A prospective multicentric observational study to evolve the usefulness of 13 predefined homoeopathic medicines in the management of acute rhinitis in children.

Aims: The study aimed to evaluate the effect of a group of homeopathic medicines in children with acute rhinitis. Materials and methods: In this multi-centric open clinical trial, a total of 784 children (408 males; 384 females) aged 6 months to 15 years, presenting symptoms of acute rhinitis were enrolled from 7 Institutes/ Units under the Central Council for Research in Homeopathy (India). Symptoms were assessed using an acute rhinitis symptom score (ARSS). A total of 13 homeopathic medicines were shortlisted after repertorizing the nosological symptoms of acute rhinitis in children and the results were analyzed. The medicines were prescribed in dilution 6c (10-12) and doses were repeated from few minutes to few hours as per the need of the case. Appearance of any change (improvement or worsening) was followed by placebo / change in dilution or change in medicine according to the response of the patient. The follow up period was up to the 7th day of illness. Results: Out of 784 children enrolled, 638 children were followed up and analyzed. A significant change in the score from the baseline (p

The Use of Antigenic SARS-CoV-2 Point-of-Care Test: The Italian Pediatric Real-Life Experience

In Italy, during the second epidemic wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapid antigenic (Ag) test at point-of-care (POCT) station were employed to quickly evaluate large numbers of swabs. We collected data of all children who underwent the Ag test in our hospital. All positive patients were recalled to perform reverse transcription polymerase chain reaction. A total of 2133 tests were collected over 1 month. Clinical data of 1941 children (median age = 3.7 years) were analyzed: 1343 (69.2%) patients complained of symptoms, 594 (30.6%) had a history of close contact with SARS-CoV-2-positive individuals. Among symptoms reported, acute rhinitis was the most frequent (67.9%), followed by cough (42.6%) and fever (31.5%). Among all tests, 95.8% resulted negative, 4.2% positive: 37/89 were confirmed. In confirmed cases, fever (56.2% vs 32.2%; P = .041) and gastrointestinal symptoms (18.8% vs 6.25%; P = .041) were significantly more frequent compared with negative children. The use of POCT for Ag test seems appropriate for SARS-CoV-2 screening in the pediatric population. In children, fever and gastrointestinal symptoms may constitute red flags of SARS-CoV-2.

Management of children with allergic rhinitis in the practice of a local pediatrician

Due to the increase in the weight of allergic diseases in the general pathology of childhood, the diagnosis and treatment of allergic rhinitis in children and the management of these patients at the outpatient stage have not lost their relevance. The period of preschool and school age is characterized by a high frequency of acute respiratory diseases of the upper respiratory tract, especially acute rhinitis, rhinopharyngitis, rhinosinusitis. This daily poses to the district pediatrician the tasks of differential diagnosis of allergic rhinitis and acute rhinitis with a prolonged course. Allergic rhinitis most often does not require hospitalization and, with timely diagnosis, does not lead to serious consequences. It is known that children who are prone to allergies suffer from acute respiratory viral infections more often and more severely than their peers. An integrated approach to the diagnosis and treatment of such children with the participation of an allergist, an otorhinolaryngologist, under the constant supervision of a district pediatrician, the rational use of drug therapy can reduce the duration of the disease, improve the quality of life of the patient.The article presents generalized principles of management of patients with allergic rhinitis from the point of view of domestic and international recommendations, describes in detail the rules of life for children with allergic rhinitis, emphasizes the role of the district pediatrician in teaching parents to ensure a hypoallergenic environment of the child. The authors present a clinical example of the effective use of a combined decognensant and an antihistamine for the treatment of acute respiratory viral infections in a child with allergic rhinitis.

Сare pathways of children with acute rhinological symptoms

Acute respiratory diseases are one of the most common reasons for visiting a doctor in pediatric practice. Most episodes of this pathology have a viral etiology, signs of inflammation from the upper respiratory tract and proceed with symptoms of acute rhinitis (acute nasopharyngitis). The most of episodes of acute rhinitis last no more than 10 days and end with the patient’s recovery. The most common complications of acute rhinitis in children are acute rhinosinusitis and acute otitis media. These diseases are often mild and rarely have complications. However, a large number of patients with acute respiratory diseases increases the likelihood of a situation in which the doctor will encounter a problem patient. The article proposes care pathways for practitioners to manage patients with acute rhinological symptoms lasting up to 10 days and from 10 days to 3 months. The care pathways are based on several key points. No1: each patient must be analyzed for the presence of alarming symptoms, upon detection of which the patient should be urgently hospitalized. No2: all patients should be dynamically observed by a doctor until complete recovery, the patient should not receive treatment without the supervision of a doctor. No3: the basis of treatment is drugs for symptomatic therapy, which are selected depending on the dominant symptom that has the greatest impact on the patient’s well-being. To eliminate nasal mucosal edema, it is rational to use nasal decongestants (original oxymetazoline) for children of all ages; the course and dosages are determined according to the age of the child. Antibacterial drugs should be prescribed strictly according to indications in the presence of convincing data for the bacterial etiology of the disease.

