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Marin C, Alobid I, López-Chacón M, VanStrahlen CR, Mullol J. Type 2 and Non-type 2 Inflammation in the Upper Airways: Cellular and Molecular Alterations in Olfactory Neuroepithelium Cell Populations. Curr Allergy Asthma Rep 2024; 24:211-219. [PMID: 38492160 PMCID: PMC11008081 DOI: 10.1007/s11882-024-01137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE OF REVIEW Neurogenesis occurring in the olfactory epithelium is critical to continuously replace olfactory neurons to maintain olfactory function, but is impaired during chronic type 2 and non-type 2 inflammation of the upper airways. In this review, we describe the neurobiology of olfaction and the olfactory alterations in chronic rhinosinusitis with nasal polyps (type 2 inflammation) and post-viral acute rhinosinusitis (non-type 2 inflammation), highlighting the role of immune response attenuating olfactory neurogenesis as a possibly mechanism for the loss of smell in these diseases. RECENT FINDINGS Several studies have provided relevant insights into the role of basal stem cells as direct participants in the progression of chronic inflammation identifying a functional switch away from a neuro-regenerative phenotype to one contributing to immune defense, a process that induces a deficient replacement of olfactory neurons. The interaction between olfactory stem cells and immune system might critically underlie ongoing loss of smell in type 2 and non-type 2 inflammatory upper airway diseases. In this review, we describe the neurobiology of olfaction and the olfactory alterations in type 2 and non-type 2 inflammatory upper airway diseases, highlighting the role of immune response attenuating olfactory neurogenesis, as a possibly mechanism for the lack of loss of smell recovery.
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Affiliation(s)
- Concepció Marin
- INGENIO, IRCE, Fundació Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain.
- Centre for Biomedical Research in Respiratory Diseases (CIBERES), Health Institute Carlos III, Madrid, Spain.
| | - Isam Alobid
- INGENIO, IRCE, Fundació Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Centre for Biomedical Research in Respiratory Diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Mauricio López-Chacón
- INGENIO, IRCE, Fundació Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Centre for Biomedical Research in Respiratory Diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Camilo R VanStrahlen
- INGENIO, IRCE, Fundació Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Centre for Biomedical Research in Respiratory Diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- INGENIO, IRCE, Fundació Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain.
- Centre for Biomedical Research in Respiratory Diseases (CIBERES), Health Institute Carlos III, Madrid, Spain.
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Catalonia, Spain.
- Universitat de Barcelona, Barcelona, Spain.
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Bergmans B, Jessurun N, van Lint J, Murk JL, van Puijenbroek E, de Vries E. Burden of non-serious infections during biological use for rheumatoid arthritis. PLoS One 2024; 19:e0296821. [PMID: 38377117 PMCID: PMC10878515 DOI: 10.1371/journal.pone.0296821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Biologicals have become a cornerstone in rheumatoid arthritis (RA) treatment. The increased risk of serious infections associated with their use is well-established. Non-serious infections, however, occur more frequently and are associated with a high socioeconomic burden and impact on quality of life but have not received the same attention in the literature to date. The aim of this study was to gain insight into the various non-serious infections reported in RA patients using biologicals and their experienced burden. MATERIALS AND METHODS The Dutch Biologic Monitor was a prospective observational study that included adults with rheumatoid arthritis and biological use who answered bimonthly questionnaires on the adverse drug reactions (ADRs) they experienced from their biological and reported the associated impact score (ranging from 1, no impact, to 5, very high impact). ADRs were assigned a MedDRA code by pharmacovigilance experts and labeled as definite, probable, possible or no infection by infectious disease professionals. Descriptive statistics were performed using medians and interquartile ranges. RESULTS A total of 586 patients were included in the final analysis. Eighty-five patients (14.5%) reported a total of 421 ADRs labeled as probable or definite infections by the experts. Patient-assigned burden was ADR-specific. Upper respiratory tract infections were most frequently reported and had a high rate of recurrence or persistence, with a median impact score of 3.0 (IQR 2.0-3.0) which remained stable over time. DISCUSSION Non-serious infections significantly outnumbered serious infections in this real-life cohort of RA patients using biologicals (77.1 non-serious infections and 1.3 serious infections per 100 patient years, respectively). Infections in the upper respiratory tract were rated as having an average burden, which remained constant over a long period of time. Awareness of the impact of recurrent and chronic non-serious infections may enable healthcare professionals to timely treat and maybe even prevent them, which would lessen the associated personal and socioeconomic burden.
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Affiliation(s)
- Barbara Bergmans
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Naomi Jessurun
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
| | - Jette van Lint
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
| | - Jean-Luc Murk
- Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Microvida, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Eugène van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy,—Epidemiology & -Economics, Groningen, The Netherlands
| | - Esther de Vries
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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Skow M, Fossum GH, Høye S, Straand J, Brænd AM, Emilsson L. Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study. J Antimicrob Chemother 2023; 78:2217-2227. [PMID: 37486144 PMCID: PMC10477136 DOI: 10.1093/jac/dkad227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVES To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate. METHODS All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes. RESULTS A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5-2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes. CONCLUSIONS Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.
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Affiliation(s)
- Marius Skow
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Guro H Fossum
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sigurd Høye
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jørund Straand
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anja Maria Brænd
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Louise Emilsson
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Varmlands Nysater, Karlstad, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Science, University of Örebro, Örebro, Sweden
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Bittner CB, Steindl H, Abramov-Sommariva D, Plach M, Abels C, Bachert C. Efficacy and effectiveness of the herbal medicinal product BNO 1016 in the management of acute rhinosinusitis in the context of antibiotic stewardship. Postgrad Med 2023; 135:607-614. [PMID: 37431675 DOI: 10.1080/00325481.2023.2234274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To substantiate the clinical efficacy and investigate the real-world effectiveness of the herbal medicinal product BNO 1016 in acute rhinosinusitis (ARS) in the context of antibiotic stewardship. METHODS We performed a meta-analysis of the clinical trials ARhiSi-1 (EudraCT No. 2008-002794-13) and ARhiSi-2 (EudraCT No. 2009-016682-28) comprising 676 patients, analyzing the reduction of the Major Symptom Score (MSS) and improvement of the Sino-Nasal Outcome Test 20 (SNOT-20) by the herbal medicinal product BNO 1016. In addition, we performed a retrospective cohort study including 203,382 patients, comparing the real-life effectiveness of BNO 1016 in reducing ARS-related adverse outcomes in comparison to antibiotics and several other established therapies. RESULTS Treatment with BNO 1016 ameliorated symptoms of ARS by reducing MSS by 1.9 points (p < 0.0001) and improved quality of life (QoL) for patients by improving SNOT-20 by 3.5 points (p = 0.001) in comparison to placebo. In patients with moderate/severe symptoms, the positive effects of BNO 1016 were even more pronounced (MSS: -2.3 points (p < 0.0001); SNOT-20: -4.9 points (p = 0.0158)). In addition, treatment with BNO 1016 was as effective or significantly more effective in reducing the risk for adverse ARS-related outcomes such as follow-up antibiotic prescriptions, sick leave ≥7 days or medical appointments due to ARS, especially when compared to antibiotics. CONCLUSION BNO 1016 is a safe and effective treatment for ARS that can help reduce the overuse of antibiotics.
