sinus augmentation procedures.
窦膜穿孔是上颌窦底抬高术中最常见的并发症。尽管目前有许多穿孔处理技术,移植材料传播仍然可能发生,这是导致急性或慢性鼻窦炎的潜在触发因素。本病例报告描述了两例异种骨替代物凝胶形式在上颌窦底提升术中意外分散到窦腔中。在这两例患者中,术后立即放射成像显示,由于手术中未被发现的隐藏穿孔,大量凝胶移植物移位到窦腔中。术后监测患者6个月,未发现与可能的鼻窦疾病相关的体征或症状。对照x线片显示没有窦膜肥大和/或残留弥散性凝胶,证实意外分散的移植物通过口鼻道复合体完全清除。为了尽量减少术后并发症,凝胶形式的骨替代物可以作为颗粒状移植物的一种有趣的替代方法,因为在鼻窦增强术中意外扩散的情况下,它们更容易从上颌窦腔中清除。
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引用次数: 1
Study of Nasal Fractional Exhaled Nitric Oxide (FENO) in Children with Allergic Rhinitis 变应性鼻炎患儿鼻腔呼出一氧化氮分数(FENO)的研究
Pub Date : 2021-10-08 DOI: 10.3390/sinusitis5020013
S. Duong-Quy, Thuy Nguyen-Thi-Dieu, K. Tran-Quang, Tram Tang-Thi-Thao, T. Nguyen-Van, Thu Vo-Pham-Minh, Q. Vu-Tran-Thien, K. Bui-Diem, V. Nguyen-Nhu, Lam Hoang-Thi, T. Craig
(1) Background: Exhaled nitric oxide (NO) has been considered as a biomarker of airway inflammation. The measurement of fractional exhaled NO (FENO) is a valuable test for assessing local inflammation in subjects with allergic rhinitis (AR). (2) Objective: To evaluate (a) the correlation between nasal FENO with anthropometric characteristics, symptoms of AR and nasal peak flows in children without and with AR; and (b) the cut-off of nasal FENO for diagnosis of AR in symptomatic children. (3) Methods: The study was a descriptive and cross-sectional study in subjects with and without AR < 18 years old. All clinical and functional characteristics of the study subjects were recorded for analysis. They were divided into healthy subjects for the control group and subjects with AR who met all inclusion criteria. (4) Results: 100 subjects (14 ± 3 years) were included, including 32 control subjects and 68 patients with AR. Nasal FENO in AR patients was significantly higher than in control subjects: 985 ± 232 ppb vs. 229 ± 65 ppb (p < 0.001). In control subjects, nasal FENO was not correlated with anthropometric characteristics and nasal inspiratory or expiratory peak flows (IPF or EPF) (p > 0.05). There was a correlation between nasal FENO and AR symptoms in AR patients and nasal IPF and EPF (p = 0.001 and 0.0001, respectively). The cut-off of nasal FENO for positive AR diagnosis with the highest specificity and sensitivity was ≥794 ppb (96.7% and 92.6%, respectively). (5) Conclusion: The use of nasal FENO as a biomarker of AR provides a useful tool and additional armamentarium in the management of allergic rhinitis.
(1)背景:呼出一氧化氮(NO)被认为是气道炎症的生物标志物。呼气一氧化氮分数(FENO)的测量是评估过敏性鼻炎(AR)患者局部炎症的一项有价值的测试。(2)目的:评估(a)无AR和有AR的儿童鼻腔FENO与人体测量学特征、AR症状和鼻峰流量的相关性;(b)截断鼻腔FENO对有症状儿童的AR诊断。(3)方法:采用描述性和横断面研究方法,研究对象为年龄< 18岁的AR患者和非AR患者。记录研究对象的所有临床和功能特征以供分析。他们被分为健康受试者作为对照组和符合所有纳入标准的AR受试者。(4)结果:纳入100例受试者(14±3岁),其中对照组32例,AR患者68例,AR患者鼻部FENO显著高于对照组:985±232 ppb比229±65 ppb (p < 0.001)。在对照组中,鼻腔FENO与人体测量特征和鼻腔吸气或呼气峰流量(IPF或EPF)无关(p < 0.05)。AR患者鼻腔FENO与AR症状、鼻腔IPF和EPF之间存在相关性(p分别为0.001和0.0001)。鼻腔FENO诊断AR阳性的最高特异性和敏感性临界值≥794 ppb(分别为96.7%和92.6%)。(5)结论:使用鼻腔FENO作为AR的生物标志物,为变应性鼻炎的治疗提供了一种有用的工具和额外的手段。
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引用次数: 2
Olfactory Disorders in Post-Acute COVID-19 Syndrome 急性后COVID-19综合征的嗅觉障碍
Pub Date : 2021-09-24 DOI: 10.3390/sinusitis5020012
L. Araujo, V. Arata, R. Figueiredo
Altered smell is one of the most prevalent symptoms in acute COVID-19 infection. Although most patients recover normal neurosensory function in a few weeks, approximately one-tenth of patients report long-term smell dysfunction, including anosmia, hyposmia, parosmia and phantosmia, with a particularly notable impact on quality of life. In this complex scenario, inflammation and cellular damage may play a key role in the pathogenesis of olfactory dysfunctions and may affect olfactory signaling from the peripheral to the central nervous system. Appropriate management of smell disturbances in COVID-19 patients must focus on the underlying mechanisms and the assessment of neurosensorial pathways. This article aims to review the aspects of olfactory impairment, including its pathophysiology, epidemiology, and clinical management in post-acute COVID-19 syndrome (PACS).