Rhinitis, rhinosinusutus and phytotherapy

Acute rhinitis and acute rhinosinusitis (ARS) have viral etiology in the most of cases, and their therapy is aimed at alleviating clinical symptoms and preventing new episodes. The indications for antibiotic therapy are severe bacterial ARS, ARS with complications, and recurrent bacterial ARS. Such a categorical approach is due to the increase of antibiotic resistance, which leads to the popularization of efficient phytotherapy. Modern herbal medical products comply with general recommendation and standards of efficacy, safety and quality, and their effectiveness has been proven in clinical trials along with synthetic drugs. In acute upper respiratory tract infections, herbal medical drugs stimulate the immune system, relieve clinical symptoms, and improve the patient’s quality of life. A significant emphasis in phytotherapy is given to complex drugs synthesized on the basis of phytoneering. One of such remedies is the herbal medicinal product containing the different parts of 5 medicinal herbs: Gentian root (Gentianae radix), Primrose flowers (with calyx) (Primulae flos (cum calycibus)), Common sorrel herb (Rumicis herba), Elder flowers (Sambuci flos) and Vervain herb (Verbenae herba). This herbal medicinal product shows secretolytic, secretomotor, antiinflammatory, antiviral and mild antibacterial farmacological effects. The article provides an analysis of studies in vitro and in vivo proving the anti-inflammatory effect of Sinupret®, its potentiating effect on nasal mucosa mucociliary transport as well as efficacy and safety in patients with rhinosinusitis.

The basic principle of pathogenetic therapy of purulent-inflammatory pathology of ENT organs

The nature of the clinical manifestations of purulent-inflammatory diseases of the ENT organs is determined, first of all, by the localization of the process, and in addition, by the severity of the reactions of general and local inflammation. In this regard, the authors of the article propose to consider the main factors of pathogenesis that determine the sequence and relationship of the stages of the inflammatory response: edema, redness, fever, pain and dysfunction. A special role in the implementation of the regulatory mechanisms of inflammation belongs to active molecules, the so-called inflammatory mediators. The authors of the article consider the main cellular and plasma mediators, concluding that most of the effects they carry out are accompanied by a violation of the integrity of the vascular wall, exudation, edema and tissue swelling. A similar reaction is, in general, nonspecific and is observed in a number of inflammatory diseases of the ENT organs, such as acute rhinitis, allergic rhinitis, acute sinusitis, eustachitis, acute otitis media. This circumstance allows the authors to conclude that a local therapeutic effect is necessary on this particular link of pathogenesis. To this end, the authors of the article propose the use of nasal decongestants, drugs with an alpha-adrenomimetic effect, which effectively relieve swelling of the nasal mucosa and facilitate nasal breathing. In clinical practice, preparations based on xylometazoline have proven themselves well.

Topical antibiotics for acute rhinosinusitis in children

Rhinitis or nasopharyngitis are the most common manifestations of acute respiratory viral infection (ARVI) in children. Inflammation of the mucous membrane in the nasal cavity develops in more than 70% of ARVI cases, and rhinovirus infection is the most common etiological factor for these conditions. In this article, the authors present a short review of the existing data on the use of combined drugs based on N-acetylcysteine and tuamingheptan in the treatment of acute rhinological pathology in children. The authors present generalized data on the nature of the course of acute rhinitis, as the main manifestation of acute respiratory viral infection in children, and modern views on the tactics of treating this condition. The main theses on symptomatic treatment of nasal obstruction in acute rhinitis using nasal decongestants are presented. However, the use of nasal vasoconstrictor drugs as monotherapy to treat acute rhinitis may be less effective, as a buildup of thick discharge in the nasal cavity, which a patient is not always able to blow out from the nose (especially in childhood), prevents the drug injected into the nasal cavity from contacting the mucous membrane. The main pathogenetic grounds for the use of mucolytics in the treatment of acute rhinitis and acute rhinosinusitis are presented. The use of N-acetylcysteine-based drugs in otorhinolaryngological practice has been substantiated. N-acetylcysteine is a direct mucolytic agent. Its action is associated with the ability of its free sulfhydryl groups to break intra- and intermolecular disulfide bonds of acidic mucopolysaccharides of a thick discharge. As conclusions, the authors talk about the prospect of using combined drugs based on N-acetylcysteine and tuamingheptan both in the symptomatic treatment of acute rhinitis and as an adjunct treatment for acute rhinosinusitis in children.

