Background: Epidemiological and experimental studies suggest that air pollution has a negative impact on human health and modifies the environment. However, the clinical implications of changes in environmental allergens secondary to air pollution have been little studied.
Objectives: To explore if the growth conditions of the Cynodon dactylon (rural vs urban area) modify the inflammatory response among patients with allergic rhinitis.Methodology: Two extracts were prepared for diagnostic test with Cyn d proteins obtained from rural and urban environment. Skin prick test (SPT), nasal challenge test (NCT), and eosinophil count in nasal mucus were performed in 3 groups: healthy subjects without rhinitis, rhinitis with (+) Cyn d, and rhinitis with (-) Cyn d.
Results: There was a 97% concordance in the positive and negative results of the SPT with the 2 extracts. However, Cyn d-urban extract generated larger wheals (P = .03) and a higher number of patients with rhinitis presented a positive NCT to this extract (n = 7 vs 14, P = .04). Patients with positive NCT had a significant increase in eosinophils in mucus, but there was no difference between the extracts. The healthy controls did not react to the extracts tested in the skin or nasal test.
Conclusion: The findings suggest that the growth conditions in urban area of Cynodon dactylon can generate changes in the protein extract and have clinical implications in patients with allergic rhinitis.
Background: Fraser syndrome is an autosomal recessive disorder characterized primarily by syndactyly, cryptophthalmos, urinary tract anomalies, ambiguous genitalia, and laryngeal anomalies. A 28-year-old man with Fraser syndrome presented with cryptophthalmos, microphthalmia, lacrimal system dysgenesis, and chronic sinusitis.
Objective: The patients' clinical condition and surgical treatment are described. A literature review was conducted, and articles relevant to the case are presented.
Methods: Case report.
Results: To our knowledge, this is the first published case report of endonasal management of dacryocystoceles in a Fraser syndrome patient. The patient was treated via endoscopic endonasal marsupialization and drainage.
Conclusion: Fraser syndrome patients may initially present to many different specialties as the spectrum of clinical manifestations is broad. Physicians treating these patients should take a collaborative approach to surgical and medical management.
Background: External nasal dilator strips are used as nonpharmacological therapy to reduce snoring and daytime sleepiness. In a product improvement initiative, a marketed strip (BRNS) and 2 prototype nasal strips were evaluated.
Objective: To compare the nasal patency and multiple-use dermal tolerability of the BRNS and prototype nasal strips using both objective and subject-reported outcome measures.
Methods: Two studies were conducted separately in healthy volunteers ≥18 years of age. A single-day nasal patency randomized crossover study assessed minimal cross-sectional area (MCA; second restriction) and nasal volume (using acoustic rhinometry); nasal inspiratory flow and resistance (using posterior rhinomanometry); and subject-reported evaluations of the BRNS compared with the butterfly strip and teardrop strip prototypes. A single-center, randomized, controlled, parallel-group, evaluator-blinded study assessed dermal tolerability of the BRNS and the butterfly strip over 7 consecutive nights of use, using the Dermal Response Scale (DRS) and subject-reported comfort and ease of removal.
Results: In the Patency study (N = 50), all 3 strips demonstrated significant improvement from baseline in MCA, nasal volume, and nasal flow parameters (resistance and peak flow). The prototype strips demonstrated significantly more improvement in nasal volume than the BRNS, and the butterfly strip showed significantly more improvement in MCA than the BRNS; all strips were similar with respect to nasal flow and subject-reported nasal breathing outcomes. In the Dermal Tolerability study (N = 82), all subjects scored 0 (no evidence of irritation) on the DRS at all 7 morning assessments; the BRNS was numerically, but not significantly, superior to the butterfly strip on subject-reported outcomes.
Conclusion: The Patency study demonstrated significant improvement from baseline in nasal dimensions and flow for all 3 evaluated strips; between-strip differences were confined to nasal dimensions. Both the BRNS and butterfly strip were generally well tolerated, with no evidence of dermal response over 7 consecutive nights of use.ClinicalTrials.gov identifiers: NCT01105949 and NCT01495494.
Background: Chronic rhinosinusitis (CRS) is a common inflammatory disease of nasal and paranasal sinuses, with many treatment methods available for the management of this disease. Recently, herbal medicines have shown a significant impact on inflammatory diseases such as CRS, and one of these herbal medicines is Nigella sativa. Therefore, the current study aimed to evaluate the effectiveness of N. sativa in patients with CRS without nasal polyp (CRSsNP).
Methods: In this randomized clinical trial, 65 patients with mild to moderate CRSsNP were enrolled based on the inclusion criteria. Patients were divided randomly into 2 parallel groups: intervention and placebo groups. Patients in the intervention group received 2 puffs/day of N. sativa nasal spray (1 g/day of N. sativa) and in the placebo group received 2 puffs/day of sodium chloride spray 0.65%.
Results: Thirty-one patients (19 men and 12 women) in the intervention group and 34 in the placebo group (18 men and 16 women) were evaluated. Lund-McKay, Lund Kennedy, and Sino-Nasal Outcome Test-22 scores were assessed for both groups after 8 weeks of treatments. These scores decreased significantly in both groups. However, these scores were significantly lower in the intervention group compared with the placebo group (P < .0001, for all).
Conclusion: The use of N. sativa nasal spray has symptom reliever effect with no adverse effects in patients with CRSsNP.
Background: Pediatric patients presenting with a nasal mass is uncommon and a high index of suspicion for it to be a meningoencephalocele is essential. Majority of these are congenital and require early intervention owing to the risk of meningitis. Surgery in these cases is very challenging because of the risk of anesthesia and limited space.
Objective: This study aimed to describe our technique and experience in managing pediatric meningoencephaloceles.
Methods: A retrospective study of 19 pediatric patients (age ranging from 40-day-old infants to 11.5-year-old children) was conducted at our tertiary care center from January 2012 to February 2017. Patients presenting with an intranasal meningoencephalocele were treated by endoscopic approach, using otological microinstruments. After detailed imaging and clinical evaluation, a tailored repair, using fat/fascia/cartilage, a multilayer closure, was carried out in all cases.
Results: All patients had a successful repair and recovery, except for one death following an episode of convulsion. There was a minor circumferential narrowing of the nasal vestibule and synechia formation in 2 of our cases.
Conclusion: Transnasal endoscopic repair of meningoencephalocele is minimally invasive. It avoids permanent anosmia and is cosmetic. A combination of miniaturized instruments and a 4-mm 0° nasal endoscope gives excellent visual field and an adequate working space. Owing to the larger defects in congenital meningoencephaloceles, a multilayer repair provides excellent outcomes.
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