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

Prescription rate and treatment patterns for allergic rhinitis from 2010 to 2018 in South Korea: a retrospective study

Background There has been little investigation on how guidelines for allergic rhinitis (AR) treatment are applied in current clinical practice. We aimed to analyze prescription trends and patterns for AR treatment according to patient characteristics over a 9-year period in Korea. Methods We used cross-sectional data from the Korean Health Insurance Review & Assessment Service National Patient Sample from 2010 to 2018. We analyzed 1,719,194 patients with AR as the principal diagnosis. Prescription rates of antihistamines, steroids, and other drugs; combination prescriptions; and first-choice prescriptions were analyzed. Results The prescription rate of first-generation antihistamines decreased over the years (2010: 29.13; 2018: 23.41). By contrast, the prescription rate of systemic steroids (2010: 23.60; 2018: 28.70), nasal steroids (2010: 9.70; 2018: 14.67), and leukotriene receptor antagonists (LTRAs) (2010: 11.13; 2018: 26.56) increased. The prescription rate of steroids was lower in patients aged 0–5 years and ≥ 65 years than in other age groups and that of LTRAs was the highest in patients aged 0–5 years. The rate of combination prescribing antihistamines and nasal steroids increased (2010: 7.99; 2018: 12.09). The rate of first-choice prescriptions with antihistamines and nasal steroids also increased (2010: 4.72; 2018: 7.24). Conclusions The results confirmed a decrease in antihistamine prescriptions, especially with first-generation, and an increase in steroid and LTRA prescriptions in patients with AR in Korea. Regarding prescription patterns, steroids were increasingly prescribed in combination with antihistamines. However, the trend was opposite in the 0–5 years and ≥ 65 years groups.

Nasal Steroids Use in the Prevention of Symptomatizing Adenoid Regrowth after Adenoidectomy

Background Regrowth of the adenoids is a well-recognized entity. Intranasal steroids for children with adenoid vegetation can provide an alternative to revision surgery. Objective To assess the ol' using nasal steroids to prevent recurrence of adenoid hypertrophy and related symptoms after adenoidectomy. Methods Controlled clinical trial. One hundred patients after adenoidectomy were divided randomly into 2 groups. Group I were patients performing surgery on odd days of the month received postoperative intranasal steroid [fluticasone propionate (50 mcg/metered dose per nostril per day)] and Group Il were patients performing surgery on even days of the month received intranasal saline spray starting at postoperative week 2 after wound healing. Both medications will be adninistrated for 8 weeks postoperatively. Patients will be followed up for minimum of 6 months by using modified SNOT Score to suit children in reporting the degree of the symptoms and i!' needed nasopharyngeal lateral X-rays. Results Highly significant difference between both groups after 6 months postoperatively. Conclusion The use of intranasal steroids may obtain successful results in children to prevent adenoid regrowth and recurrence of related nasal symptoms after adenoidectomy. The most appropriate drug, the most efficient dose, and optimal treatment duration need to be investigated and determined.

Efficacy of Adenoidectomy for the Management of Chronic Rhinosinusitis in Children Older Than 7 Years of Age

Objectives: While adenoidectomy is the first-line surgical management of chronic rhinosinusitis (CRS) in young children, evidence regarding its utility in older children is lacking. This study aimed to assess the efficacy of adenoidectomy in children 7 to 18 years old with regard to symptom control, postoperative medication use, and the need for additional surgery. Methods: Single-institution retrospective chart review of patients ages 7 to 18 undergoing adenoidectomy for CRS from 2009 to 2019. Patients with cystic fibrosis and ciliary disorders were excluded. Comorbidities, preoperative and postoperative symptoms (rhinorrhea, congestion, anosmia, and facial pain), medication use (antibiotics, antihistamines, nasal steroids, and irrigations), and Lund-Mackay scores were extracted. McNemar’s or Wilcoxon Rank Sum Tests were used to assess rates of symptom control and medication use. Fisher’s exact or Chi-square tests were used to assess for factors associated with symptom persistence. Results: Ninety-seven patients with a mean age of 9 years (range 7-18) were identified. Patients were shown to experience significantly decreased rates of rhinorrhea (64.9% vs 20.6%, <.001), congestion (95.9% vs 26.8%, <.001), facial pain (17.5% vs 3.1%, .001), use of nasal steroids (79.4% vs 36.1%, <.001), antihistamines (47.4% vs 20.6%, <.001), and number of antibiotics (median 1 vs 0, <.001) after adenoidectomy. No patient or disease factors were associated with symptom persistence. Nine patients (9.3%) required additional nasal surgery. Conclusion: In this cohort of older children with CRS with limited follow up, additional surgery is not routinely done following adenoidectomy, the results suggest that adenoidectomy alone may provide adequate symptom control and medication reduction.

