Diagnosis and Treatment of Local Allergic Rhinitis

Some patients with chronic rhinitis have a positive nasal allergen provocation test (NAPT) without systemic IgE sensitization by skin prick tests or serum allergen-specific IgE (sIgE). This novel concept is called local allergic rhinitis (LAR) and affects children and adults worldwide, but is underdiagnosed. LAR is not just the initial state of allergic rhinitis (AR), it is a unique form of chronic rhinitis that is neither classical AR nor non-AR. Many of the features of AR and LAR are similar, such as a positive NAPT, positive type 2 inflammatory markers, including the nasal discharge of sIgE, and a high incidence of asthma. A differential diagnosis of LAR needs to be considered in patients with symptoms suggestive of AR in the absence of systemic atopy, regardless of age. The diagnostic method for LAR relies on positive responses to single or multiple allergens in NAPT, the sensitivity, specificity, and reproducibility of which are high. The basophil activation test and measurement of IgE in nasal secretions also contribute to the diagnosis of LAR. Treatment for LAR is similar to that for AR and is supported by the efficacy and safety of allergen exposure avoidance, drug therapy, and allergen immunotherapy. This review discusses current knowledge on LAR.

Radiomics for Diagnosis and Radiotherapy of Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is a malignant tumor of the head and neck. The primary clinical manifestations are nasal congestion, blood-stained nasal discharge, headache, and hearing loss. It occurs frequently in Southeast Asia, North Africa, and especially in southern China. Radiotherapy is the main treatment, and currently, imaging examinations used for the diagnosis, treatment, and prognosis of NPC include computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)-CT, and PET-MRI. These methods play an important role in target delineation, radiotherapy planning design, dose evaluation, and outcome prediction. However, the anatomical and metabolic information obtained at the macro level of images may not meet the increasing accuracy required for radiotherapy. As a technology used for mining deep image information, radiomics can provide further information for the diagnosis and treatment of NPC and promote individualized precision radiotherapy in the future. This paper reviews the application of radiomics in the diagnosis and treatment of nasopharyngeal carcinoma.

Sinonasal mycosis following transfrontal craniotomy in three dogs

CASE DESCRIPTION Three dogs were presented for investigation of chronic nasal discharge and epistaxis 141, 250, and 357 days after undergoing transfrontal craniotomy to treat an intracranial meningioma (2 dogs) or a meningoencephalocele (1 dog). CLINICAL FINDINGS CT findings were consistent with destructive rhinitis and frontal sinusitis in all 3 dogs, with results of histologic examination and fungal culture of samples obtained during frontal sinusotomy confirming mycotic infection. Frontal sinusotomy revealed fungal plaques covering a combination of bone and residual surgical tissue adhesive at the site of the previous craniotomy in all 3 dogs. Aspergillus spp were identified in all 3 dogs, and Chrysosporium sp was also identified in 1 dog. TREATMENT AND OUTCOME Surgical curettage was followed by antifungal treatment (topical clotrimazole in 2 dogs and oral itraconazole for 3 months in 1 dog). Nasal discharge improved in the short-term but recurred in all dogs 99, 118, and 110 days after frontal sinusotomy. One dog received no further treatment, 1 dog received an additional 8.5 months of oral itraconazole treatment, and 1 dog underwent 2 additional surgical debridement procedures. At last follow-up, 2 dogs were alive 311 and 481 days after frontal sinusotomy; the third dog was euthanized because of status epilepticus 223 days after frontal sinusotomy. CLINICAL RELEVANCE Sinonasal mycosis should be considered as a potential complication in dogs developing persistent mucopurulent nasal discharge, intermittent epistaxis, and intermittent sneezing following transfrontal craniotomy. The pathophysiology may be multifactorial, and potential risk factors, including use of surgical tissue adhesive in the frontal sinus, require further investigation.

