Diseases with major salivary glands enlargement and orbits, nose and paranasal sinuses lesions in the practice of a rheumatologist

Objective: to analyze the nosological spectrum, demographic, clinical and laboratory characteristics of diseases with a significant enlargementof major salivary (SG) / lacrimal glands, and/or accessory organs of the eye and paranasal sinuses lesions in rheumatological practice.Patients and methods. This work includes 73 patients who underwent a complex clinical and laboratory, imaging, pathomorphological and histomolecular examination, which was necessary to establish a nosological diagnosis. In all cases, the diagnosis was confirmed pathomorphologically.Results and discussion. Sjogren's syndrome (SjS) was diagnosed in 30 (41%) patients (14 of them developed lymphoproliferative disorder, LPD, as a complication), granulomatosis with polyangiitis (GPA) – in 12 (16.4%), IgG4-related disease (IgG4-RD) – in 10 (13.7%), sarcoidosis – in 6 (8.2%), non Langerhans cell histiocytosis – in 2 (2.7%), AL-amyloidosis – in 1 (1.4%), Warthin's tumor – in 1 (1.4%), chronic atrophic rhinitis – in 1 (1.4%), infectious lesions – in 3 (4.1%) (HIV-associated – in 2, dirofilariasis – in 1), idiopathic inflammatory pseudotumor – in 6 (8.2%). In 1 (1.4%) patient, the diagnosis could not be established.A massive increase of major SG was observed in 46 patients, more often (in 28 cases) with SjS with LPD or without it, with IgG4-RD (in 7) and sarcoidosis (in 6). Orbital lesions were observed in 18 patients: in 7 with IgG4-RD, in 5 with idiopathic inflammatory pseudotumor, in 2 with sarcoidosis, in 2 with GPA, and in 1 each with non Langerhans cell histiocytosis and dirofilariasis. Nasal lesions in the form of chronic rhinosinusitis with or without nasal septum perforation, were found in 18 patients, 12 of whom suffered GPA and 6 – IgG4-RD.Two algorithms, that can facilitate the choice of additional studies and the direction of diagnostic search have been proposed for practicing rheumatologists.Conclusion. Taking into account the possible similarity of clinical manifestations of the diseases with the formation of mass-like tissue, the differential diagnosis should be based on pathomorphological study.

Dysfunction of the mucous membrane in the pathogenesis of chronic diseases of the nasal cavity

Performing not only respiratory, but also protective, olfactory, aesthetic and a number of other functions, the nose is an important part of the upper respiratory tract. The mucous membrane of the nasal cavity is the first protective barrier of the body that protects against the effects of adverse environmental factors, carrying out warming, purification and neutralization of the inhaled air. This mission is provided by the activity of the multilayered columnar ciliated epithelium, consisting of three main types of cells: ciliate, goblet and basal. The main protective mechanism in the nasal cavity is mucociliary clearance, carried out by means of nasal mucus and beating of cilia unidirectional towards the nasopharynx with a frequency of up to 1000 per minute. Violation of the integrity and disruption of the physiological functions of the mucous membrane of the nasal cavity leads to the development of pathological processes, which in turn can lead to a failure in the work of other organs and systems of the body. To date, about 16-18% of all diseases of the ENT organs are chronic forms of rhinitis. According to the ICAR classification, which is based on the pathophysiological mechanisms of the development of rhinitis, allergic and non-allergic forms are distinguished. Common to various forms is the effect of certain factors on the mucous membrane of the nasal cavity and, as a consequence, a violation of the mechanisms of its work.One of the forms of chronic rhinitis, caused by thinning of the mucous membrane and severe disorders of mucociliary transport, is atrophic rhinitis. The main symptoms of the disease are dryness, the formation of crusts in the nasal cavity, periodic bleeding. The approach to the treatment of acute and chronic processes against the background of atrophic changes in the nasal cavity should be comprehensive and aimed at restoring the physiological functions of the mucous membrane and the mechanisms of mucociliary transport.

The modern view of treatment of allergic rhinitis and it’s combination with bronchial asthma

In recent years, there has been a significant increase in the prevalence of diseases of the nose and paranasal sinuses. Inflammatory diseases of the mucous membrane nasal cavities (rhinitis) are most commonly characterized as a syndrome in which the patient experiences some combination of persistent nasal symptoms, including rhinorrhea, sneezing, nasal congestion, itching and burning in the nasal cavity. Among the chronic forms of rhinitis, allergic rhinitis occupies a large place along with vasomotor, infectious, hypertrophic, catarrhal and atrophic rhinitis. Allergic rhinitis is a significant social and medico-economic problem, since it significantly reduces the quality of life of patients and requires significant treatment costs. This nosology is found in the practice of doctors of all specialties, however, the correct diagnosis and the appointment of adequate therapy can take many months and years. Currently, the concept of “common airways” is widely discussed, which demonstrates the close relationship between allergic rhinitis and bronchial asthma and proves that the inflammatory response can be supported and enhanced by interrelated mechanisms. Therefore, patients with allergic rhinitis should be examined for the presence of bronchial asthma. In turn, patients with bronchial asthma need to diagnose allergic rhinitis, and treatment should be aimed at suppressing allergic inflammation in both the upper and lower respiratory tract. This article discusses modern diagnostic and therapeutic approaches to patients with these diseases, which make it possible to efficiently and timely identify allergic rhinitis and initiate appropriate adequate treatment. The article also discusses the feasibility of using combined therapy with levocetirizine and montelukast in the above nosologies.

