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International Journal of Pediatric... May 2024As the role of sinonasal anatomical variants as predisposing factors in determining the lateralization of acute rhinosinusitis-related orbital complications (ARS-OC) in...
INTRODUCTION
As the role of sinonasal anatomical variants as predisposing factors in determining the lateralization of acute rhinosinusitis-related orbital complications (ARS-OC) in pediatrics remains a topic of debate, this study further explores the potential association between anatomical variations and ARS-OC.
METHODS
A retrospective study was conducted on children who had been admitted with ARS-OC using medical records and sinus CT scans to compare anatomical differences between the affected and contralateral sides. This study aimed to identify bony anatomical disparities that may impact OC laterality secondary to ARS. The anatomical features examined included septal deviation, concha bullosa, lamina papyracea dehiscence (LPD), and uncinate process abnormalities.
RESULTS
The CT scans of 57 pediatric patients (114 sides) were reviewed. Our results indicated that bony anatomical variations were associated with ARS-OC laterality (63 % vs. 37 %, P = 0.006), yielding an odds ratio of 2.91. Additionally, our study revealed a significant association between ipsilateral LPD with the increased risk of ARS-OC (39 % vs. 1.8 %, P < 0.05), with an odds ratio of 34.3 compared to the opposite side.
CONCLUSIONS
LPD might play a role in the pathophysiology of pediatric ARS-OC, as it is associated with a significantly higher risk of affecting the ipsilateral side. Further research is necessary to determine whether LPD is a causative factor or a result of ARS.
Topics: Humans; Male; Female; Retrospective Studies; Child; Sinusitis; Rhinitis; Tomography, X-Ray Computed; Acute Disease; Child, Preschool; Paranasal Sinuses; Orbital Diseases; Adolescent; Anatomic Variation; Rhinosinusitis
PubMed: 38657427
DOI: 10.1016/j.ijporl.2024.111958 -
The Laryngoscope Apr 2024Acute invasive fungal sinusitis (AIFS) classically presents as an aggressive fungal infection that can spread beyond its origin in the sinuses in immunocompromised...
Acute invasive fungal sinusitis (AIFS) classically presents as an aggressive fungal infection that can spread beyond its origin in the sinuses in immunocompromised patients. Although there have been reports of AIFS in immunocompetent, non-diabetic patients, it is extremely rare and the true mechanism behind it is unknown. A thirty-eight year old immunocompetent, non-diabetic woman underwent bilateral ESS for chronic rhinosinusitis with nasal polyps at a tertiary care center and post-operatively developed AIFS. Patient underwent uncomplicated ESS, was packed with foam containing triamcinolone and discharged on steroid rinses and a prednisone taper. Surgical pathology demonstrated left-sided colonization with non-invasive fungal elements consistent with a mycetoma. She presented on post-operative Day 11 with headache and left-sided retro-orbital pain. A culture of her left nasal cavity grew Rhizopus spp and MRI demonstrated evidence of invasive fungal infection of left sphenoid mucosa as well as inflammatory changes in the left orbit centered at the orbital apex. She was started on amphotericin and underwent a left-sided debridement with biopsies which demonstrated angioinvasive fungal disease. Her vision in her left eye worsened to 20/800 and she was treated with transcutaneous retrobulbar injection of amphotericin B. After stable interval imaging she was discharged on a long-term course of antifungals. Extensive immunologic work-up was unremarkable. We describe a case of an immunocompetent patient who developed AIFS after sinus surgery for CRS and a mycetoma likely as a result of local immune suppression and post-surgical trauma. Laryngoscope, 2024.
PubMed: 38651570
DOI: 10.1002/lary.31463 -
Pediatrics May 2024
Topics: Humans; Anti-Bacterial Agents; Sinusitis; Acute Disease; Child
PubMed: 38646696
DOI: 10.1542/peds.2024-065732 -
Pediatrics May 2024Acute sinusitis is one of the leading causes of antibiotic prescriptions in children. No recent systematic reviews have examined the efficacy of antibiotics compared... (Meta-Analysis)
Meta-Analysis
CONTEXT
Acute sinusitis is one of the leading causes of antibiotic prescriptions in children. No recent systematic reviews have examined the efficacy of antibiotics compared with placebo.