Saliva Quantification of SARS-CoV-2 in Real-Time PCR From Asymptomatic or Mild COVID-19 Adults

The fast spread of COVID-19 is related to the highly infectious nature of SARS-CoV-2. The disease is suggested to be transmitted through saliva droplets and nasal discharge. The saliva quantification of SARS-CoV-2 in real-time PCR from asymptomatic or mild COVID-19 adults has not been fully documented. This study analyzed the relationship between salivary viral load on demographics and clinical characteristics including symptoms, co-morbidities in 160 adults diagnosed as COVID-19 positive patients recruited between September and December 2020 in four French centers. Median initial viral load was 4.12 log10 copies/mL (IQR 2.95–5.16; range 0–10.19 log10 copies/mL). 68.6% of adults had no viral load detected. A median load reduction of 23% was observed between 0–2 days and 3–5 days, and of 11% between 3–5 days and 6–9 days for the delay from onset of symptoms to saliva sampling. No significant median difference between no-symptoms vs. symptoms patients was observed. Charge was consistently similar for the majority of the clinical symptoms excepted for headache with a median load value of 3.78 log10 copies/mL [1.95–4.58] (P < 0.003). SARS-CoV-2 RNA viral load was associated with headache and gastro-intestinal symptoms. The study found no statistically significant difference in viral loads between age groups, sex, or presence de co-morbidity. Our data suggest that oral cavity is an important site for SARS-CoV-2 infection and implicate saliva as a potential route of SARS-CoV-2 transmission.

Nasal Transmissible Venereal Tumor (TVT) in Dogs

Background: Transmissible venereal tumors (TVT) are naturally occurring neoplasms that can be transmitted through copulation or cell transplantation. It is a disease that affects canines, has no preference for sex or breed, and generally noticed in the external genital apparatus. Extragenital occurrence may eventually be seen; however, nasal involvement has been described in only a few reports of studies conducted in Brazil. Therefore, the objective of this study is to report 3 cases of nasal TVT in dogs who were treated in 2 municipalities in the mountainous region of Santa Catarina, Brazil.Cases: This case report includes 3 male mixed-breed canines of age 3-13. Only 1 of the animals was castrated. As per the medical history, some points, such as an enlarged nasal region, sneezing, nasal discharge, and hoarseness, reported by the dogs’ respective owners were similar among all the dogs. Likewise, nosebleed was observed on physical examination in all the cases. The result of cytological examination was inconclusive only in 1 case. Rhinoscopy, incisional biopsy, and histopathological examination were then performed for achieving a definitive diagnosis. In the 2 cases wherein cytology gave conclusive results, the cytological smears showed changes suggestive of TVT, such as cells with eccentric nuclei and little cytoplasm, which had vacuoles inside them. In 2 cases, radiographic examinations of the skull were also performed. The images showed changes in bone radiopacity, conformation of trabeculae with areas of bone lysis and cell proliferation, and irregularity in the contour of the nasal bone. After TVT diagnosis was confirmed, chemotherapy was initiated using vincristine at a dose of 0.75 mg/m2 for 2 cases and 0.025 mg/kg for the remaining case. The number of chemotherapy sessions and duration of treatment until the resolution of lesions and clinical signs varied as per the differences in the patients’ blood counts performed prior to each session.Discussion: TVT occurs between 1 and 7 years of life. It occurs more frequently in sexually active animals and has no preference for breed. Of the 3 cases reported herein, only one of the patients was elderly. All the patients were male mixed-breed dogs, and only 1 of them was castrated. The implantation of neoplastic cells through natural mounts, licks, scratches, or bites of affected areas are the most widely accepted reasons for the transmission of this neoplasm. With regard to the nasal presentation described in the present report, it is hypothesized that the smelling or licking of the neoplastic areas by the animal may favor cell implantation, leading to the subsequent development of a tumor. Nasal TVT should be considered as a differential diagnosis for dogs with chronic symptoms of the upper respiratory tract, such as increased local volume, nasal discharge, nosebleed, and sneezing. These signs are consistent with those described in this report. Radiographic evaluation was performed in 2 cases and both showed changes in bone radiopacity and trabeculae conformation, in addition to areas of bone lysis and cell proliferation, which are common in neoplastic processes. A presumptive diagnosis can be achieved from the medical history, clinical signs, and physical examination. Cytological and histopathological examination are the confirmatory methods; however, it is used less frequently and especially when cytological evaluation does not provide a definitive diagnosis. Antineoplastic chemotherapy with vincristine is the first-choice treatment protocol, which also proved to be effective for the patients in this report. Although TVT commonly affects the external genitalia of dogs, in the cases reported herein, it was located exclusively in the nasal region. Keywords: TVT, dog, nasal, vincristine.Título: Tumor venéreo transmissível (TVT) nasal em cãesDescritores: TVT, cão, nasal, vincristine.

