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Ruszczak Z, Dimitrov DT, Abdelhadi S, Filipova ZM, Schwartz RA. Interrupting aerosol spread and nasal acquisition of SARS-CoV-2 with topical trichloroacetic acid. Ital J Dermatol Venerol 2022; 156:637-641. [PMID: 35088970 DOI: 10.23736/s2784-8671.21.06987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The devastating effects of the coronavirus designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have merited many approaches to combat COVID-19. Since it is transmitted largely by fine droplets and aerosols, air defense with suitable ventilation and mask use might be enhanced by attacking the virus and its likely main point of invasion, the nasal mucosa. We recommend formal clinical trials employing topical trichloroacetic acid (TCA), which successfully blocks the nasal entry point for airborne allergens and to be curative for the early stages of viral infections of the oral mucosa. TCA chemically redesigns the nasal and nasopharyngeal epithelia to in effect remove receptors and cell, allowing SARS-CoV-2 viral attachment. TCA fits the ideal category for medication, being inexpensive, readily available, easy-to-use, and proven to be safe for suggested use. We postulate its potential efficacy in SARS-CoV-2 infection and urge consideration of clinical trials. Local delivery of TCA in the form of contact application directly to the nasal cavity may have a preventive effect, potentially neutralizing virus entry and subsequential virus spread to the lower respiratory tract, especially for those at high risk. In addition, TCA may diminish the local viral load and its replication potential in those newly infected.
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Affiliation(s)
- Zbigniew Ruszczak
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates - .,Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates -
| | - Dimitre T Dimitrov
- Division of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.,Ministry of Presidential Affairs, Abu Dhabi, United Arab Emirates
| | - Shaden Abdelhadi
- Division of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Zlatina M Filipova
- Elysee DSMC, Abu Dhabi, United Arab Emirates.,Amrita Wellness Clinic, Birkirkara, Malta
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Abdelhadi S, Ruszczak Z, Schwartz RA. COVID-19: Topical agents and therapeutic prevention of nasal viral acquisition. Dermatol Ther 2020; 34:e14454. [PMID: 33107144 DOI: 10.1111/dth.14454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
Since the spread of SARS-CoV-2 became a pandemic, the number of cases has been continuously growing worldwide. Numerous recommendations and suggestions have been published to prevent the acquisition and spread of the SARS-CoV-2, especially to protect health workers and front-line caregivers. SARS-CoV-2 is transmitted by aerosol, rendering air defense with suitable ventilation and adequate mask use pivotal. Recently, locally applied antiseptic, antiviral, or structure competitive receptor blockers were suggested to attack the virus at its main point of invasion, the nasal mucosa and nasopharynx. We discuss the most plausible and safe ideas to reduce viral load at the point of entry, and subsequently the spread of SARS-CoV-2 to the lower respiratory tract, lungs, and other organs. In addition, we analyze the value and recommend clinical trials employing topical trichloroacetic acid (TCA), a substance well known from dermatologic and cosmetic procedures. It has been proven to successfully block the nasal entry for airborne allergens, preventing the development of allergic rhinitis and asthma, and to be curative for early stages of viral infections entering through the oral mucosa. For SARS-CoV-2, TCA in a single, short-time application is expected to remodel the nasal and nasopharyngeal epithelia, eliminating both the receptors and cells responsible for viral entry and subsequent viral spread to the lower respiratory tract. Moreover, this may have therapeutic benefits for those recently infected by reducing local viral replication. Such procedures are cheap, safe, and can be conducted in almost every setting, especially in regions with inadequate financial and logistic resources.