OBJECTIVE
We sought to determine if antibiotics are superior to placebo in the treatment of acute sinusitis in children.
DATA SOURCES
Medline and Embase were searched from their origin to July 2023.
STUDY SELECTION
We considered randomized placebo-controlled studies focusing on the treatment of acute sinusitis. In all studies, symptoms were present for <4 weeks and subjects were <18 years of age.
DATA EXTRACTION
Two authors independently extracted the data. We pooled data primarily using fixed-effects models.
RESULTS
Analysis of 6 included studies showed that antibiotic treatment reduced the rate of treatment failure by 41% (with a risk ratio of 0.59; 95% confidence interval 0.49-0.72) compared with placebo. There was substantial heterogeneity between the studies (I2 = 69.7%), which decreased substantially when the 1 study with a high risk of bias was removed (I2 = 26.9%). Children treated with antibiotics were 1.6 times more likely to have diarrhea than those who were not treated with antibiotics (risk ratio = 1.62, 95% confidence interval 1.04-2.51).
LIMITATIONS
A small number of studies were eligible for inclusion. Included studies differed in their methodology.
CONCLUSIONS
In children with clinically diagnosed acute sinusitis, antibiotics significantly reduced the rate of treatment failure compared with placebo. However, given the favorable natural history of sinusitis, our results could also support close observation without immediate antibiotic treatment.
Topics: Humans; Anti-Bacterial Agents; Sinusitis; Child; Acute Disease; Randomized Controlled Trials as Topic; Treatment Failure; Adolescent
PubMed: 38646685
DOI: 10.1542/peds.2023-064244 -
JAMA May 2024
Topics: Adult; Humans; Male; Acute Disease; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Diabetes Mellitus, Type 1; Immunocompromised Host; Infusions, Intravenous; Laryngoscopy; Liposomes; Mucormycosis; Orbital Diseases; Rhinosinusitis; Rhizopus oryzae; Tomography, X-Ray Computed
PubMed: 38630502
DOI: 10.1001/jama.2024.0642 -
American Journal of Rhinology & Allergy Jul 2024Environmental exposures have been postulated to play an important role in the pathophysiology of chronic rhinosinusitis (CRS). Particulate matter (PM) is one of the most...
BACKGROUND
Environmental exposures have been postulated to play an important role in the pathophysiology of chronic rhinosinusitis (CRS). Particulate matter (PM) is one of the most widely studied ambient air pollutants, but its peri-operative impact on CRS is unknown.
OBJECTIVE
To determine the effect of acute, peri-operative PM exposure on outcomes after endoscopic sinus surgery (ESS).
METHODS
Participants with CRS who self-selected ESS were prospectively enrolled. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility values scores were recorded. Using residence zip codes, a secondary analysis of patient exposure to PM <2.5 μm and <10 μm (PM2.5 and PM10, respectively) was performed for the month of surgery utilizing data from Environmental Protection Agency air quality monitors. Spearman's correlation coefficients (ρ), 95% confidence intervals (CIs), and effect estimates (β) were used to determine the magnitudes of association. Simple, multivariate regression analysis was also completed.
RESULTS
One hundred and seven patients from four geographically unique institutions across the US were enrolled with a follow-up of 6 months. Patients with higher peri-operative PM2.5 exposure had less improvement in their SNOT-22 scores after ESS compared to those with less exposure using both univariate analysis (ρ = 0.26, 95% CI: 0.08, 0.43; = .01) and after covariate adjustment with multivariate analysis ( = 1.06, 95% CI: 0.001, 2.14, = .05). Similar associations were not found with SF-6D outcomes or with PM10 as an exposure of interest. No significant correlations were found between peri-operative PM levels and Lund-Kennedy endoscopy scores post-operatively.
CONCLUSION
Preliminary data from this pilot study reveal that PM exposure at the time of ESS may negatively associate with post-operative improvement in sinonasal quality-of-life. Larger, population-based studies with more standardized PM exposure windows are needed to confirm the clinical significance of the present findings.