Spectrum of Nasopharyngeal Cancers Seen in the Department of Radiation Oncology University College Hospital, Ibadan

Background: Nasopharyngeal cancer was initially thought to be an uncommon disease in Nigeria, but recent studies have shown a steady increase in the incidence of the disease with an associated increase in morbidity and mortality due to late presentation. Method: This was a retrospective review of patients with nasopharyngeal cancer seen in the department of Radiation Oncology U.C.H. Ibadan from 2000 to 2009. Patient's bio-data, clinical-pathologic presentation and site of referral were retrieved using data extraction form and subsequently analysed using Micrsoft Exel (2013). Results: A total of 205 patients with histologically confirmed nasopharyngeal cancer seen during the study period were analysed. The mean age of the patients was 41.7 years with 144 (70.2%) males and 61(29.8%) females. The commonest presenting complaint was cervical lymphadenopathy in 98.5% of patients followed by nasal blockade, nasal discharge and epistaxis with 82.0%, 78.0% and 51.2% respectively. Undifferentiated carcinoma was the commonest histologic type (68.8%). Majority of patients were civil servants (33.2%). The habit of smoking and alcohol ingestion were unspecified in majority of patients (43.4%). Ingestion of smoked fish has been found in majority of patients 122(59.5%) with the disease in this study. Most of the patients came from southern part of the country which coincide with geographic distribution of Burkitt lymphoma, hence the possibility of Ebsteinbarr virus (EBV) as one of the likely causative agents. Conclusion: Nasopharyngeal cancer is common. Cervical lymphadenopathy, nasal blockade with undifferentiated histology and late presentation were the norm. Referrals were from all the regions of the country.

FIRST REPORT OF CANINE MYIASIS WITH SHEEP NASAL BOT FLY, Oestrus ovis, IN SLOVENIA

First larval stage (L1) of Oestrus ovis was recovered by flushing of the nasal cavity during rhinoscopy in an urban living dog. The dog was taken to the Small animal clinic after an acute onset of sneezing and bilateral nasal discharge. In Europe, there are sporadic reports of nasal myiasis in dogs caused by sheep bot flies, and the overall prevalence of O. ovis is high in Mediterranean countries. Because of its habitat expansion due to climate change, it should be considered as a differential diagnosis when an animal patient presents with signs of rhinitis in areas bordering the Mediterranean climate. This is the first report of a dog infested by sheep nasal bot fly in Slovenia.Key words: Oestrus ovis; sheep bot fly; nasal myiasis; dog; climate changesPRVI PRIMER PASJE MIAZE Z OVČJIM NOSNIM ZOLJEM, Oestrus ovis, V SLOVENIJIIzvleček: Med rinoskopijo in spiranjem nosne votline, smo pri psu, ki živi v urbanem okolju, ugotovili ličinke prve stopnje (L1) zajedavca Oestrus ovis. Lastniki so psa pripeljali na Kliniko za male živali po akutnem izbruhu kihanja in bilateralnega nosnega izcedka. V Evropi so dokumentirani sporadični primeri nosne miaze pri psih zaradi ovčjega nosnega zolja, O. ovis, in skupna prevalenca ovčjega zajedavca je v mediteranskih državah visoka. Zaradi klimatskih sprememb, se habitat nosnih zoljev čedalje bolj širi, za kar je pomembno O. ovis vključiti v seznam diferencialnih diagnoz pri pacientih s kliničnimi znaki rinitisa tudi na področjih, ki mejijo na mediteransko klimo. To je prvi opisan primer infestacije psa z ovčjim nosnim zoljem v Sloveniji.Ključne besede: Oestrus ovis; ovčja nosni zolj; nosna miaza; pes; podnebne spremembe

