Roles Played by the PI3K/Akt/HIF-1α Pathway and IL-17A in the Chinese Subtype of Chronic Sinusitis with Nasal Polyps

Background. The Chinese subtype of CRSwNP may have a unique pathogenesis. This study was designed to seek the role of the PI3K/Akt/HIF-1α pathway and IL-17A in CRSwNP. Methods. The total IgE, ECP, and IL-17A levels were determined by UniCAP100 and ELISA. The activity of MPO was detected by the biochemical techniques. The protein expressions of HIF-1α, p-Akt, and PI3K were detected by the WB method. HIF-1α and IL-17A mRNA levels were measured by RT-PCR. Results. The CRSwNP group showed significantly elevated MPO activity, PI3K, p-AKT protein, HIF-1α, and IL-17A mRNA levels in nasal polyps. Stimulated by the TNF-α, the PI3K, p-AKT, HIF-1α, and IL-17A levels significantly elevated in the fibroblasts. Inhibited by the Wortmannin, those indicators significantly declined in the fibroblasts. Conclusion. The PI3K/Akt/HIF-1α pathway played a role in the pathogenesis of CRSwNP. The elevated IL-17A level might be responsible for the neutrophilic inflammation in CRSwNP. The PI3K/Akt/HIF-1α pathway might regulate the IL-17A-related inflammation in CRSwNP.

CLINICAL EVALUATION OF AGNIKUMARA RAS IN DUSHTA PRATISHYAYA

In Ayurveda, the disease sinusitis can be co-related with “Dushta Pratishyaya” which arises as a complication of the disease “Pratishyaya”. A detailed description of Pratishyaya has been mentioned in Sushruta Samhita (Su. Ut 24/4). While explaining the complication of Pratishyaya, Dushta Pratishyaya has been mentioned. The features of the disease Dushta Pratishyaya, in general, is similar to that of Chronic Sinusitis in modern science. In modern medicine, management of Sinusitis includes Antibiotics, analgesics, Nasal steroids, Nasal Irrigation, Surgery etc. Even then there is no complete cure for Chronic Sinusitis through modern management. Hence to find out a solution through Ayurveda, Agnikumara Ras has been selected for the present study. Agni kumara Ras has been selected from the text Basavarajeeyam. It consists of five ingredients- Shuddha Vatsanabha, Maricha, Kushta, Mustha and Vacha. Keywords: Dushta Pratishyaya, Agnikumara Ras, Clinical evaluation

Improvement in Non-Pulmonary CFTR-Related Symptoms in a Patient With p.Phe508del/p.Arg117His (7T) Cystic Fibrosis Treated with Ivacaftor

Introduction: Diagnosis and management of CRMS/CFSPID and cystic fibrosis (CF) with mild phenotypes remains challenging, and this extends to expanding practice with the use of CFTR modulators. Case: We describe a case of an 18-year-old man with p.F508del/p.Arg117His(7T) initially presenting with CRMS/CFSPID. He went on to be diagnosed with pancreatic sufficient CF with minimal lung disease and no bronchiectasis. However, he has had significant CFTR-related symptoms with recurrent pancreatitis and chronic sinusitis. These non-pulmonary symptoms resolved following introduction of the CFTR modulator ivacaftor. Discussion/ Conclusion: Diagnosis and follow up of CRMS/CFSPID infants remains challenging, with most guidelines based on consensus opinion. Care for those with mild CF phenotypes, CRMS/CFSPID and those with CFTR-RD must be individualised, and open dialogue, education and patient centred care is necessary to ascertaining which patients might benefit from management in a multidisciplinary CF clinic and treatment. There may be a role for expanding the use of CFTR modulators to include non-pulmonary manifestations of CFTR dysfunction in some cases.

MANAGEMENT OF CHRONIC SINUSITIS THROUGH ALTERNATE RECHANA AND SNEHANA NASYA - REPORT FROM A PILOT STUDY

Chronic sinusitis is the chronic inflammatory condition affecting the paranasal sinuses. It may be correlated to Dushta pratisyāya in Ayurveda, which is a Kapha predominant disease affecting jatṟuṛdhva bhāgā which needs teekshna virecana nasya for its management. Vāgbhaṭācārya opines that except for vātika rogas, nasya should be done as ekāhāntara (alternate day) i.e., with a gap of one day in between. But according to Cakṟadatta commentary, ekāhāntara nasya is to be done with virecana nasya and snehana nasya on alternate days. For virecana nasya, Tuḷasi patṟa svarasa (Ocimum sanctum Linn.) and for snehana nasya, Aṇutaila were selected. A patient aged 43 years diagnosed with adult rhinosinusitis diagnostic criteria was taken for the study and was given ekāhāntara nasya with Tuḷasi patṟa svarasa and Aṇutaila for 7 days. During follow up period Pathyākṣadhātṟyādi kaṣāya was given for 15 days. Samyak nasya lakṣaṇa and Event evaluation scales were assessed on each day of nasya and Scale for scoring of symptoms, Rhinosinusitis Disability Index and Visual Analogue Scale were assessed before trial, after trial and after follow up. After the course of treatment 100% improvement was found in the Scale for scoring of symptoms, Rhinosinusitis Disability Index and Visual Analogue Scale. Keywords: Case report, Ekāhāntara (alternate day) nasya, Tuḷasipatṟasvarasa, Aṇutaila, Chronic sinusitis

Blowout fracture-associated orbital cellulitis progressing to panophthalmitis: a case report

Background Parvimonas micra is known as a causative agent of chronic periodontal disease. This Gram-positive obligate anaerobic coccus was cultured from the ocular surface of blowout fracture-related orbital cellulitis progressing to panophthalmitis. Case presentation The patient was a woman in her fifties who had panic disorder and subsequently was a victim of domestic violence. These factors led to delayed consultation. At the initial visit to an ophthalmologist, the ocular surface of the right eye was covered with pus. Swelling of the upper and lower eyelids prevented the eyelid from closing and exophthalmos, severe corneal ulcer, panophthalmitis, and no light perception were observed. Head computed tomography revealed an old blowout fracture and chronic sinusitis with orbital cellulitis. P. micra were isolated from culture of pus samples from the sinus and from the ocular surface. Conclusions There is a possibility that P. micra invaded the orbit via the fragile bony site and caused orbital cellulitis, severe corneal ulcer, and panophthalmitis that required enucleation. In cases of coexisting old blowout fracture and chronic sinusitis, the chronic sinusitis should be treated as quickly as possible.

Case Report: A Case of Sarocladium strictum Meningoencephalitis in an Immunocompetent Patient After Invasive Operation

As an opportunistic phytopathogen, Sarocladium strictum has only been shown to cause neurological disease in immunocompromised patients, where antifungal therapy was not effective. We report a case of Sarocladium strictum meningoencephalitis in an apparently immunocompetent young woman who presented with severe headache and slight fever after undergoing transnasal endoscopic repair of cerebrospinal fluid rhinorrhea. Chronic sinusitis and suspicious intracranial fungal lesions were observed on enhanced magnetic resonance imaging (MRI). Both culture and metagenomic next-generation sequencing of her cerebrospinal fluid were positive for Sarocladium strictum. After local debridement, treatment with amphotericin B plus voriconazole and Ommaya reservoir implantation, the patient improved significantly. Unfortunately, her symptoms worsened again despite plenty of antifungal therapy for a month.