scholarly journals Characterization of Aeroallergen Sensitivities in Children with Allergic Rhinitis and Chronic Rhinosinusitis

2014 ◽  
Vol 5 (3) ◽  
pp. ar.2014.5.0102 ◽  
Author(s):  
Ahmad R. Sedaghat ◽  
Wanda Phipatanakul ◽  
Michael J. Cunningham
Keyword(s):  
Immune Deficiency ◽  
Allergic Rhinitis ◽  
Chronic Rhinosinusitis ◽  
Skin Testing ◽  
Care Center ◽  
Tertiary Care ◽  
Comorbid Condition ◽  
Consecutive Series ◽  
Co Morbidity ◽  
Sensitivity Profile

Allergic rhinitis is a common comorbid condition in pediatric chronic rhinosinusitis (CRS). Testing for aeroallergen sensitization should therefore be considered in the evaluation of children with CRS. At present the aeroallergen sensitivity profile of children with CRS remains uncharacterized. In this study, we retrospectively identify a consecutive series of children with CRS and allergic rhinitis who have undergone joint otolaryngology and allergy evaluation at a single tertiary care center. We describe the aeroallergen sensitivity profiles (based upon formal skin testing) of these children, stratifying them according to co-morbidity status: 1) CRS with cystic fibrosis (CF), 2) CRS with immune deficiency and 3) uncomplicated CRS (without co-morbid CF, immune deficiency or primary ciliary dyskinesia). We identify 208 children (average age 9.3 years, standard deviation 4.8 years) with CRS and allergic rhinitis meeting inclusion criteria, 140 with uncomplicated CRS, 64 with co-morbid immune deficiency and 4 with co-morbid CF. The prevalence of indoor aeroallergen sensitivities (62.9–100.0%) was more common than that of outdoor aeroallergen sensitivities (43.8–50.0%) in all three cohorts of children. In all three cohorts, the most common indoor aeroallergen sensitivity was to dust mites (50.0–75.0%) and the most common outdoor aeroallergen sensitivity was to tree pollens (43.8–50.0%). The aeroallergen sensitivity profile of children with CRS and allergic rhinitis appears to be similar to that of the general pediatric population with allergic rhinitis, and parallels the aeroallergen sensitivities previously described for adults with CRS and allergic rhinitis. Knowledge of the aeroallergen sensitivities in children with CRS and allergic rhinitis will enhance both diagnostic and treatment strategies.

scholarly journals Symptomatology and allergen types in patients presenting with allergic rhinitis

2012 ◽  
Vol 18 (1) ◽  
pp. 30-35
Author(s):  
R Nepali ◽  
B Sigdel ◽  
P Baniya
Keyword(s):  
Allergic Rhinitis ◽  
Allergic Conjunctivitis ◽  
Care Center ◽  
Tertiary Care ◽  
Chief Complaint ◽  
Age Group ◽  
Tertiary Care Center ◽  
Co Morbidity ◽  
Males And Females ◽  
Global Health Problem

Allergic rhinitis, despite its complex patho-physiology, is a global health problem with the increasing prevalence. The current study which was conducted at one of the tertiary care center in the country comprised of 548 diagnosed cases of allergic rhinitis and thus treated during the period extending from January 2010 to June 2011. In the study, males and females were almost equally distributed, constituting the ratio of 1:0.9. Among them, the patients from 20 –29 year of age group was the most commonly affected (38.1%). In our study most of the patients were housewives (30.3%) and the house dusts mites (76.3%), was the most common etiological factors. Majority of the patients presented with sneezing (86.7%) as the chief complaint. Of the total subjects, 18.6% presented with co-morbidity of allergic conjunctivitis and 8.9% with that of sinusitis. DOI: http://dx.doi.org/10.3329/bjo.v18i1.10411  Bangladesh J Otorhinolaryngol 2012; 18(1): 30-35

Office-Based Sinus Surgery for Cystic Fibrosis Chronic Rhinosinusitis

ORL ◽  
2020 ◽  
pp. 1-4
Author(s):  
Daniel B. Spielman ◽  
David A. Gudis
Keyword(s):  
Cystic Fibrosis ◽  
Mechanical Ventilation ◽  
Chronic Rhinosinusitis ◽  
Local Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Office Setting