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Affiliation(s)
| | - Hubert Steindl
- Research & Development, Bionorica SE, Neumarkt i. d. OPf, Germany
| | | | - Michael Plach
- Research & Development, Bionorica SE, Neumarkt i. d. OPf, Germany
| | - Christoph Abels
- Research & Development, Bionorica SE, Neumarkt i. d. OPf, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Muenster, Muenster, Germany
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Herbal Medicines for Rhinosinusitis: A Systematic Review and Network Meta-analysis. Curr Allergy Asthma Rep 2023; 23:93-109. [PMID: 36609950 DOI: 10.1007/s11882-022-01060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW To analyze and compare the effects of herbal medicines (HMs) for treating different forms of rhinosinusitis. RECENT FINDINGS Forty-seven randomized controlled trials evaluating 18 HMs in six different rhinosinusitis populations were included in the network meta-analysis. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. For the common cold, Pelargonium sidoides offered the most beneficial effect on symptom improvement (moderate certainty of evidence). For acute post-viral rhinosinusitis, Cineole and Pelargonium sidoides were the most effective treatments for controlling symptoms (moderate certainty), while Spicae aetheroleum was most effective for health-related quality of life (HRQoL) improvement (moderate certainty). For chronic rhinosinusitis without nasal polyps (CRSsNP), Origanum vulgare was the most beneficial treatment for improving symptoms and HRQoL (low certainty). Evidence of HMs for acute bacterial rhinosinusitis, chronic rhinosinusitis with nasal polyps, and unclassified chronic rhinosinusitis was restricted to a limited number of studies. Adverse events should be of concern in some HMs, such as Spicae aetheroleum or Mytorl. Several HMs improved patient-important outcomes, above minimal clinically important differences, in treating common cold, acute post-viral rhinosinusitis, and CRSsNP. Further studies with adequate sample sizes and long-term follow-ups are warranted to support the current evidence. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION PROSPERO ID: CRD42022328265 May 10, 2022.
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Effects of nasal septum deviation and concha bullosa surgery on the frequency and financial burden of acute rhinosinusitis. Ir J Med Sci 2023; 192:341-347. [PMID: 36098946 DOI: 10.1007/s11845-022-03156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nasal septum deviation/concha bullosa (DNS)/(CB) are known to be predisposing factors in the pathophysiology of acute rhinosinusitis (ARS). However, the effects of surgical treatment of these pathologies on ARS have not been adequately investigated. AIMS To reveal the effects of the surgical treatment of DNS and CB on the frequency of the ARS, the use of antibiotics (ABs), and the direct cost incurred. METHODS Medical records of the patients who had undergone successful surgery for DNS/CB and were diagnosed with ARS in the preoperative and postoperative 3-year period were retrospectively analyzed. The average annual number of ARS examinations of the patients, the number of ABs prescribed, and prescription, examination, and total health system costs were compared. RESULTS Fifty-three patients (33 men (62%) and 20 women (38%)) were included in the study. There was a statistically significant decrease in the mean annual number of examinations for ARS, the number of ABs prescribed, prescription, examination, and total health system costs (p < 0.05) in the postoperative period compared with the preoperative period. CONCLUSIONS The present study determined that successful surgeries performed in patients with DNS/CB resulted in a significant decrease in the average annual number of examinations performed for ARS, number of AB prescriptions, and prescription, examination, and total health system costs. With these results, it seems beneficial to direct patients to surgery within the framework of the health policies of countries to reduce the frequency and financial burden of ARS in DNS/CB patients.
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Neurons, Nose, and Neurodegenerative Diseases: Olfactory Function and Cognitive Impairment. Int J Mol Sci 2023; 24:ijms24032117. [PMID: 36768440 PMCID: PMC9916823 DOI: 10.3390/ijms24032117] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Olfactory capacity declines with aging, but increasing evidence shows that smell dysfunction is one of the early signs of prodromal neurodegenerative diseases such as Alzheimer's and Parkinson's disease. The study of olfactory ability and its role in neurodegenerative diseases arouses much interest in the scientific community. In neurology, olfactory impairment is a potential early marker for the onset of neurodegenerative diseases, but the underlying mechanism is poorly understood. The loss of smell is considered a clinical sign of early-stage disease and a marker of the disease's progression and cognitive impairment. Highlighting the importance of biological bases of smell and molecular pathways could be fundamental to improve neuroprotective and therapeutic strategies. We focused on the review articles and meta-analyses on olfactory and cognitive impairment. We depicted the neurobiology of olfaction and the most common olfactory tests in neurodegenerative diseases. In addition, we underlined the close relationship between the olfactory and cognitive deficit due to nasal neuroepithelium, which is a direct extension of the CNS in communication with the external environment. Neurons, Nose, and Neurodegenerative diseases highlights the role of olfactory dysfunction as a clinical marker for early stages of neurodegenerative diseases when it is associated with molecular, clinical, and neuropathological correlations.
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Gurov AV, Yushkina MA, Muzhichkova AV. [Postviral rhinosinusitis, focus on pathogenetic therapy]. Vestn Otorinolaringol 2023; 88:38-43. [PMID: 37450389 DOI: 10.17116/otorino20228803138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Currently, the problem of acute rhinosinusitis continues to be relevant due to the frequent occurrence of this pathology. A certain difficulty is caused by the differential diagnosis of viral, post-viral and bacterial forms of rhinosinusitis, which carries the risks of irrational therapy. The authors of the article discuss the role of a viral infection in the etiology and pathogenesis of acute rhinosinusitis, the stages in the development of an inflammatory reaction on the mucous membrane of the nose and paranasal sinuses, and the disruption of mucociliary clearance. The authors consider options for the pathogenetic therapy of postviral sinusitis, concluding that the use of local combined preparations containing the mucolytic acetylcysteine and the vasoconstrictor component of tuaminoheptane sulfate is effective.