Nasopharyngeal Polyp in a Cat: Clinical Assessment

The case report describes diagnosis and surgical treatment of nasopharyngeal polyp in a 3-months-old mixed breed female cat with sneezing, runny nose, lack of appetite and change of voice Serous tear discharge, mucopurulent nasal discharge and increased sensitivity in trachea were detected at clinical examination of the cat Following inspection of the oral cavity, it was observed that the soft palate was bulged and had a different appearance from the normal anatomical structure Significant alterations were not determined in the haematological, biochemical and radiographic examinations However, nasopharyngeal polyp was determined following the contrast-enhanced computed tomography examination After the polyp was removed by a simple invasive procedure, clinical findings of the cat started to improve as from the second day One month after the operation, the she was completely cured and became healthy In conclusion, nasopharyngeal polyp has to be considered for cats with lack of appetite, sneezing, runny nose and change of voice, and collaboration between oropharyngeal examination and transversal shots of the computed tomography would constitute a reliable approach for a precise diagnosis and preoperative planning for feline nasopharyngeal polyps.

Case Report on Carcinoma on Hard Palate

Background: The hard palate is a thin horizontal bony plate made up of two bones of the facial skeleton, located on the roof of the mouth. The bones are the palatine process of the maxilla and the horizontal plate of the palatine bone. The hard palate spans the alveolar arch formed by the alveolar process that holds the upper teeth (when these are developed). If cancer is detected early, the overall 5-year survival rate for all persons is 85 percent. If cancer has progressed to other tissues or organs, as well as regional lymph nodes, the overall 5-year survival rate is 67%. Objective: Want to highlight the importance of primary prevention; education on risks of alcohol/tobacco use and oral hygiene. Secondary prevention; Early biopsy of any ulceration of the hard palate that does not regress with medical treatment. This would allow early diagnosis and minimal treatment with less morbidity and better survival chances. Case Presentation: A male of 58 yrs. old came with Pain in the mouth, difficulty in breathing, difficulty in mastication, difficulty in deglutition, balm application, change in voice tooth exfoliation, lack of appetite. Aggravates on mastication, difficulty in deglutition for 2 months, burning sensation on the consumption of spicy food for 2 months change in voice, nasal discharge, loss of appetite, weight loss, tooth exfoliation in the upper front region of jaw, and balm application (2-3episodes, 15 days back). All necessary investigations were carried out such as X-ray, MRI, CT scan, a biopsy of the tissue sample, and diagnosed Carcinoma on the Hard Palate. Treatment of this patient received antiemetic, analgesic, antibiotic, vitamin supplementary. Prognosis: After treatment, the patient shows great improvement. Conclusion: The therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. The survival rate depends on several factors, including early diagnosis, histological characteristics and appropriate management. When ca of the palate is detected primary, the management is very effective.

Evaluation of therapeutic efficacy of oxytetracycline against caprine respiratory mycoplasmosis using clinical score card method

Mycoplasmosis in goats is one of the challenging and continuous threats to small ruminant farming causing huge economic losses. This study was carried out to evaluate the therapeutic efficacy of oxytetracycline against caprine respiratory mycoplasmosis. Nasal swabs collected from fourteen goats showing clinical signs like cough, nasal discharge and abnormal breath sounds were screened for the presence of Mycoplasma spp. by polymerase chain reaction. The severity of the disease as well as the clinical improvement was recorded using a clinical score card. Oxytetracycline was administered intravenously at 15 mg/kg/day for 5 days along with supportive medications. Significant reduction in clinical score was observed after treatment and complete recovery was attained in 62.5 per cent animals.