Can Topical Nasal Steroid Prevent the Loss of Smell in Covid-19?

Purpose: The purpose of this study is to evaluate the effects of nasal steroid use on the loss of smell in patients diagnosed with Covid-19.Material and Method: 211 patients diagnosed with Covid-19 with positive PCR tests between April 2020 and December 2020 and followed up and treated in the Elazig City Hospital Pandemic Clinic were included in this cross-sectional study. The demographic data, comorbidities and drug use histories of the patients were interviewed face-to-face and recorded.Findings: The average age of the patients was 53.55 ± 17.81 (129 men, 82 women). Regarding the age, gender and comorbidities of the patients, there was no difference between the groups with and without loss of smell in terms of average age and gender. Anosmia developed in 50 patients (23.5%) and hyposmia developed in 84 patients (40%). No decrease or loss of sense of smell was observed in 77 patients. 26 of these patients were using nasal steroids at the time of diagnosis, and none of them had a decrease or loss in sense of smell.Results: With the results of the study, it has presented for the first time to the literature that the use of nasal steroids can prevent the loss of smell, which is one of the common neurological symptoms in Covid-19. The results of our study suggest that the nasal steroid, which plays an immunomodulatory role, can be a shield against loss of smell by creating a local anti-inflammatory effect in the nasal mucosa and around the olfactory nerve.

Upper airway cough syndrome may be the main cause of chronic cough in Japan: a cohort study

BackgroundUpper airway cough syndrome (UACS) is generally considered a common cause of chronic cough but remains poorly recognised in Japan.ObjectiveThis study aimed to assess whether UACS was a common cause of chronic cough in Japan, as is true in other countries. Interview and examination items were evaluated for their potential use in UACS diagnosis.Methods All patients with chronic cough were preliminarily diagnosed with bronchial asthma, UACS, gastroesophageal reflux disease, or post-infectious prolonged cough, based on interviews and examinations. Treatment centred on nasal steroids was administered to the UACS group and standard treatment to the other groups. The observation period lasted 4 weeks. The subjective cough score at first diagnosis was set at 10, and the final diagnosis was made based on the treatment administered at the time the cough score had decreased to ≤ 2. The associations between the presence or absence of UACS and interview and examination items were statistically evaluated.Results Among 230 patients with chronic cough, 146 were diagnosed with UACS-only. Multivariate logistic regression revealed that the assessment items ‘awareness of mucus accumulating in the back of the throat’, ‘presence of abnormal echography findings’, ‘absence of associated coughing when exercising’ and ‘presence of coughing persisting after onset’ were significantly correlated with the presence or absence of UACS (p < 0.05).ConclusionsUACS may be the most common cause of chronic cough in Japan and may be effectively treated with nasal corticosteroids. Diagnosing UACS might be possible by selecting appropriate interview and examination items.

Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis

Objective: Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in randomized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS. Methods: A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed. Results: Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies. Conclusions: Nasal irrigation with corticosteroids is beneficial and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted.

Neurological Complications of Acute Rhinosinusitis: Meningitis

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.

Study of the effect of balloon sinuplasty in patients with rhinosinusitis

<p class="abstract"><strong>Background:</strong> A new technique which has revolutionized sinus surgery recently is balloon sinuplasty. The vast majority of patients with chronic rhinosinusitis improve with medical management, including antibiotics, saline irrigation, nasal steroids, antihistamines, allergy therapy, and asthma control. This study was conducted to study the effect of balloon sinuplasty in patients affected with rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in all the patients visiting our hospital. Medical treatment included oral and sometimes intravenous antibiotics, nasal steroids, decongestants, systemic steroids, and allergy management. Those who had a positive biopsy were excluded from this study. The selected cohort of 20 patients, were prepared for balloon sinuplasty surgery in the same way as for conventional functional endoscopic sinus surgery (FESS) and were operated by our surgical team. </p><p class="abstract"><strong>Results:</strong> 20 patients were included in the study, 70% men and aged 30±12 years. Sinuplasty was performed in 32 sinuses of 20 patients (22 maxillary, 4 sphenoid and 8 frontal sinuses).</p><p class="abstract"><strong>Conclusions:</strong> Sinuplasty with balloon catheterization is effective in reducing symptoms and improving quality of life in selected patients with chronic rhinosinusitis. The results are beyond reported symptoms and confirm the benefit of balloon sinuplasty.</p><p class="abstract"> </p>