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Affiliation(s)
- A V Gurov
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - M A Yushkina
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - A V Muzhichkova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
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Prevalence of Antibiotic Prescription in Patients with Acute Rhinosinusitis Treated by General Practitioners and Otolaryngologists in Germany-A Retrospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11111576. [PMID: 36358231 PMCID: PMC9686956 DOI: 10.3390/antibiotics11111576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
(1) Background: The goal of this retrospective cohort study, based on real-world data and conducted in Germany, was to investigate the prevalence of antibiotic (AB) prescription in patients with acute rhinosinusitis (ARS). (2) Methods: Data from the Disease Analyzer database were used for this cross-sectional study. Patients aged ≥18 years diagnosed with acute sinusitis by general practitioners (GPs) and ear, nose, throat (ENT) specialists between January 2012 and December 2020 were included. The main outcome of the study was the proportion of patients with ARS who received an AB prescription on the day of diagnosis or within three days afterwards. The proportion was estimated separately for patients treated by GPs and ENTs, and also for five age groups, as well as women and men. (3) Results: In total, 308,095 patients were diagnosed with ARS (187,838 by GPs and 120,257 by ENTs). 50.9% of patients treated by GPs and 50.0% treated by ENTs received an AB prescription. AB prevalence increased with age from 46.9% in the age group 18−30 years to 55.5% in the age group > 60 years. (4) Conclusions: We have shown a high prevalence of potentially inappropriate AB prescription for adult patients with ARS in both GP and ENT practices and also among both women and men and in several age groups. There is an urgent need for interventions to reduce inappropriate AB use.
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Pfaar O, Beule AG, Jobst D, Kraft K, Stammer H, Röschmann-Doose KIL, Wittig T, Stuck BA. Phytomedicine ELOM-080 in Acute Viral Rhinosinusitis: A Randomized, Placebo-Controlled, Blinded Clinical Trial. Laryngoscope 2022. [PMID: 36222438 DOI: 10.1002/lary.30418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/28/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND ELOM-080 is a phytomedicine approved for the treatment of acute and chronic inflammatory diseases of the respiratory tract, sinusitis, and bronchitis in particular. This prospective, randomized, placebo-controlled, double-blind clinical trial was conducted to assess efficacy and safety of ELOM-080 in the treatment of acute viral rhinosinusitis (AVRS). METHODS Patients with AVRS received oral treatment (4 × 1 capsule per day) with either ELOM-080 or matching placebo. Primary endpoints were the change in major symptom score (MSS) after 7 and 14 days of treatment assessed by the investigator (MSSINV ). Secondary endpoints were changes in MSS assessed by the patients (MSSPAT ), olfactory function (12-item Sniffin' Sticks), 20-Item Sino-Nasal Outcome Test (SNOT-20 GAV; German adapted version), influence of treatment on viral load, and safety. RESULTS Four hundred and sixty-three patients were randomized. At day 4, subjective burden of disease (MSS) was significantly ameliorated compared to placebo (p = 0.012). During the first treatment week MSS scores improved about 1 day earlier, and 3 days earlier in the second week. Effect with ELOM-080 on mean MSSINV was statistically significantly superior to placebo at visit 3 (p = 0.016) and visit 4 (p = 0.014). In chemosensory testing identification scores improved comparably in both treatments. The improvement of the SNOT-20 GAV was more pronounced in ELOM-080 patients. Treatment with ELOM-080 indicated a potential for decreasing viral load. Both treatments were well tolerated. CONCLUSION ELOM-080 improves the burden of AVRS significantly in comparison to placebo, remission of symptoms occurred 3 days earlier. The results confirm the efficacy and safety of ELOM-080 for treatment of AVRS. LEVEL OF EVIDENCE 1 Laryngoscope, 2022.
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Affiliation(s)
- Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Achim G Beule
- Department of Otolaryngology University Hospital Muenster, Muenster, Germany and Department of Otolaryngology, Head and Neck Cancer, University Clinic Greifswald, Greifswald, Germany
| | - Detmar Jobst
- Institute for Pharmacology and Toxicology, University of Bonn, Bonn and University of Witten-Herdecke, Herdecke, Germany
| | - Karin Kraft
- Chair of Naturopathic Medicine, University Medicine Rostock, Rostock, Germany
| | - Holger Stammer
- PHARMALOG Institut für klinische Forschung GmbH, Ismaning, Germany
| | | | - Thomas Wittig
- G. Pohl-Boskamp GmbH & Co. KG, Hohenlockstedt, Germany
| | - Boris A Stuck
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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Nanjo Y, Okuma T, Kuroda Y, Hayakawa E, Shibayama K, Akimoto T, Murashima R, Kanamori K, Tsutsumi T, Suzuki Y, Namba Y, Makino F, Nagashima O, Sasaki S, Takahashi K. Multiple Types of Taste Disorders among Patients with COVID-19. Intern Med 2022; 61:2127-2134. [PMID: 35527025 PMCID: PMC9381347 DOI: 10.2169/internalmedicine.9065-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Based on the increasing incidence of smell and taste dysfunction among coronavirus disease 2019 (COVID-19) patients, such issues have been considered an early symptom of infection. However, few studies have investigated the type of taste components that are most frequently affected in COVID-19 patients. This study investigated the difference in frequencies of the types of taste component disorders among hospitalized COVID-19 patients. Methods In this retrospective, single-center, observational study, patients' background characteristics, clinical course, laboratory and radiological findings, and details on taste and/or smell disorders were collected and analyzed from medical records. Patients A total of 227 COVID-19 patients were enrolled, among whom 92 (40.5%) complained of taste disorders. Results Multiple types of taste disorders (hypogeusia/ageusia and hypersensitivity, or hypersensitivity and changing tastes) were reported in 10 patients. In particular, 23 patients reported hypersensitivity to at least 1 type of taste, and 2 patients complained of a bitter taste on consuming sweet foods. Impairment of all taste components was found in 48 patients (52.2%). The most frequent taste disorder was salty taste disorder (81 patients, 89.0%). Hypersensitivity to salty taste was most frequently observed (19 patients, 20.9%). Conclusion Patients with COVID-19 develop multiple types of taste disorders, among which salty taste disorder was the most frequent, with many patients developing hypersensitivity to salty taste. As smell and taste are subjective senses, further studies with the combined use of objective examinations will be required to confirm the findings.