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Affiliation(s)
- Shaden Abdelhadi
- Department of Internal Medicine and Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Zbigniew Ruszczak
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Robert A Schwartz
- Department of Dermatology and Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
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Satpute SS, Joshi SV, Arora R, Prabha N, Keche P, Nagarkar NM. Cryosurgery Vs Trichloroacetic Acid Chemical Cautery for the Treatment of Hypertrophied Nasal Turbinate: A Comparative Study. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2020; 32:303-309. [PMID: 33014907 PMCID: PMC7515624 DOI: 10.22038/ijorl.2019.39039.2293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: The Study Aimed To Compare The Results of Cryosurgery With Trichloroacetic Acid Chemical (TCA) Cautery For The Treatment of Hypertrophied Nasal Turbinates. Materials and Methods: This was a prospective study of 70 patients with nasal obstruction due to hypertrophied nasal turbinates who were randomly divided in 2 groups of 35 each. In group 1, patients underwent inferior nasal turbinate reduction by cryosurgery and in group 2 patients with cautery by 50 % TCA. The patients were evaluated using SNOT-20 score pre and postoperatively on 6th month. Results: Significant improvement in symptoms was seen in 28 patients (80 %) in group 1 and in 10 patients (28.57%) in group 2..Improvement in average SNOT Score after cauterization of hypertrophied nasal turbinates by cryosurgery was from 55(severe) to 16(mild) and by TCA was from 54(severe) to 32(mod) in 6 months and this was statistically significant (P<0.001). Complications like bleeding, scarring, infection and adhesion formation were more with TCA than that of cryosurgery group and among these complications scarring was statistically significant (P =0.003). Conclusion: The use of cryosurgical treatment for hypertrophied nasal turbinates is a safe, curative method as compared to that of TCA cautery which is less curative and with more complications.
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Affiliation(s)
- Satish S Satpute
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Samir V Joshi
- Department of Otorhinolaryngology and Head and Neck Surgery, BJ Government Medical College, Pune, India
| | - Ripudaman Arora
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Neel Prabha
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Prashant Keche
- Department of Otorhinolaryngology and Head and Neck Surgery, SVN Govt Medical College, Yavatmal, India
| | - Nitin M Nagarkar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Rodrigues F, Freire AP, Uzeloto J, Xavier R, Ito J, Rocha M, Calciolari R, Ramos D, Ramos E. Particularities and Clinical Applicability of Saccharin Transit Time Test. Int Arch Otorhinolaryngol 2019; 23:229-240. [PMID: 30956710 PMCID: PMC6449131 DOI: 10.1055/s-0038-1676116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 10/06/2018] [Indexed: 11/02/2022] Open
Abstract
Introduction The importance of mucociliary clearance (MCC) for the respiratory system homeostasis is clear. Therefore, evaluating this defense mechanism is fundamental in scientific research and in the clinical practice of pulmonology and of associated areas. However, MCC evaluation has not been so usual due to the complexity of methods that use radiolabeled particles. Nevertheless, as an interesting alternative, there is the saccharin transit time (STT) test. This method is reproducible, simple to perform, noninvasive, does not demand high costs, and has been widely used in studies of nasal MCC. Although the STT test is widely used, there is still lack of a detailed description of its realization. Objective The present literature review aims to provide basic information related to the STT test and to present the findings of the previous studies that used this method, discussing variations in its execution, possible influences on the obtained results and limitations of the method, as well as to relate our experience with the use of STT in researches. Data Synthesis There are several factors that can alter the results obtained from STT tests, which would raise difficulties with proper interpretation and with the discussion of the results among different studies. Conclusions Saccharin transit time is a widely used method for the evaluation of nasal MCC, and therefore, the standardization related to the previous and concurrent to test orientations, and also its execution, become essential to improve its accuracy, and allow comparisons among different studies.