Platelet-Rich Plasma Injection in Patients with Atrophic Rhinitis

<b><i>Objective:</i></b> To investigate the effect of platelet-rich plasma (PRP) injection in patients with atrophic rhinitis. <b><i>Methods:</i></b> Prepared PRP was injected into the inferior turbinate bilaterally, and nasal bacterial cultures were conducted. Improvement of symptoms was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) and the Sino-Nasal Outcome Test-22 (SNOT-22). Nasal mucociliary clearance was assessed using the saccharin transit time (STT). <b><i>Results:</i></b> In the PRP-injected group (group A), NOSE (throughout the study) and SNOT-22 (1 month after injection) scores were significantly decreased during the study. However, the saline spray group (group B) showed no significant nasal symptom improvement during the study period. In group A, the STT was improved until 3 months after the injection. In contrast, group B showed STT improvement after 2 months that was maintained throughout the study. <b><i>Conclusion:</i></b> PRP injections can improve nasal symptoms and nasal mucociliary function in patients with atrophic rhinitis.

Comparative genomics of the Pasteurella multocida toxin

Pasteurella multocida is a zoonotic pathogen whose genetic heterogeneity is well known. Five serogroups and 16 serotypes of P. multocida have been recognized thus far based on capsular polysaccharide typing and lipopolysaccharide typing, respectively. Progressive atrophic rhinitis in domestic pigs is caused by P. multocida strains containing toxA, which encodes a heat-labile toxin. In this study, by comparative analyses of the genomes of many strains, it has been shown that toxA is sparsely distributed in P. multocida. Furthermore, full-length homologs of P. multocida toxA were found only in two other bacterial species. It has also been shown that toxA is usually associated with a prophage. Among the toxA-containing prophages that were compared, an operon putatively encoding a type II restriction-modification system was present only in strains LFB3, HN01, and HN06. These results indicate that the selection and maintenance of the heat-labile toxin and the type II restriction-modification system are evolutionarily less favorable among P. multocida strains. Phylogenetic analysis using the alignment- and parameter-free method CVTree3 showed that deduced proteome sequences can be used as effectively as whole/core genome single nucleotide polymorphisms to group P. multocida strains in relation to their serotypes and/or genotypes.

Treatment of Atrophic Rhinitis with Manuka Honey–a non-randomized control trial, and a new theory of etiopathogenesis for the disease.

Exact etiology of Atrophic rhinitis (AtR) is yet unknown. Polygenic and polybacterial causes have been implicated in the onset and progression of this disease. AtR doesn’t respond to any particular modality of treatment that targets specific etiology, this describes its multifactorial nature. In this study, we report on a non-randomized control trial on the use of a nasal spray of 10% Manuka honey in patients with AtR attending the out-patient unit of the Department of Otorhinolaryngology and Head Neck Surgery. In this study, we show significant observations: 1. Decreased fetid smell, 2. Thickening of the mucosa, 3. Decreased inflammation with healed mucosal ulcers, 4. Increased concentration of the mucosal glands, 5. Alteration in Nasal microbiome, and 6. Increased expression of SCFA receptors. These changes occurred in response to honey therapy, and are consequent to the resetting of the Nasal microbiome.

Nasal Myiasis: A Neglect State

Background: Nasal myiasis is a parasitic condition of human being and animal species in which nose and paranasal sinuses infested by Diptera Larvae of Chrysomya albiceps and Oestrus ovis group of flies. It is rare and sporadic, usually occurs in adults, the elderly, debilitated poor, and neglected patients suffering from chronic Sinonasal diseases. Methods: A cohort retrospective study of 11 cases in the Department of Otolaryngology and Head-Neck Surgery, Comilla Medical College Hospital, Cumilla, Bangladesh from 01 July 2016 to 31 June 2020. Results: Incidence of nasal myiasis out of total admitted in the inpatient department was 0.03%. Of them, the female was 10 (90.91%), the male 01 (9.09%) (P-value <0.001), age range 35-70 years, the adult was 09 (81.82%), and the elderly 02 (18.18%) (P-value <0.001). The left nostril exhibited 08 (72.73%), and right nostril 03 (27.27%) (P-value <0.05). Social class showed poor was 08 (72.73%), and lower middle class to working 03 (27.27%) (P value< 0.05), villagers was 09 (81.82%), and slum dwellers 02 (18.18%) (P-value <0.001), Sinonasal mass was 07 (63.64%), and atrophic rhinitis 04 (36.36%) (P-value <0.001), Sinonasal malignancy was 06 (85.71%), and benign 01 (14.29%) (P-value <0.001). Conservative traditional treatment was 07 (63.64%), and endoscopic removal 04 (36.36%) (P-value <0.001), recovery without complication was 10 (90.91%), and complication occurred in 01 (9.09%) (P value<.001). Conclusion: Nasal myiasis is a progression of other disease processes of the nose and paranasal sinuses of adults and the elderly in a low socioeconomic group of people. They need extra care medical services to overcome it.