Topics: Humans; Particulate Matter; Sinusitis; Male; Female; Rhinitis; Endoscopy; Middle Aged; Chronic Disease; Paranasal Sinuses; Environmental Exposure; Aged; Adult; Treatment Outcome; Prospective Studies; Follow-Up Studies; Surveys and Questionnaires; Quality of Life
PubMed: 38623645
DOI: 10.1177/19458924241246371 -
Journal of the Pediatric Infectious... Jun 2024Acute respiratory tract infections (ARTIs) account for most antibiotic prescriptions in pediatrics. Although US guidelines continue to recommend ≥10 days antibiotics... (Review)
Review
Acute respiratory tract infections (ARTIs) account for most antibiotic prescriptions in pediatrics. Although US guidelines continue to recommend ≥10 days antibiotics for common ARTIs, evidence suggests that 5-day courses can be safe and effective. Academic imprinting seems to play a major role in the continued use of prolonged antibiotic durations. In this report, we discuss the evidence supporting short antibiotic courses for group A streptococcal pharyngitis, acute otitis media, and acute bacterial rhinosinusitis. We discuss the basis for prolonged antibiotic course recommendations and recent literature investigating shorter courses. Prescribers in the United States should overcome academic imprinting and follow international trends to reduce antibiotic durations for common ARTIs, where 5 days is a safe and efficacious course when antibiotics are prescribed.
Topics: Humans; Anti-Bacterial Agents; Respiratory Tract Infections; Acute Disease; Sinusitis; Pharyngitis; Otitis Media; Child; Drug Administration Schedule; Streptococcal Infections; Practice Guidelines as Topic; Rhinitis; United States; Streptococcus pyogenes
PubMed: 38581154
DOI: 10.1093/jpids/piae034 -
Journal of Medical Case Reports Apr 2024A long-term ruxolitinib-treated patient with primary myelofibrosis, who was co-infected with aspergillosis infection during a short period, developed acute invasive...
INTRODUCTION
A long-term ruxolitinib-treated patient with primary myelofibrosis, who was co-infected with aspergillosis infection during a short period, developed acute invasive fungal sinusitis with consequent orbit apex syndrome. This may be the first reported case in the world. This is a 75-year-old Chinese man; the patient was admitted with 2-month history of headache accompanied by numbness and 8-day history of vision loss. The preliminary clinical diagnoses were suspected acute invasive fungal sinusitis or adenoid cystic carcinoma. We performed endoscopic debridement and antifungal therapy. About 90 days after surgery, magnetic resonance imaging revealed no recurrence of pathological tissue.
CONCLUSION
One of the bases for the occurrence of invasive fungal sinusitis may be the patient's long-term use of ruxolitinib for essential thrombocythemia. Some patients with invasive fungal sinuses have atypical nasal symptoms and are referred to the corresponding departments with eye and headache as the first symptoms. It is suggested that enhanced magnetic resonance imaging should be performed at an early stage. Surgical treatment in combination with antifungal and enhanced immunotherapy can effectively prevent the spread of infection and reduce the risk of death.
Topics: Aged; Humans; Male; Antifungal Agents; Headache; Nitriles; Pyrazoles; Pyrimidines; Sinusitis
PubMed: 38576050
DOI: 10.1186/s13256-024-04486-3 -
Neurologic Clinics May 2024Headache affects around half of patients in the acute phase of COVID-19 and generally occurs at the beginning of the symptomatic phase, has an insidious onset, and is... (Review)
Review
Headache affects around half of patients in the acute phase of COVID-19 and generally occurs at the beginning of the symptomatic phase, has an insidious onset, and is bilateral, and of moderate to severe intensity. COVID-19 may also present complications that cause acute and persistent headaches, such as cerebrovascular diseases, rhinosinusitis, meningitis, and intracranial hypertension. In 10% to 20% of patients with COVID-19, headache may persist beyond the acute phase. In general, the headache improves over time. To date, there are no clinical trials that have assessed the treatment of persistent post-COVID-19 headache.
Topics: Humans; COVID-19; Headache; Intracranial Hypertension; Rhinosinusitis
PubMed: 38575263
DOI: 10.1016/j.ncl.2023.12.006