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Affiliation(s)
- Yuta Nanjo
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Tomoko Okuma
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yumi Kuroda
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Eri Hayakawa
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Kohei Shibayama
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Takashi Akimoto
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Ryoko Murashima
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Koichiro Kanamori
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Takeo Tsutsumi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yohei Suzuki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yukiko Namba
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Fumihiko Makino
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Osamu Nagashima
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Shinichi Sasaki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
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12
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Pietraś A, Mielnik-Niedzielska G. Acute Rhinosinusitis in Children with Inhalant Allergies. CHILDREN (BASEL, SWITZERLAND) 2022; 9:836. [PMID: 35740773 PMCID: PMC9222100 DOI: 10.3390/children9060836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022]
Abstract
Rhinosinusitis is an essential medical problem in pediatric populations. Due to a lack of studies considering allergy impact on pediatric rhinosinusitis, it seems legitimate to investigate this subject. The aim of this paper was to assess the influence of inhalant allergy on acute rhinosinusitis in children. The study involved 100 pediatric patients aged between 3 and 17 years who were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology of the Medical University of Lublin due to acute rhinosinusitis. The control group consisted of 50 children without allergy, and the study group consisted of 50 children suffering from inhalant allergy. The methodology employed in this study involved medical history and laryngological examination, as well as laboratory and radiological testing. Dust mite allergy was the most common allergy among patients in the study group. Patients with allergies presented at the hospital later than patients without allergy, and their hospitalization lasted longer due to more severe sinus disease, higher inflammatory parameters, multiple sinus involvement, more frequent fever or rhinosinusitis complications, especially orbital occurrence. Most children in the control group required only pharmacological treatment. Inhalant allergy, especially dust mite allergy, contributes to more severe acute rhinosinusitis in children.
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Affiliation(s)
- Aleksandra Pietraś
- Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, 20-093 Lublin, Poland;
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13
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Kjelle E, Andersen ER, Krokeide AM, Soril LJJ, van Bodegom-Vos L, Clement FM, Hofmann BM. Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Arne Magnus Krokeide
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Lesley J J Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Leti van Bodegom-Vos
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fiona M Clement
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics, The University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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Othman BA, Maulud SQ, Jalal PJ, Abdulkareem SM, Ahmed JQ, Dhawan M, Priyanka, Choudhary OP. Olfactory dysfunction as a post-infectious symptom of SARS-CoV-2 infection. Ann Med Surg (Lond) 2022; 75:103352. [PMID: 35169465 PMCID: PMC8830927 DOI: 10.1016/j.amsu.2022.103352] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 01/08/2023] Open
Abstract
The unexpected onset smell and taste disability was being recognized as a COVID-19 related symptom. Loss of smell might occur alone or be followed by other COVID-19 symptoms, such as a dry cough, fever, headache, and shortness of breath. Other virus infections have been linked to anosmia (parainfluenza, rhinovirus, SARS, and others), affecting up to 20% of the adult population, which is much less common than SARS-CoV-2 infection. A hypothesis about the pathophysiology of post-infectious olfactory loss is that viruses could make an inflammatory response of the nasal mucosa or directly damage the olfactory neuroepithelium. However, in patients with COVID-19, loss of smell may occur without other rhino logic symptoms or suggestive nasal inflammation. According to evidence, anosmia-related SARS-CoV-2 could be a new viral syndrome unique to COVID-19. Furthermore, through experimental intranasal inoculation in mice, SARS-CoV-2 can be inoculated into the olfactory neural circuitry. This disease has not had the required focus, most likely because it is not life-threatening in and of itself. Though patients' quality of living is significantly reduced as their olfactory ability is lost, resulting in lowering and inadequate appetite, excessive or unbalanced food consumption, as well as an overall sense of insecurity. This review aims to give a quick overview of the latest epidemiological research, pathological mechanisms for the dysfunction of smell, and taste in patients infected with SARS-CoV-2. In addition, the initial diagnosis and treatment options for dysfunction are also discussed. The pathological mechanism of SARS-CoV-2 infection in olfactory dysfunction. Pathognomonic symptoms of sinonasal impairment in COVID-19 patients. Treatment of olfactory dysfunction after SARS-CoV-2 infection.
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15
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Baša M, Sovtić A. Treatment of the most common respiratory infections in children. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-37857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Acute respiratory infections are the most common group of infective diseases in the pediatric population. Although the improvement of health care and vaccination program has led to a significant reduction in the incidence of certain respiratory infections, the combination of a high prevalence in vulnerable pediatric categories and uncritical prescription of antibiotics, due to the inability to adequately distinguish between viruses and bacterial etiology, still represents a significant challenge for the public health system. In order to promote rational antibiotic therapy with an overall improvement of both diagnostic and therapeutic principles, acute respiratory diseases have been the subject of consideration in numerous publications and national guidelines. Nonspecific clinical manifestations with pathogen heterogeneity and both anatomical and physiological characteristics of the child's respiratory system during growth and development have created the need for individualized therapy. Since the guidelines emphasize the undoubtful and crucial benefits of symptomatic therapy (e.g. analgesics in acute otitis media, supplemental oxygen in lower respiratory tract infections with hypoxemia), the use of antibiotics and corticosteroids is indicated in selected cases with a severe clinical picture. The choice of antibiotic depends on the clinical condition, presumed causative agent, and local epidemiologic circumstances. Respiratory support (oxygen therapy and/or artificial ventilation) is reserved for inpatient treatment of cases with a particularly severe clinical picture and associated complications.
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O'Neill B, Kalia S, Gill P, Hum S, Moran-Venegas C, Stoller R, Greiver M, Agarwal P, Kirubarajan A, DeKoven S, Eisen D, Pinto A, Dunn S. Association between new-onset anosmia and positive SARS-CoV-2 tests among people accessing outpatient testing in Toronto, Ontario: a retrospective cross-sectional study. CMAJ Open 2021; 9:E1134-E1140. [PMID: 34876415 PMCID: PMC8673484 DOI: 10.9778/cmajo.20210085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Reports have suggested that anosmia is strongly associated with SARS-CoV-2 infection, but patients were often asked about this symptom after their diagnosis. This study assessed associations between prospectively reported anosmia and other symptoms related to SARS-CoV-2 infection, and SARS-CoV-2 positivity in community testing centres in Toronto, Ontario. METHODS We conducted a retrospective cross-sectional study in which data were collected from 2 COVID-19 assessment centres affiliated with 2 hospitals in Toronto, Ontario, from Apr. 5 to Sept. 30, 2020. We included symptomatic profiles of all people who underwent a SARS-CoV-2 test at either clinic within the study period. We used generalized estimating equations to account for repeat visits and to assess associations between anosmia and other symptoms and SARS-CoV-2 positivity. RESULTS A total of 83 443 SARS-CoV-2 tests were conducted across the 2 sites for 72 692 participants during the study period. Of all tests, 1640 (2.0%) were positive; 837 (51.0%) of people who tested positive were asymptomatic. The adjusted odds ratio for the association between anosmia and test positivity was 5.29 (95% confidence interval [CI] 4.50-6.22), with sensitivity of 0.138 (95% CI 0.121-0.154), specificity of 0.980 (95% CI 0.979-0.981), a positive predictive value of 0.120 (95% CI 0.106-0.135) and a negative predictive value of 0.983 (95% CI 0.982-0.984). INTERPRETATION Anosmia had high specificity and a positive predictive value of 12% for SARS-CoV-2 infection in this community population with low prevalence of SARS-CoV-2 positivity. The presence of anosmia should increase clinical suspicion of SARS-CoV-2 infection, and our findings suggest that people presenting with this symptom should be tested.