Syringe with Nasal Applicator versus Syringe Alone for Nasal Irrigation in Acute Rhinosinusitis: A Matched-Pair Randomized Controlled Trial

<b><i>Background/Aims:</i></b> Nasal saline irrigation is a common procedure to relieve nasal symptoms in upper respiratory tract diseases. There is no consensus on the recommended nasal saline delivery devices. The objectives of this study were to evaluate efficacy, satisfaction, adherence, and adverse effects in patients with acute upper respiratory tract diseases using a syringe with a nasal applicator for nasal irrigation. <b><i>Methods:</i></b> Patients with acute nasopharyngitis, acute rhinitis, or acute rhinosinusitis were randomly allocated to use either (1) a syringe with a nasal applicator or (2) a syringe alone to irrigate one nostril. After the patients had completed irrigation with the allocated device in one nostril, they were instructed to perform nasal irrigation using the other device in the other nostril. All patients were instructed to use a syringe with a nasal applicator at home. The efficacy, satisfaction scores, adherence, and adverse effects were recorded. <b><i>Results:</i></b> Sixty-four patients were enrolled. The mean age of the patients was 33.95 years (18–59 years). The mean duration of symptoms was 4.80 days. None of the enrolled patients regularly performed nasal irrigation. Forty-two had acute nasopharyngitis, 10 had acute rhinitis, and 12 had acute rhinosinusitis. At baseline, the mean overall efficacy score for the syringe with a nasal applicator was 8.17 ± 1.43, and that for the syringe alone was 5.95 ± 2.02 (MD 2.23, <i>p</i> &#x3c; 0.001, 95% CI 1.75–2.70). At 1 week, the syringe with the nasal applicator had significantly higher scores in 3 of 4 domains, including symptom relief, ease of use, and patients’ willingness to recommend the device to others, compared to baseline (<i>p</i> &#x3c; 0.05). None of the enrolled patients had epistaxis, retained/dislodged the applicator during irrigation, or experienced an allergic reaction to the applicator after 1 week of nasal irrigation. <b><i>Conclusion:</i></b> Use of a syringe with an applicator for nasal irrigation yielded high scores in overall efficacy.

Prevalence of acute inflammatory otorhinolaryngological diseases in hematopoietic stem cell transplant recipients

The article presents the results of a study of the prevalence of acute (exacerbation of chronic) otorhinolaryngological pathology at the stages of hematopoietic stem cell transplantation (HSCT). The frequency of the studied pathology was assessed at the stage of pre-transplant screening, at the stage before graft engraftment and at the stage after graft engraftment up to 180 days. The study included 1129 cases of HSCT performed at the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation from January 2017 to December 2019. The median age of the patients was 27 years (min – 0,36, max – 73,22). Allogeneic HSCT was performed in 784 (69,4%) cases, autologous HSCT in 345 (30,6%) cases. The power of the study was 0,95. A comparative analysis using the Pearson χ2 criterion revealed that infectious complications were significantly more frequent with allo-HSCT than with auto-HSCT, both at the stage before engraftment (χ2 = 21.8 at p <0.0001) and at the stage after graft engraftment (χ2 = 224,78 at p < 0.0001). It was also shown that acute symptoms of rhinosinusitis prevailed at all stages of HSCT, reaching 5,3% (95% CI 5.0% – 5,6%) at the stage before transplantation, 3,01% (95% CI 2, 8% – 3,2%) at the stage before engraftment, and 8,13% (95% CI 7,67% – 8,60%) at the stage after engraftment. At the stage before engraftment, rhinosinusitis competed with the diagnosis of acute pharyngitis, with a frequency of 34 (36,17%) and 33 (35,11%), respectively. Acute rhinosinusitis, acute rhinitis, and strep throat were the most common diagnoses at all three stages assessed. The rest of the acute inflammatory otorhinolaryngological diagnoses were observed in less than 2% of cases each. Establishing the frequency of acute otorhinolaryngological pathology at the stages of HSCT; understanding the most relevant nosologies. This allows us to focus on further study of the factors of their development, prevention and treatment.