嗅觉改变是急性COVID-19感染最常见的症状之一。虽然大多数患者在几周内恢复正常的神经感觉功能,但大约十分之一的患者报告长期嗅觉功能障碍,包括嗅觉缺失、嗅觉减退、嗅觉缺失和嗅觉缺失,对生活质量的影响尤为显著。在这种复杂的情况下,炎症和细胞损伤可能在嗅觉功能障碍的发病机制中发挥关键作用,并可能影响从外周神经系统到中枢神经系统的嗅觉信号。对COVID-19患者嗅觉障碍的适当管理必须关注其潜在机制和神经感觉通路的评估。本文综述了急性后冠状病毒肺炎综合征(PACS)嗅觉功能障碍的病理生理、流行病学和临床管理等方面的研究进展。
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引用次数: 5
Effects of the Traditional Mediterranean Diet in Childhood Recurrent Acute Rhinosinusitis 传统地中海饮食对儿童复发性急性鼻窦炎的影响
Pub Date : 2021-09-02 DOI: 10.3390/sinusitis5020011
F. Calatayud-Sáez, B. Calatayud, Ana Calatayud
Introduction: There are more and more studies that demonstrate the anti-inflammatory effects of the traditional Mediterranean diet (TMD). The aim of the study was to assess the effects of an intervention with the TMD in patients with recurrent acute and chronic rhinosinusitis. Material and Methods: We performed a pretest–posttest comparison study in 114 patients (56 girls and 58 boys) aged one to five years who had three or more acute rhinosinusitis episodes in the period of 1 year. They were included for a year in the nutritional program “Learning to eat from the Mediterranean”. The anthropometric, clinical, and therapeutic characteristics were studied. Results: All the studied indicators showed a positive and statistically significant evolution. Of the patients, 53.5% did not have any episode of acute rhinosinusitis, and 26.3% had only one, compared to the 3.37 they had on average in the previous year. The use of antibiotics decreased by 87.6%. The degree of satisfaction of the families was very high. The Mediterranean Diet Quality Index (KIDMED) that assesses the quality of the TMD rose from 7.7 to 11 points. Conclusions: The adoption of the TMD could have promising effects in the prevention and treatment of recurrent acute and chronic rhinosinusitis, limiting the pharmacological and surgical intervention in many of these patients.
越来越多的研究证实了传统地中海饮食(TMD)的抗炎作用。该研究的目的是评估TMD对复发性急性和慢性鼻窦炎患者的干预效果。材料和方法:我们对114名1至5岁的患者(56名女孩和58名男孩)进行了一项前测后测比较研究,这些患者在1年内有3次或3次以上的急性鼻窦炎发作。他们被纳入了为期一年的“学习地中海饮食”营养计划。研究了人体测量学、临床和治疗特点。结果:各项指标均呈显著正相关,且有统计学意义。53.5%的患者没有任何急性鼻窦炎发作,26.3%的患者只有一次急性鼻窦炎发作,而前一年的平均发病率为3.37。抗生素的使用下降了87.6%。家庭满意度非常高。评估TMD质量的地中海饮食质量指数(KIDMED)从7.7分上升到11分。结论:采用TMD预防和治疗复发性急慢性鼻窦炎具有良好的效果,限制了许多患者的药物和手术干预。
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引用次数: 6
Persistent Nasal Obstruction: An Expression of the Pro-Inflammatory State? 持续性鼻塞:促炎状态的表达?
Pub Date : 2021-06-15 DOI: 10.3390/SINUSITIS5010010
F. Calatayud-Sáez, B. Calatayud, Ana Calatayud
Introduction: During the first years of life, the oro-pharyngeal lymphoid tissue gradually increases in size, causing in some children difficulty breathing and often leading to surgical removal of the tonsils and adenoids. The objective of the study is to assess the effects of the Mediterranean diet in children who had chronic upper airway obstruction. Material and methods: This was a prospective study pre-test/post-test comparison. Eighty-seven patients from two to eight years old were recruited. A food reeducation program based on the Mediterranean diet was applied for one year. Clinical, therapeutic, and anthropometric variables were studied. Results: The degree of nasal obstruction decreased in 95.1% of the patients. After the nutritional intervention, the number of colds with bacterial complications decreased by 80.26%; 60.9% had no bacterial complications during the year of the study. The use of antibiotics decreased by 81.94%. Symptomatic treatment decreased by 61.2%. Most patients did not require surgical intervention, and clinical evolution suggested that it would no longer be necessary. Conclusions: We can conclude by saying that the application of the traditional Mediterranean diet could be effective in the prevention and treatment of persistent nasal obstruction, limiting pharmacological and surgical intervention in many of these patients.
在生命的最初几年中,口咽淋巴组织逐渐增大,导致一些儿童呼吸困难,常常导致手术切除扁桃体和腺样体。该研究的目的是评估地中海饮食对患有慢性上呼吸道阻塞的儿童的影响。材料和方法:这是一项前瞻性研究,测试前/测试后比较。87名年龄从2岁到8岁的患者被招募。以地中海饮食为基础实施了为期一年的食物再教育计划。研究了临床、治疗和人体测量变量。结果:95.1%的患者鼻塞程度减轻。营养干预后,合并细菌并发症的感冒次数减少80.26%;60.9%的患者在研究期间无细菌并发症。抗生素使用率下降81.94%。对症治疗下降61.2%。大多数患者不需要手术干预,临床发展表明不再需要手术干预。结论:传统地中海饮食可有效预防和治疗顽固性鼻塞,限制了许多顽固性鼻塞患者的药物和手术干预。
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引用次数: 7
期刊
Sinusitis
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