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Affiliation(s)
- Braden O'Neill
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Sumeet Kalia
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Peter Gill
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Susan Hum
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Carla Moran-Venegas
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Rebecca Stoller
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Michelle Greiver
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Payal Agarwal
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Abirami Kirubarajan
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Samuel DeKoven
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - David Eisen
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Andrew Pinto
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Sheila Dunn
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
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Gorbunov SA, Rusetsky YY, Kudryashov SE, Malyavina US. [The evolution of methods of active irrigation of paranasal sinuses in rhinosinusitis. Part 2]. Vestn Otorinolaringol 2021; 86:99-105. [PMID: 34499456 DOI: 10.17116/otorino20218604199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inflammation of the paranasal sinuses significantly reduces the quality of life of people and causes marked economic damage to society. The striking clinical picture of sinusitis has always forced doctors to study the disease, as evidenced by the first records of the anatomy and diseases of the paranasal sinuses by doctors in ancient Egypt more than 3.000 years BC. Sinusitis has been treated in different ways in different historical periods. Effective medication treatment appeared relatively recently and began to steadily replace the older instrumental methods, to which many people had a preconceived notion of invasiveness. However, many studies are showing the positive effect of active drainage methods and, moreover, there is data showing that the discomfort during such procedures is slightly higher than during dental treatment under local anesthesia. This article presents a review of the available scientific literature on the use of different treatments for bacterial rhinosinusitis at different historical stages, ranging from the first publications on puncture techniques to balloon dilatation and the modern approach to conservative treatment.
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Affiliation(s)
- S A Gorbunov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
| | - Yu Yu Rusetsky
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,National Medical Research Center for Children's Health, Moscow, Russia
| | - S E Kudryashov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
| | - U S Malyavina
- National Medical Research Center for Children's Health, Moscow, Russia
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18
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Levi E, Ronen O. Physician adherence to acute rhinosinusitis antibiotic treatment guidelines. J Investig Med 2021; 69:1434-1438. [PMID: 34348962 DOI: 10.1136/jim-2021-001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/03/2022]
Abstract
Antibiotic treatment guidelines promote proper diagnosis and treatment and optimize antibiotic treatment, minimizing both antimicrobial resistance to antibiotics and financial expenditure. This study aimed to investigate whether community physicians and emergency department (ED) physicians diagnose and treat acute rhinosinusitis according to accepted guidelines. This was a retrospective study of medical records and referrer letters of patients admitted to the medical center between 2014 and 2015. Physician adherence to antibiotic guidelines regarding indication, type and duration of treatment was assessed. Overall, the study included 84 patients diagnosed with acute rhinosinusitis and admitted to the ED. Fewer than 20% of doctors treating patients with rhinosinusitis at our institution followed the current recommended guidelines. In most cases, the type of treatment administered by ED physicians and by community physicians complied with the guidelines (90% and 96%, respectively, p=0.564). The duration of treatment prescribed by the ED physicians aligned with the guidelines in 37.7% of the cases. There was insufficient compliance with acute rhinosinusitis treatment guidelines among all treating physicians in this study, which was characterized by excessive antibiotic treatment. Therefore, ways to increase understanding and adherence to clinical guidelines, and to provide optimal settings in the clinics to carry out the guidelines should be investigated.
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Affiliation(s)
- Esther Levi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
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Venekamp RP, Hoogland J, van Smeden M, Rovers MM, De Sutter AI, Merenstein D, van Essen GA, Kaiser L, Liira H, Little P, Bucher HC, Reitsma JB. Identifying adults with acute rhinosinusitis in primary care that benefit most from antibiotics: protocol of an individual patient data meta-analysis using multivariable risk prediction modelling. BMJ Open 2021; 11:e047186. [PMID: 34210729 PMCID: PMC8252877 DOI: 10.1136/bmjopen-2020-047186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Acute rhinosinusitis (ARS) is a prime reason for doctor visits and among the conditions with highest antibiotic overprescribing rates in adults. To reduce inappropriate prescribing, we aim to predict the absolute benefit of antibiotic treatment for individual adult patients with ARS by applying multivariable risk prediction methods to individual patient data (IPD) of multiple randomised placebo-controlled trials. METHODS AND ANALYSIS This is an update and re-analysis of a 2008 IPD meta-analysis on antibiotics for adults with clinically diagnosed ARS. First, the reference list of the 2018 Cochrane review on antibiotics for ARS will be reviewed for relevant studies published since 2008. Next, the systematic searches of CENTRAL, MEDLINE and Embase of the Cochrane review will be updated to 1 September 2020. Methodological quality of eligible studies will be assessed using the Cochrane Risk of Bias 2 tool. The primary outcome is cure at 8-15 days. Regression-based methods will be used to model the risk of being cured based on relevant predictors and treatment, while accounting for clustering. Such model allows for risk predictions as a function of treatment and individual patient characteristics and hence gives insight into individualised absolute benefit. Candidate predictors will be based on literature, clinical reasoning and availability. Calibration and discrimination will be evaluated to assess model performance. Resampling techniques will be used to assess internal validation. In addition, internal-external cross-validation procedures will be used to inform on between-study differences and estimate out-of-sample model performance. Secondarily, we will study possible heterogeneity of treatment effect as a function of outcome risk. ETHICS AND DISSEMINATION In this study, no identifiable patient data will be used. As such, the Medical Research Involving Humans Subject Act (WMO) does not apply and official ethical approval is not required. Results will be submitted for publication in international peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42020220108.
