International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

A longitudinal study of lung bacterial pathogens in patients with primary ciliary dyskinesia

AbstractIn patients with primary ciliary dyskinesia (PCD), impaired mucociliary clearance leads to an accumulation of secretions in the airways and susceptibility to repeated bacterial infections. The primary aim of this study was to investigate the bacterial flora in non-chronic and chronic infections in the lower airways of patients with PCD. We retrospectively reviewed the presence of bacteria from patients with PCD during an 11-year period and genotyped 35 Pseudomonas aeruginosa isolates from 12 patients with chronic infection using pulsed-field gel electrophoresis. We identified 5450 evaluable cultures from 107 patients with PCD (median age 17 years, range 0–74 years) (median age at diagnosis 7.8 years, range 0–63 years). Haemophilus influenzae was the most frequent microorganism. Other common pathogens were P. aeruginosa, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. The number of patients colonized with P. aeruginosa at least once varied from 11 to 44 patients (15–47%) annually, and 42 patients (39%) met the criteria for chronic infection at least once. Pseudomonas aeruginosa was more frequently isolated in teenagers and adults than children (p 0.02) and the prevalence was significantly lower in patients with preschool (<6 years) PCD diagnosis (p 0.04). Ten out of 12 patients (83%) were chronically infected with a unique clone-type of P. aeruginosa. No sharing of clone-types or patient-to-patient transmission was observed. In conclusion, PCD patients were infected by a unique set of bacteria acquired in an age-dependent sequence. Pseudomonas aeruginosa frequently colonizes the lower respiratory tract and the incidence of chronic infection was higher than previously reported

Early genetic adaptation associated with chronic pseudomonas aeruginosa airways infection

Background: Increased survival in patients (pts) with CF showed the importance of assessing extrapulmonary complications, as scoliosis (S); the prevalence of S in North America was 20 times greater in CF children than in the general population. S is an evolutive spinal deformity which causes functional disorders on the spinal structures and leads to a restrictive pulmonary disease. Skeletal CF abnormalities (malnutrition, delayed bone mineralization and pubertal development, muscular dysfunctions, osteoporosis) may increase the risk of S. The conservative treatment with brace is often difficult in CF pts because of ventilatory problems. Aims: 1) create a screening protocol to determine prevalence of S in a group of CF pts; 2) assess the reliability of S screening by CF respiratory therapist (RT); 3) create a flow-chart to monitor S. Materials and Methods: Pts with CF diagnosis (confirmed by sweat test or genotyping), 6-19 years old (yrs), regular follow-up in Treviso CF Centre and ability to perform the evaluation maneuver were included. The study is divided into 4 parts: 1) Creation of a protocol to detect spinal deformities: evaluation of posture and measurement of hump by quantification of the angle of trunk rotation (ATR) using Bunnell\u2019s scoliometer in the Adams forward bending test position; 2) RT evaluation of all pts; 3) Blind specialist (sp) evaluation of all pts with ATR 654\ub0 and some with ATR 0\ub0-3\ub0; 4) Definition of a flow chart to monitor S evolution in all pts. Results: In all, 55 pts (26 males) with mean age 12.91 yrs (6.17\u201319.22), mean BMI 17.86 kg/cm2, mean FEV1 91.42%pred and mean FVC 96.36%pred performed the RT\u2019s evaluation. Male and female groups are homogeneous for age, BMI and indexes of respiratory function. Based on ATR values, pts are divided in two groups: 1) negative group (N) with ATR 0\ub0-3\ub0; 2) positive group (P) with ATR>4\ub0. Between N and P there was a statistical difference for FVC (p>0.001). Twenty thoracic (74.07%), 5 lumbar (18.52%) and 2 thoracolumbar (7.41%) curves were found; leg dysmetria >1 cm was evidenced in 66.66% of P. All pts of P and some of N were also blindly evaluated by a sp physician and measured ATR was compared to RT\u2019s values. There was a significant correlation between the 2 evaluations (R2=0.857; p10\ub0 Cobb) was diagnosed in 3 pts (5.45%), 2 males, with the indications of brace. Conclusions: The higher prevalence of S in CF pts (5.45%) showed the importance of assessing this aspect. This simple screening protocol with ATR measurement is a feasible and reliable way to assess spinal deformities in CF pts and to identify the need for sp evaluation. Considering the frequency of reevaluation in the healthy population and the high prevalence of risk factors in young CF pts, a flow chart was created: all pts have to be reassessed by the rt every 6 months (pts with fast statural growth should be evaluated more frequently) and pts with ATR>4\ub0 should be sent to the sp. Further studies will be necessary to establish S prevalence in adult CF pts. Reassessment of these pts and follow-up of pts with brace prescription will be necessary