<b><i>Objective:</i></b> Chronic rhinosinusitis (CRS) is nearly ubiquitous in the cystic fibrosis (CF) population, and many patients require multiple endoscopic sinus surgeries throughout their lifetime. Recent studies have demonstrated the profound pulmonary and systemic health benefits of comprehensive CRS treatment. Both endotracheal intubation with mechanical ventilation and inpatient hospital care represent significant risks for CF patients. The goal of this study is to evaluate the safety and feasibility of performing revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia to decrease the need for mechanical ventilation and inpatient hospitalization. <b><i>Methods:</i></b> This is a prospective cohort study conducted at a tertiary care academic medical center with a CF Foundation-accredited care center. Patients with CF and refractory CRS despite prior surgery and medical therapy were eligible for inclusion. Comprehensive revision ESS was performed in the office using only local anesthesia. <b><i>Results:</i></b> Five patients were enrolled and underwent revision endoscopic sinus surgery without complication. The average preoperative Sinonasal-Outcome Test-22 score was 52.0 ± 12.1 and the average preoperative Lund-Mackay score was 15.2 ± 3.8. No patients requested aborting the procedure early due to pain, discomfort, or any other reason. No subjects required prolonged observation or postoperative hospital admission. <b><i>Conclusion:</i></b> This prospective pilot study is the first to demonstrate the safety and feasibility of performing comprehensive revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia.

scholarly journals Role of anatomical variations in chronic rhinosinusitis on diagnostic nasal endoscopy and computed tomography scan of paranasal sinuses

2019 ◽  
Vol 6 (1) ◽  
pp. 101
Author(s):  
Falguni J. Parmar ◽  
Avani D. Patel
Keyword(s):  
Computed Tomography ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Care Center ◽  
Tertiary Care ◽  
Middle Turbinate ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
Advantages And Disadvantages

<p class="abstract"><strong>Background:</strong> Diagnostic nasal endoscopy (DNE) and computed tomography (CT) of para nasal sinuses play an important role in the diagnosis and treatment of chronic rhinosinusitis (CRS). The aim and objective of the study is to see the anatomical variations of the sinonasal region in CRS on DNE and CT paranasal sinuses (PNS).</p><p class="abstract"><strong>Methods:</strong> A descriptive type retrospective study of 30 patients attending the ENT outpatient department of our tertiary care center clinically diagnosed as CRS with symptoms persisting for 12 weeks or more, along with previously failed medical management, including topical nasal steroids, systemic decongestant and extended courses of antibiotics and who were willing to undergo endoscopic sinus surgery are included.  </p><p class="abstract"><strong>Results:</strong> Majority of the patients had septal deviation either an anterior or posterior deviation but majority of the cases are asymptomatic for the deviation. Anatomical variations of uncinate process, middle turbinate, inferior turbinate, frontal recess, agger nasi cells, haller cells were studied as well.</p><p class="abstract"><strong>Conclusions:</strong> Prolonged duration of  rhinosinusitis symptoms (more than 8-12 weeks) is the primary reason to evaluate a patient for CRS and making the choice between CT PNS or DNE is patient and disease dependent. Understanding the advantages and disadvantages of each helps us realize that they are of synergistic in nature and not competitive.</p>

Incidence of asymptomatic COVID-19 positivity in cancer patients and effects on therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13506-e13506
Author(s):  
Nicole Ross ◽  
Elizabeth A. Handorf ◽  
Caitlin R. Meeker ◽  
Giana Chen ◽  
Donald Baldwin ◽  
...  
Keyword(s):  
General Population ◽  
Cancer Care ◽  
Care Delivery ◽  
Conditional Logistic Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Co Morbidity ◽  
Procedure Type