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Affiliation(s)
- Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Hoogland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maroeska M Rovers
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - An I De Sutter
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | | | - Laurent Kaiser
- Department of Medicine, Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Helena Liira
- Department of General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Autralia, Perth, Western Australia, Australia
- Department of General Practice and Primary Care, University of Helsinki, Helsinki, Finland
| | - Paul Little
- Primary Care & Population Sciences Unit, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Heiner Cc Bucher
- Basel Institute for Clinical Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Kusnik A, Weiss C, Neubauer M, Huber B, Gerigk M, Miethke T, Hunter N, Rotter N, Ludwig S, Schell A, Ebert MP, Teufel A. Presence of gustatory and olfactory dysfunction in the time of the COVID-19 pandemic. BMC Infect Dis 2021; 21:612. [PMID: 34174816 PMCID: PMC8234756 DOI: 10.1186/s12879-021-06294-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The unexpected outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused more than 49 million cases and an estimated 2,000,000 associated deaths worldwide. In Germany, there are currently more than 2,000,000 laboratory-confirmed coronavirus disease 2019 (COVID-19) cases including 51,800 deaths. However, regional differences also became apparent and with the second wave of infections, the detailed characterization of COVID-19 patients is crucial to early diagnosis and disruption of chains of infections. METHODS Handing out detailed questionnaires to all individuals tested for COVID-19, we evaluated the clinical characteristics of negative and positive tested individuals. Expression of symptoms, symptom duration and association between predictor variables (i.e. age, gender) and a binary outcome (olfactory and gustatory dysfunction) were assessed. RESULTS Overall, the most common symptoms among individuals who tested positive for SARS-CoV-2 were fatigue, headache, and cough. Olfactory and gustatory dysfunction were also reported by many SARS-CoV-2 negative individuals, more than 20% of SARS-CoV-2 negative tested individuals in our study reported olfactory and gustatory dysfunction. Independent of SARS-CoV-2 status, more females displayed symptoms of gustatory (29.8%, p = 0.0041) and olfactory dysfunction (22.9%, p = 0.0174) compared to men. CONCLUSIONS Bringing early SARS-CoV-2 tests to the populations at risk must be a main focus for the upcoming months. The reliability of olfactory and gustatory dysfunction in COVID-19 negative tested individuals requires deeper investigation in the future.
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Affiliation(s)
- Alexander Kusnik
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Clincial Cooperation Unit Healthy Metabolism, Center for Preventive Medicine Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Department of Statistics, Biomathematics and Information Processing, Heinrich Lanz Center for Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Melanie Neubauer
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bianca Huber
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marlis Gerigk
- Institute of Medical Microbiology and Hygiene, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Miethke
- Institute of Medical Microbiology and Hygiene, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
- Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty of Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Hunter
- Institute of Medical Microbiology and Hygiene, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sonja Ludwig
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Angela Schell
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Clincial Cooperation Unit Healthy Metabolism, Center for Preventive Medicine Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Teufel
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Clincial Cooperation Unit Healthy Metabolism, Center for Preventive Medicine Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Department of Medicine II, Division of Hepatology, Division of Clinical Bioinformatics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Rhinitis Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1492-1503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
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Bennett S, Meghji S, Syeda F, Bhat N. Neurological Complications of Acute Rhinosinusitis: Meningitis. ALLERGY & RHINOLOGY 2021; 12:2152656721996258. [PMID: 33717637 PMCID: PMC7917423 DOI: 10.1177/2152656721996258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Meningitis remains a rare but potentially life-threatening intracranial complication of acute rhinosinusitis. We describe a case of a 62-year-old man with a background of chronic rhinosinusitis who presented to hospital with confusion, fever and bilateral green purulent rhinorrhoea. After immediate sepsis management, urgent contrast-enhanced computed tomography head revealed opacification of all paranasal sinuses and bony erosion of the lateral walls of both ethmoid sinuses. He was treated with intravenous antibiotics, topical nasal steroids, decongestants and irrigation. Following a turbid lumbar puncture and multidisciplinary discussion, he was admitted to the critical care unit and later intubated due to further neurological deterioration. After 13 days admission and rehabilitation in the community he made a good recovery. This case highlights the importance of timely diagnosis and appropriate management of acute rhinosinusitis and awareness of the possible complications. Joint care with physicians and intensivists is crucial in the management of these sick patients.
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Affiliation(s)
- Stephen Bennett
- Department of Otolaryngology & Head and Neck Surgery, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - Sheneen Meghji
- Department of Otolaryngology & Head and Neck Surgery, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - Farahnaz Syeda
- Department of Otolaryngology & Head and Neck Surgery, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - Nazir Bhat
- Department of Otolaryngology & Head and Neck Surgery, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
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Zeng M, Wang DY, Mullol J, Liu Z. Chemosensory Dysfunction in Patients with COVID-19: What Do We Learn from the Global Outbreak? Curr Allergy Asthma Rep 2021; 21:6. [PMID: 33537862 PMCID: PMC7857344 DOI: 10.1007/s11882-020-00987-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Chemosensory dysfunction in the patients with COVID-19 has been reported frequently in the studies from different regions of the world. However, the prevalence of smell and/or taste disorders presents significant ethnic and geographic variability. In addition, the pathogenesis of chemosensory dysfunction remains unclarified. RECENT FINDINGS This is a narrative review on the recent state of the prevalence, mechanism, and diagnostic and therapeutic strategy of chemosensory dysfunction in COVID-19 patients during the global pandemic. The chemosensory dysfunction was analysis based on recent studies, which either used questionnaires, Likert scales (0-10), or smell tests to estimate the smell and taste dysfunction. The ethnic and geographic difference of the prevalence of smell and/or taste disorders and the potential underlying mechanisms have been discussed. Several suggestions on the diagnosis and treatment of COVID-19 patients with smell and taste disorders were summarized for the physicians. This review provides a comprehensive overview of the current studies regarding the chemosensory dysfunction during the COVID-19 worldwide outbreak.
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Affiliation(s)
- Ming Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
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Assessment of mucociliary clearance as an indicator of nasal function in patients with COVID-19: a cross-sectional study. Eur Arch Otorhinolaryngol 2020; 278:1863-1868. [PMID: 33185743 PMCID: PMC7661319 DOI: 10.1007/s00405-020-06457-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE We assessed the effects of COVID-19 infection on nasal mucociliary activity. METHODS The study was conducted in the pandemic wards of Adiyaman University Training and Research Hospital during April and May 2020. All patients admitted to the COVID-19 pandemic wards during the study period were invited to participate in the study. The study included 40 adults who agreed to participate and underwent a mucociliary clearance test successfully. The primary outcome was mucociliary clearance time and the secondary variables of interest were age, sex, and sino-nasal outcome test-22 scores. The control group included 40 concomitant healthy patients who visited the outpatient ear, nose and throat clinic with non-nasal symptoms. RESULTS The study included 40 COVID-19-positive patients and 40 healthy controls. The mean mucociliary clearance times of the study (15.53 ± 5.57 min) and control (9.50 ± 3.70 min) groups were significantly different (Z = 4.675, p < 0.001). However, the mucociliary clearance time was not significantly different between males and females (t = 0.590, p = 0.558). CONCLUSIONS Nasal mucociliary clearance time was prolonged in COVID-19 patients compared to healthy controls. Thus, we conclude that smell and taste are crucial symptoms that should not be overlooked in patients suspected of COVID-19 disease.