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Affiliation(s)
- Fernanda Rodrigues
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Ana Paula Freire
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Juliana Uzeloto
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Rafaella Xavier
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Juliana Ito
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Marceli Rocha
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Renata Calciolari
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Dionei Ramos
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
| | - Ercy Ramos
- Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
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Huang Z, Velasquez N, Nguyen A, Ye T, Le W, Bravo DT, Hwang PH, Zhou B, Nayak JV. Topical Corticosteroid Pretreatment Mitigates Cellular Damage After Caustic Injury to the Nasal Upper Airway Epithelium. Am J Rhinol Allergy 2019; 33:277-285. [PMID: 30638033 DOI: 10.1177/1945892418823305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Topical corticosteroids are currently employed to reduce established airway inflammation; their prophylactic use might help limit cellular damage against harmful stimuli. OBJECTIVES To determine the effects of a prophylactic topical application of budesonide (BD) on an in vivo nasal epithelium injury model induced by trichloroacetic acid (TCA). METHODS C57Bl/6 mice were exposed to intranasal TCA topical application. Three groups received topical intranasal BD, saline solution, or no intervention prior to a single topical exposure to TCA. Controls were not exposed to TCA. Whole nasal cavity coronal sections were analyzed at 1, 3, and 6 days postinjury at tissue and cellular levels using histopathological analysis, immunofluorescent staining, and fresh tissue RNA microarray analysis. RESULTS Prophylactic topical corticosteroid exposure protected the nasal epithelium from acute damage, maintaining epithelial thickness and cell survival. Six days following TCA exposure, epithelial and cellular changes were less pronounced on the BD-treated group compared to all exposure groups. The microarray analysis was used to evaluate the gene transcripts in all treatment groups. Ciliary tip protein, Sentan, and submucosal protein S100b were identified as potential factors in epithelial airway protection; immunofluorescent staining corroborated their presence and location within the respiratory epithelium. CONCLUSION Topical corticosteroid treatment to the nasal epithelium can mitigate several of the early deleterious effects of acute epithelial damage in experimental airway injuries caused by TCA. These findings suggest a novel, direct cytoprotective effect of corticosteroids on the nasal epithelium, and the potential of expanding the use of prophylactic periprocedural topical corticosteroids for respiratory epithelial tissues.
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Affiliation(s)
- Zhenxiao Huang
- 1 Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,2 Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Nathalia Velasquez
- 2 Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Alan Nguyen
- 2 Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Ting Ye
- 3 Department of Otolaryngology - Head and Neck Surgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Le
- 2 Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Dawn T Bravo
- 2 Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter H Hwang
- 2 Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Bing Zhou
- 1 Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jayakar V Nayak
- 2 Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Yanagisawa S, Oshio T, Kato M, Kano M, Tsuji Y, Morikawa Y. Endoscopic chemocauterization for pyriform sinus fistula in children. Pediatr Int 2017; 59:807-811. [PMID: 28387991 DOI: 10.1111/ped.13294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/25/2017] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although complete excision is the standard treatment for pyriform sinus fistula (PSF), it has recently been suggested that chemocauterization via the internal orifice of the fistula could be an effective non-invasive treatment for the condition. The present report describes the details of our experience with and the efficacy of endoscopic chemocauterization for pediatric PSF. METHOD Between January 2010 and June 2015, four patients were diagnosed with PSF and scheduled to undergo endoscopic chemocauterization. Under general anesthesia, trichloroacetic acid (TCA) solution was endoscopically injected through the opening of the fistula using a fine plastic tube. Esophagogram was obtained at 3 weeks after the procedure to search for recurrence. Complete closure of the fistula was confirmed on endoscopy at 2-3 months after chemocauterization. RESULTS Two of the four patients were treated once, and the remaining patients required further chemocauterization procedures. No recurrence developed in any patient after it had been confirmed that the fistula's internal orifice had been obliterated. Some transient complications, such as sore throat, nausea or temporary vocal fold paresis, occurred. CONCLUSION Chemocauterization with TCA seems to be a useful first-choice treatment for PSF.