e13506 Background: As the coronavirus disease 2019 (COVID-19) pandemic threatens the delivery of cancer care, challenges to providing safe and quality care persist. Screening measures including SARS-CoV-2 polymerase-chain reaction (CovPCR) testing prior to invasive procedures, therapy administration, were instituted to address risk of spread from asymptomatic (AS) pts. Studies have documented poor outcomes with COVID-19 in cancer pts with rate of AS COVID-19 ranging from 0.6%- 8%. (Liang et.al, 2020; Al-Shamsi, et.al, 2020, Shah et.al. 2020). In the general population, rates of AS cases was estimated to be 17% (Byambasuren, O., 2020). This study aimed to examine the incidence and characteristics of AS COVID -19 in cancer pts, and determine its effect on cancer care delivery at a tertiary care center. Methods: With IRB approval, a retrospective chart review was conducted on cancer pts undergoing CoVPCR screening. Pts were considered AS if they had no recent fever (≥100.5 °F), cough, headache, loss of taste/smell, shortness of breath, diarrhea, or high risk exposure. This analysis compared cases (positive CoVPCR) identified by screening of AS pts to control (negative CoVPCR) pts (matched by planned procedure type and month of screening). Each COVID case was matched to 2 negative controls on month and planned procedure type. Patient characteristics and outcomes were compared between cases and controls using conditional logistic regression or Mantel-Haenszel tests. Results: Between 03/2020 and 09/2020, 4143 AS pts underwent CovPCR testing and 75 were chosen for analysis (25 cases; 50 controls). The incidence of AS COVID-19 in cancer pts was 0.6% (25/4143). Median age was lower in the cases (64 vs 70y, p = 0.04). Gender, race, primary cancer diagnosis, and co-morbidity distribution was similar between cases and controls. Of the cases, 10 pts (40%) never underwent the planned oncologic intervention while 11 (44%) had a delay related to the positive CoVPCR (2 pts had no intervention planned). Only 1 pt (2%) in control arm didn’t undergo the planned procedure. The mean duration of delay was 18 days (range 0-49 days, SD 16.72) in cases versus Zero days in control. Four (16.7%) cases developed symptoms within 14 days of positive CoVPCR testing but the PCR value did not predict this conversion. Conclusions: Incidence of AS COVID in our cancer pts was significantly lower than general population. Active screening delayed oncologic care but with institution of safety measures like separate treatment rooms and scheduling procedures at the end of the day have ensured safe and prompt cancer care delivery during the pandemic. Future research needs will address incorporating vaccination status into the screening algorithm to limit widespread CoVPCR screening, thus improving care delivery and cost effectiveness.

Outcomes in Treatment of Rhinosinusitis in the Setting of Medication Induced Immunosuppression

2020 ◽  
pp. 194589242094793
Author(s):  
Rahul Alapati ◽  
Jayakar V. Nayak ◽  
Peter H. Hwang ◽  
Zara M. Patel
Keyword(s):  
Chronic Rhinosinusitis ◽  
Surgical Management ◽  
Medical Management ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Pathways ◽  
Acute Rhinosinusitis ◽  
Significant Difference ◽  
Immunosuppressed Patients ◽  
Snot 22

Background There is no data currently available to direct nuanced treatment for recurrent acute and chronic rhinosinusitis (RARS, CRS) in patients on daily, long term medications that suppress the immune system. Objective This study sought to evaluate the outcomes of different treatment pathways when treating immunosuppressed patients with chronic rhinosinusitis or recurrent acute rhinosinusitis. Methods A retrospective review of patients on immune suppressing medication presenting to a tertiary care center with RARS or CRS between the years 2014–2019 was completed. Patients were categorized into three groups based on treatment: medical management alone (MM), surgery after medical management (SAMM), or upfront surgery (US). Lund-Kennedy scores (LKS) and SNOT-22 scores were evaluated at baseline, 1 month, 3 months and 6 months from presentation. Results 68 patients met inclusion criteria, with no difference in demographics between groups. Patients who were treated with US and SAMM had significantly higher baseline LKS than those who were treated with MM alone (p = 0.050, p = 0.039). Once this difference was controlled for, there was no significant difference in overall change of LKS between the three groups over time. There was no significant disparity in baseline SNOT-22 scores between the three groups, but patients who underwent US had a significantly higher improvement in SNOT-22 from baseline compared to those undergoing MM alone (p = 0.013). Conclusion Patients experiencing chronic rhinosinusitis and recurrent acute rhinosinusitis who are taking immunosuppressive medication can significantly improve from both medical and surgical management, but upfront surgical management appears to result in greater disease resolution relative to medical management in those with CRS. More study is needed in the RARS patient population regarding upfront surgery versus medical management.

scholarly journals Depression among patients undergoing maintenance hemodialysis at a tertiary care center in Kathmandu, Nepal

2018 ◽  
Vol 5 (2) ◽  
pp. 4-11
Author(s):  
Nora Ranjitkar Manandhar ◽  
Rabi Shakya ◽  
Bimal Pandey ◽  
Pratik Wagley
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Alcohol Intake ◽  
Care Center ◽  
Tertiary Care ◽  
Maintenance Hemodialysis ◽  
Tertiary Care Center ◽  
Housing Status ◽  
Co Morbidity ◽  
Prevalence Of Depression