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Olfactory Dysfunction in a Mexican Population Outside of COVID-19 Pandemic: Prevalence and Associated Factors (the OLFAMEX Study). Curr Allergy Asthma Rep 2020; 20:78. [PMID: 33161494 PMCID: PMC7649040 DOI: 10.1007/s11882-020-00975-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW To study the prevalence of olfactory loss and its associated factors in a Mexican population a cross-sectional analytical study based on a population interviewed about health, epidemiologic aspects, and sense of smell (tested with four scents: rose, banana, perfume, and gas) was conducted to evaluate olfactory detection, memory, and identification. Levels of sense of smell perception were determined when the participants detected, recognized, or identified all (normosmia), 1-3 (hyposmia), or none (anosmia) of the odorants. Associated factors of olfactory dysfunction were identified by multivariate analysis (odds ratio, 95%CI). RECENT FINDINGS Olfactory dysfunction is a prevalent disorder affecting up to 20% of the general population. In addition to viral infection, including COVID-19, a number of other causes and factors may also be involved. 1,956 surveys were conducted and 1,921 were analyzed. Most of the participants (62.1%) were women. The general prevalence of olfactory dysfunction, regarding detection, was 7.2% (7.1% hyposmia, 0.1% anosmia). Age-related olfactory deterioration was observed in both sexes from the 5th decade of life (OR 2.74, p = 0.0050). Women showed better olfactory identification (OR 0.73, p = 0.0010). Obesity (OR 1.97, p = 0.0070), low educational level, bad/very bad self-perceived olfactory function (OR 2.74, p = 0.0050), olfactory loss for less than one week (OR 1.35, p = 0.0030), exposure to toxics/irritants (OR 1.31, p = 0.0030), active smoking (OR 1.58, p < 0.0010), and type 2 diabetes mellitus (OR 2.68, 95%CI 1.74-4.10, p < 0.0001) were identified as factors associated with olfactory dysfunction. These results in a Mexican population suggest better olfactory identification (verbalization) in females. Age was a determining factor in the olfactory deterioration process and obesity and diabetes mellitus were also associated with olfactory disorders. Finally, these findings reinforce the differential diagnosis with other potential causes of sense of smell loss, during the COVID-19 outbreak.
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Venekamp R, Hansen JG, Reitsma JB, Ebell MH, Lindbaek M. Accuracy of signs, symptoms and blood tests for diagnosing acute bacterial rhinosinusitis and CT-confirmed acute rhinosinusitis in adults: protocol of an individual patient data meta-analysis. BMJ Open 2020; 10:e040988. [PMID: 33148765 PMCID: PMC7640527 DOI: 10.1136/bmjopen-2020-040988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION This protocol outlines a diagnostic individual patient data (IPD) meta-analysis aimed at developing simple prediction models based on readily available signs, symptoms and blood tests to accurately predict acute bacterial rhinosinusitis and CT-confirmed (fluid level or total opacification in any sinus) acute rhinosinusitis (ARS) in adults presenting to primary care with clinically diagnosed ARS, target conditions associated with antibiotic benefit. METHODS AND ANALYSIS The systematic searches of PubMed and Embase of a review on the accuracy of signs and symptoms for diagnosing ARS in ambulatory care will be updated to April 2020 to identify relevant studies. Authors of eligible studies will be contacted and invited to provide IPD. Methodological quality of the studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Candidate predictor selection will be based on knowledge from existing literature, clinical reasoning and availability. Multivariable logistic regression analyses will be used to develop prediction models aimed at calculating absolute risk estimates. Large unexplained between-study heterogeneity in predictive accuracy of the models will be explored and may lead to either model adjustment or derivation of separate context-specific models. Calibration and discrimination will be evaluated to assess the models' performance. Bootstrap resampling techniques will be used to assess internal validation and to inform on possible adjustment for overfitting. In addition, we aim to perform internal-external cross-validation procedures. ETHICS AND DISSEMINATION In this IPD meta-analysis, no identifiable patient data will be used. As such, the Medical Research Involving Humans Subject Act does not apply, and official ethical approval is not required. Findings will be published in international peer-reviewed journals and presented at scientific conferences. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020175659.
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Affiliation(s)
- Roderick Venekamp
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jens Georg Hansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Morten Lindbaek
- Department of General Practice, Institute for Health and Society, University of Oslo, Oslo, Norway
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Pang KW, Chee J, Subramaniam S, Ng CL. Frequency and Clinical Utility of Olfactory Dysfunction in COVID-19: a Systematic Review and Meta-analysis. Curr Allergy Asthma Rep 2020; 20:76. [PMID: 33048282 PMCID: PMC7552599 DOI: 10.1007/s11882-020-00972-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
Background Olfactory dysfunction (OD) has been gaining recognition as a symptom of COVID-19, but its clinical utility has not been well defined. Objectives To quantify the clinical utility of identifying OD in the diagnosis of COVID-19 and determine an estimate of the frequency of OD amongst these patients. Methods PubMed was searched up to 1 August 2020. Meta-analysis A included studies if they compared the frequency of OD in COVID-19 positive patients (proven by reverse transcription polymerase chain reaction) to COVID-19 negative controls. Meta-analysis B included studies if they described the frequency of OD in COVID-19 positive patients and if OD symptoms were explicitly asked in questionnaires or interviews or if smell tests were performed. Results The pooled frequency of OD in COVID-19 positive patients (17,401 patients, 60 studies) was 0.56 (0.47–0.64) but differs between detection via smell testing (0.76 [0.51–0.91]) and survey/questionnaire report (0.53 [0.45–0.62]), although not reaching statistical significance (p = 0.089). Patients with reported OD were more likely to test positive for COVID-19 (diagnostic odds ratio 11.5 [8.01–16.5], sensitivity 0.48 (0.40 to 0.56), specificity 0.93 (0.90 to 0.96), positive likelihood ratio 6.10 (4.47–8.32) and negative likelihood ratio 0.58 (0.52–0.64)). There was significant heterogeneity amongst studies with possible publication bias. Conclusion Frequency of OD in COVID-19 differs greatly across studies. Nevertheless, patients with reported OD were significantly more likely to test positive for COVID-19. Patient-reported OD is a highly specific symptom of COVID-19 which should be included as part of the pre-test screening of suspect patients.