Extensive Endoscopic Image-Guided Sinus Surgery Decreases BPI-ANCA in Patients with Cystic Fibrosis

Antineutrophil cytoplasm autoantibodies (ANCA) directed against bactericidal/permeability-increasing protein (BPI) are common in patients with cystic fibrosis (CF), and serum levels are correlated with lung colonization by Pseudomonas aeruginosa and the severity of lung damage. The production of BPI-ANCA may be due to the costimulation of BPI when mounting an immune response against P. aeruginosa. The effect of surgery aiming to eradicate bacteria and infected tissue on BPI-ANCA levels is sparsely described. A cohort of patients with CF were included: 53 patients having extensive image-guided sinus surgery (EIGSS) with topical postoperative antibiotic treatment, 131 non-operated controls and 36 who had double lung transplantation (LTX). In all 219 patients, serum samples before and after surgery or at similar intervals were analysed for IgG and IgA BPI-ANCA. The EIGSS group showed a highly significant decrease in both IgA and IgG BPI-ANCA levels compared with their own preoperative values and control group values (P andlt; 0.0010.02). The LTX patients also showed a highly significant decrease in both IgA and IgG BPI-ANCA levels (P andlt; 0.001). EIGSS and LTX decrease IgA and IgG BPI-ANCA levels in patients with CF, indicating that extensive removal of infected tissue influences the pathogenic process of autoantibody production. The results shown herein are in favour of applying EIGSS in selected patients with CF and for using BPI-ANCA as a surrogate marker for guiding further therapeutic interventions.Funding Agencies|Statens Serum Institut||Candys Foundation||</p

(Re)presentation of consumer in Latvian advertisements during perestroika and post soviet period: discourse of gender identity (1985–2004)

Elektroniskā versija nesatur pielikumusPromocijas darbs veltīts reklāmas lomai patērētāja identitātes un dzimtes priekšstatu veidošanā Latvijā no 1985. līdz 2004. gadam. Tā uzmanības centrā reklāmas (at)veidoto patēriņa un patērētāju dzīvesstila paraugu nozīme dzimtes identitātes nostiprināšanā un normalizēšanā pēcpadomju periodā. Darba teorētiskajā daļā iztirzāta reklāmas sociālā loma un tās komunicētās simboliskās nozīmes, kā arī vizuālās komunikācijas, identitātes un patēriņa problēmas. Tajā analizēta padomju un pēcpadomju patērētāja identitāte, tās veidošanu ietekmējošie nosacījumi, kā arī transformācijas perioda sociālā vide un izmaiņas reklāmas praksē. Pētījums veikts, izmantojot diskursa analīzes pieeju un kontentanalīzi. Darba rezultāti raksturo Latvijas reklāmas attīstību, pēcpadomju sabiedrību, patērnieciskā dzīves veida iedibināšanos, tādējādi bagātinot zināšanas par Latvijas iedzīvotāju identitātēm. Atslēgvārdi: identitāte, patēriņš, dzimte, dzimtes displejs, reklāma, pēcpadomju, patērētājs, vizuālā komunikācijaThe doctoral thesis is dedicated to the role of advertising in creation of consumer identities and gender notions in Latvia from 1985 until 2004. It focuses on the role consumption and consumer lifestyle models (re)produced by advertisements played in strengthening and normalizing of gender identity in the post-Soviet period. The theoretical part of the thesis discusses the social role of advertising and symbolic meanings it communicates, as well as visual communication, identity and consumption issues. The thesis analyzes the Soviet and post-Soviet consumer's identity, conditions influencing its formation as well as social environment and changes to advertising practice during the period of transformation. The study is conducted using a discourse analysis approach and content analysis. Results of the study characterise development of advertising in Latvia, transition processes of post-Soviet society and establishment of consumer life style thus enriching knowledge about various identities of Latvia’s inhabitants. Keywords: identity, consumption, gender, gender displays, advertising, post-Soviet, consumer, visual communicatio