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Affiliation(s)
- Satohiko Yanagisawa
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Takehito Oshio
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan.,Department of Pediatric Surgery, Shikoku Central Hospital, Shikokuchuo, Ehime, Japan
| | - Mototoshi Kato
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Motohiro Kano
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Yuki Tsuji
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Yasuhide Morikawa
- Department of Pediatric Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
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Wei H, Shi L, Zhang J, Xia Y, Cuan J, Zhang Y, Li W, Yan A, Jiang X, Lang MF, Sun J. High-intensity focused ultrasound leads to histopathologic changes of the inferior turbinate mucosa with allergic inflammation. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2425-2430. [PMID: 25130451 DOI: 10.1016/j.ultrasmedbio.2014.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/21/2014] [Accepted: 05/19/2014] [Indexed: 06/03/2023]
Abstract
This study was aimed at understanding the histopathologic changes that occur in the nasal mucosa of patients with perennial allergic rhinitis after high-intensity focused ultrasound (HIFU) treatment. Biopsy specimens of the inferior turbinate mucosa were taken from 11 PAR patients before, immediately after and 1 y after HIFU treatment. Morphometric analysis revealed that the density of eosinophils and other inflammatory cells increased immediately after treatment and then were decreased significantly 1 y post-treatment. Submucosal glands were swollen and venous sinusoids were dilated, but there was no statistically significant change in their density, immediately after treatment. However, both glands and venous sinusoids significantly decreased in number 1 y after HIFU treatment. The ciliated epithelium or basement membrane of the nasal mucosa was well preserved at all stages. In conclusion, HIFU is a tolerable and effective treatment to reduce inflammation of the inferior turbinate mucosa in patients with perennial allergic rhinitis.
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Affiliation(s)
- Hongquan Wei
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Lei Shi
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jingru Zhang
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Xia
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jingjing Cuan
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yong Zhang
- Department of Pathology, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Wei Li
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Aihui Yan
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xuejun Jiang
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ming-Fei Lang
- Department of Physiology, Dalian University Medical School, Dalian, Liaoning, China.
| | - Jing Sun
- Department of Otolaryngology, First Hospital of China Medical University, Shenyang, Liaoning, China.
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Wei H, Zhang Y, Shi L, Zhang J, Xia Y, Zang J, Yan A, Li W, Jiang X. Higher dosage of HIFU treatment may lead to higher and longer efficacy for moderate to severe perennial allergic rhinitis. Int J Med Sci 2013; 10:1914-20. [PMID: 24324369 PMCID: PMC3856383 DOI: 10.7150/ijms.7117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/11/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study was to compare the efficacies and side effects of high intensity focused ultrasound (HIFU) treatment for perennial allergic rhinitis (PAR) with regular and increased dosage. STUDY DESIGN A prospectively assembled cohort was retrospectively analyzed through visual analogue scale (VAS). METHODS Regular dosage of HIFU treatment was applied to 56 PAR patients in group A. An increased dosage as twice as the regular one was applied to 48 patients in group B. Nasal obstruction, sneezing, rhinorrhea and rhinocnesmus, which were recognized as the four main symptoms of allergic rhinitis (AR), were evaluated before treatment, 3 months after treatment, and 1 year after treatment. The satisfaction of patients was also evaluated at 1 year postoperatively. Biopsy of the inferior turbinate and morphometric analysis were applied to 11 patients in group A and 10 in group B before HIFU treatment and 3 months after treatment. RESULTS Comparing the AR symptoms before treatment, There is no statistical difference observed between group A and B (p>0.05). The four main symptoms at 3 months and 1 year after treatment were all significantly improved (p<0.01) in both group A and B. The VAS scores of AR symptoms in Group B were lower than those in Group A at the same stage after treatment, especially at 1 year after treatment (p<0.05). Comparing the results at 3 months and 1 year after treatment, a tendency of recurrence of these symptoms was observed statistically in group A (p<0.05), but not in group B (p>0.05). More cases of nasal dryness and perirhinal swelling were found in group B than those in group A (p<0.05), while all side effects were mild and temporary. Patients in group B were more satisfied than those in group A (p=0.0866 >0.05), though not statistically significant. More reduction of the eosinophils, other inflammatory cells, and the submucosal glands was observed after HIFU treatment in group B than that in group A (p<0.05). CONCLUSIONS A proper increment of HIFU dosage may be recommended to meet the needs of more improvement of AR symptoms and less recurrence.
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Affiliation(s)
- Hongquan Wei
- 1. Department of Otolaryngology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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