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Affiliation(s)
- Khang Wen Pang
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore.
| | - Jeremy Chee
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore
| | - Somasundaram Subramaniam
- Department of Otolaryngology-Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Chew Lip Ng
- Department of Otolaryngology-Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
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Mullol J, Alobid I, Mariño-Sánchez F, Izquierdo-Domínguez A, Marin C, Klimek L, Wang DY, Liu Z. The Loss of Smell and Taste in the COVID-19 Outbreak: a Tale of Many Countries. Curr Allergy Asthma Rep 2020; 20:61. [PMID: 32748211 PMCID: PMC7397453 DOI: 10.1007/s11882-020-00961-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Olfactory dysfunction in upper airway viral infections (common cold, acute rhinosinusitis) is common (> 60%). During the COVID-19 outbreak, frequency of sensory disorders (smell and/or taste) in affected patients has shown a high variability from 5 to 98%, depending on the methodology, country, and study. RECENT FINDINGS A sudden, severe, isolated loss of smell and/or taste, in the absence of other upper airway inflammatory diseases (allergic rhinitis, chronic rhinosinusitis, nasal polyposis), should alert individuals and physicians on being potentially affected by COVID-19. The evaluation of smell/taste disorders with a visual analogue scale or an individual olfactory or gustatory test, at the hospital or by telemedicine, to prevent contamination might facilitate an early detection of infected patients and reduce the transmission of SARS-CoV-2. During the COVID-19 outbreak, patients with sudden loss of smell should initiate social distancing and home isolation measures and be tested for SARS-CoV-2 diagnostic test when available. Olfactory training is recommended when smell does not come back after 1 month but can be started earlier.
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Affiliation(s)
- Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain.
- INGENIO, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Catalonia, Spain.
- CIBER of Respiratory Diseases (CIBERES), Barcelona, Catalonia, Spain.
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain
- INGENIO, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Catalonia, Spain
- CIBER of Respiratory Diseases (CIBERES), Barcelona, Catalonia, Spain
| | - Franklin Mariño-Sánchez
- Rhinology and Skull Base Surgery Unit, ENT Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Concepció Marin
- INGENIO, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Catalonia, Spain
- CIBER of Respiratory Diseases (CIBERES), Barcelona, Catalonia, Spain
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Abstract
PURPOSE OF REVIEW The purposes of the review are as follows: (1) to define acute rhinosinusitis (ARS) and their phenotypes, (2) to highlight the ARS management according to international guidelines, (3) to compare the physicians' management with the ARS guideline recommendations, and (4) to report ARS socioeconomic burden. RECENT FINDINGS Bacterial and non-bacterial ARS have similar symptoms, although they can be discriminated by using a combination of specific signs and symptoms. The prescription of antibiotics should be limited to clearly suspected bacterial ARS. There is an overuse of diagnosis tools and treatment prescriptions. The total cost per ARS episode in Europe is over €1000. ARS is mainly an inflammatory disease triggered by viral infection, and few cases end up developing bacterial infection. In most of the cases, it is a self-resolving disease which diagnosis is mainly clinical and the treatment symptomatic. The incidence of complications is low and independent of antibiotic use. There is a high socioeconomic burden associated to ARS.
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Affiliation(s)
- Francesca Jaume
- Servei d'Otorrinolaringologia, Hospital Comarcal d'Inca, Carretera Vella de Llubí, 07300, Inca, Illes Balears, Spain.
| | - Meritxell Valls-Mateus
- Servei d'Otorrinolaringologia, Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
- Immunoal.lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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Shakhova EG. [Comparative study of the efficacy of combined nasal topical drug and topical decongestants in the treatment of acute rhinosinusitis]. Vestn Otorinolaringol 2020; 85:46-50. [PMID: 32885637 DOI: 10.17116/otorino20208504146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the drug Frinozol (nasal spray phenylephrinein 0.25% + cetirizine 0.25%) comparison with Rinostop Extra (nasal spray oxymetazoline 0.05%) in relation to nasal symptoms of rhinosinusitis, evaluated on rating scales, when using these drugs intranasally for 7 days in patients with acute viral and post-viral rhinosinusitis of mild (VAS 0-3) and moderate (VAS 3-7). PATIENTS AND METHODS The randomized open-label study included 60 ambulatory patients (men and women aged 18 to 60 years) with a verified diagnosis of acute rhinosinusitis (ARS) lasting no more than 120 hours. 1 group of patients took Frinozol (nasal spray phenylephrinein 0.25% + cetirizine 0.25%) for 2 sprays per each nostril 3 times a day for 7 days; 2 group - Rinostop Extra (nasal spray oxymetazoline 0.05%) at the same dose and the therapy regimen. We evaluated 3 visits (day 1, day 3, and day 7) with an ENT examination on each of them; questionnaires on the 1st and 3rd visits of nasal symptoms (nasal obstruction, rhinorrhea, hyposmia) on the visual analog scale (VAS) and Clinical Global Impression Scale-CGI. Active anterior rhinomanometry (AAR) was performed on the 1st, 2nd and 3rd visits using the PTS-14P-01 rhinomanometer Rinolan before and 20 minutes after the use of the drugs Frinozol and oxymetazoline 0.05%.
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Affiliation(s)
- E G Shakhova
- Volgograd State Medical University, Volgograd, Russia
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31
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Abstract
PURPOSE OF REVIEW The sense of smell is today one of the focuses of interest in aging and neurodegenerative disease research. In several neurodegenerative diseases, such as Parkinson's disease and Alzheimer's disease, the olfactory dysfunction is one of the initial symptoms appearing years before motor symptoms and cognitive decline, being considered a clinical marker of these diseases' early stages and a marker of disease progression and cognitive decline. Overall and under the umbrella of precision medicine, attention to olfactory function may help to improve chances of success for neuroprotective and disease-modifying therapeutic strategies. RECENT FINDINGS The use of olfaction, as clinical marker for neurodegenerative diseases is helpful in the characterization of prodromal stages of these diseases, early diagnostic strategies, differential diagnosis, and potentially prediction of treatment success. Understanding the mechanisms underlying olfactory dysfunction is central to determine its association with neurodegenerative disorders. Several anatomical systems and environmental factors may underlie or contribute to olfactory loss associated with neurological diseases, although the direct biological link to each disorder remains unclear and, thus, requires further investigation. In this review, we describe the neurobiology of olfaction, and the most common olfactory function measurements in neurodegenerative diseases. We also highlight the evidence for the presence of olfactory dysfunction in several neurodegenerative diseases, its value as a clinical marker for early stages of the diseases when combined with other clinical, biological, and neuroimage markers, and its role as a useful symptom for the differential diagnosis and follow-up of disease. The neuropathological correlations and the changes in neurotransmitter systems related with olfactory dysfunction in the neurodegenerative diseases are also described.
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