Introductions:Patients with chronic kidney disease have a high burden of somatic symptoms which may be due to depression. This study analyses occurrence of depression in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) at a tertiary care center in Kathmandu, Nepal.  Methods: This is a retrospective study done at Patan Hospital, a tertiary care teaching hospital of Patan Academy of Health sciences, Lalitpur, Nepal. Translated in Nepali language and validated Beck Depression Inventory (BDI) was used. A cut-off of 16/17 was used to define depression.   Results: Altogether 56 patients were included, mean age 54.375±17.87 years, time on HD 25.06±21.58 months, BDI score 19.18±10.16. The prevalence of depression was 51.8%. There was no significant differences of BDI score and rate of depression in genders, housing status, education level, alcohol intake, presence of co-morbidity and shift of HD. However, there was a significant association of BDI score and the employment status, p=0.026 and the affordability of erythropoiesis stimulating agent, p=0.033.  Conclusions: Depression was common in patients undergoing hemodialysis treatment and the rate of depression was significantly lower in the patients who were employed and used of erythropoiesis stimulating agent.

scholarly journals Priapism: Comorbid Factors and Treatment Outcomes in a Contemporary Series

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Henry P. Gottsch ◽  
Richard E. Berger ◽  
Claire C. Yang
Keyword(s):  
Substance Abuse ◽  
Mental Illness ◽  
Erectile Dysfunction ◽  
Treatment Outcomes ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Low Flow ◽  
Comorbid Condition ◽  
Ischemic Priapism

Objective. The goal of this study is to describe comorbid characteristics in patients who have priapism, and their treatment outcomes.Methods. Chart review was undertaken on men who had a diagnosis of priapism from a tertiary medical center, from 2000–2010. Men with priapism due exclusively to the use of prescription erectile aids and medications were not included in the review.Results. We identified 79 patients with the priapism. The most common type of priapism was the low flow variant. High flow priapism was identified in 2 patients. The most common general comorbid condition associated with priapism was mental illness (including substance abuse), which was present in 56% of the patients. Neurogenic priapism accounted for 19% of the total priapism events. Psychopharmaceutical agents and recreational drugs were commonly associated with ischemic priapism. Acute complications of priapism treatment were not common, but long-term complications, especially erectile dysfunction, were frequent.Conclusions. We describe the characteristics and outcomes of a large group of patients with priapism. Our experience at a tertiary care center indicates that mental illness, including substance abuse disorders, is a highly prevalent comorbid condition in men who experience priapism. Consistent with previous reports, erectile dysfunction is the most common complication from priapism and its treatment, occurring in the majority of men.

scholarly journals Coexistence of Allergic Rhinitis in Children Attending Paediatric Asthma Clinic

2019 ◽  
Vol 39 (3) ◽  
pp. 142-146
Author(s):  
Rajesh Kumar Singh ◽  
Ashish Kumar Simalti
Keyword(s):  
Allergic Rhinitis ◽  
Epidemiological Study ◽  
Age Of Onset ◽  
Tertiary Care ◽  
North India ◽  
Tertiary Care Centre ◽  
Global Initiative For Asthma ◽  
Co Morbidity ◽  
Prospective Epidemiological Study ◽  
Global Initiative

Introduction: Asthma and allergic rhinitis are considered manifestations of the chronic inflammatory respiratory syndrome of the common airways or united airways disease. We conducted a prospective epidemiological study to evaluate the prevalence of allergic rhinitis among children already diagnosed as having asthma. Methods: A prospective epidemiological study was carried out during 2015 to 2016 at a tertiary care centre in North India. The severity of asthma was classified according to the Global Initiative for Asthma (GINA) report & allergic rhinitis according to Allergic Rhinitis and Its Impact on Asthma (ARIA). Results: A total of 64 children were screened. After excluding five subjects (7.8%), 59 subjects with asthma were analysed. We could not find any definitive correlation between severity of asthma to severity of allergic rhinitis (p > 0.05). The prevalence of co morbidity of asthma and allergic rhinitis was maximum when onset of asthma was between three to six years (70%), was 40% for < three years and 50% when age of onset was six to nine years. The age of onset of asthma in children having asthma only was five years and that of children with both asthma and allergic rhinitis was 5.5 years. This difference was not significant (p > 0.05).  Conclusion: There was a high prevalence of co morbidity (50.84%) of allergic rhinitis among patients with asthma. A positive correlation was found between duration and severity of asthma, but this was not observed for allergic rhinitis. In most cases asthma preceded or started with AR.

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