Endonasal infrared thermometry for the diagnosis of allergic inflammation of the nasal mucosa in patients with bronchial asthma

© 2017, Nizhny Novgorod State Medical Academy. All rights reserved. Bronchial asthma (BA) is often associated with chronic inflammatory processes in the nasal mucosa; these processes give rise to allergic rhinitis, chronic rhinosinusitis, adenoiditis, and polypous rhinosinusitis. Due to their multiple symptoms, these diseases of the upper respiratory tract, especially allergic rhinitis, are often difficult to verify in patients with asthma. The aim of the study was to evaluate the diagnostic potential of endonasal IR thermometry in BA patients suspected of allergic rhinitis. Materials and Methods. Fifty children diagnosed with both BA and allergic rhinitis and 15 healthy children, matched by gender and age, participated in the study. The endonasal temperature determined with contactless IR thermometry was confronted with the symptoms of allergic rhinitis and sinusitis assessed with the TNSS and SNOT-20 questionnaires. The results were compared with the severity of nasal obstruction as determined through the anterior active rhinomanometry. Results. The nasal temperature in patients with asthma and allergic rhinitis was 33.77 [33.37; 34.17]°С, which was significantly lower than that in the group of healthy children (34.98 [34.57; 35.39] °С; p=0.0006); the body temperature did not differ between the groups (36.55 [36.45; 36.65] and 36.58 [36.40; 36.76] °С, respectively; p=0.5). We found a negative correlation between the values of nasal temperature and the sinusitis symptom scores in patients with BA and allergic rhinitis (R=–0.32; p=0.02). Conclusion. Patients with both BA and allergic rhinitis showed a decreased endonasal temperature in comparison with healthy children; the endonasal temperature can serve an indicator of allergic inflammation of the nasal mucosa

Rationale and design of the PeriOperative ISchemic Evaluation-3 (POISE-3) : a randomized controlled trial evaluating tranexamic acid and a strategy to minimize hypotension in noncardiac surgery

Altres ajuts: Canadian Institutes of Health Research (CIHR, FDN-143302); General Research Fund (14104419), Research Grant Council, Hong Kong SAR, China; National Health and Medical Research Council, Funding Schemes (NHMRC Project Grant 1162362), Australia; McMaster University Department of Medicine Career Research Award and a Physicians' Services Incorporated (PSI) Foundation Mid-Career Clinical Research Award.Background: For patients undergoing noncardiac surgery, bleeding and hypotension are frequent and associated with increased mortality and cardiovascular complications. Tranexamic acid (TXA) is an antifibrinolytic agent with the potential to reduce surgical bleeding; however, there is uncertainty about its efficacy and safety in noncardiac surgery. Although usual perioperative care is commonly consistent with a hypertension-avoidance strategy (i.e., most patients continue their antihypertensive medications throughout the perioperative period and intraoperative mean arterial pressures of 60 mmHg are commonly accepted), a hypotension-avoidance strategy may improve perioperative outcomes. Methods: The PeriOperative Ischemic Evaluation (POISE)-3 Trial is a large international randomized controlled trial designed to determine if TXA is superior to placebo for the composite outcome of life-threatening, major, and critical organ bleeding, and non-inferior to placebo for the occurrence of major arterial and venous thrombotic events, at 30 days after randomization. Using a partial factorial design, POISE-3 will additionally determine the effect of a hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of major cardiovascular events, at 30 days after randomization. The target sample size is 10,000 participants. Patients ≥45 years of age undergoing noncardiac surgery, with or at risk of cardiovascular and bleeding complications, are randomized to receive a TXA 1 g intravenous bolus or matching placebo at the start and at the end of surgery. Patients, health care providers, data collectors, outcome adjudicators, and investigators are blinded to the treatment allocation. Patients on ≥ 1 chronic antihypertensive medication are also randomized to either of the two blood pressure management strategies, which differ in the management of patient antihypertensive medications on the morning of surgery and on the first 2 days after surgery, and in the target mean arterial pressure during surgery. Outcome adjudicators are blinded to the blood pressure treatment allocation. Patients are followed up at 30 days and 1 year after randomization. Discussion: Bleeding and hypotension in noncardiac surgery are common and have a substantial impact on patient prognosis. The POISE-3 trial will evaluate two interventions to determine their impact on bleeding, cardiovascular complications, and mortality. Trial registration: ClinicalTrials.gov NCT03505723. Registered on 23 April 2018

Rationale and design of the PeriOperative ISchemic Evaluation-3 (POISE-3): a randomized controlled trial evaluating tranexamic acid and a strategy to minimize hypotension in noncardiac surgery

Background For patients undergoing noncardiac surgery, bleeding and hypotension are frequent and associated with increased mortality and cardiovascular complications. Tranexamic acid (TXA) is an antifibrinolytic agent with the potential to reduce surgical bleeding; however, there is uncertainty about its efficacy and safety in noncardiac surgery. Although usual perioperative care is commonly consistent with a hypertension-avoidance strategy (i.e., most patients continue their antihypertensive medications throughout the perioperative period and intraoperative mean arterial pressures of 60 mmHg are commonly accepted), a hypotension-avoidance strategy may improve perioperative outcomes. Methods The PeriOperative Ischemic Evaluation (POISE)-3 Trial is a large international randomized controlled trial designed to determine if TXA is superior to placebo for the composite outcome of life-threatening, major, and critical organ bleeding, and non-inferior to placebo for the occurrence of major arterial and venous thrombotic events, at 30 days after randomization. Using a partial factorial design, POISE-3 will additionally determine the effect of a hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of major cardiovascular events, at 30 days after randomization. The target sample size is 10,000 participants. Patients ≥45 years of age undergoing noncardiac surgery, with or at risk of cardiovascular and bleeding complications, are randomized to receive a TXA 1 g intravenous bolus or matching placebo at the start and at the end of surgery. Patients, health care providers, data collectors, outcome adjudicators, and investigators are blinded to the treatment allocation. Patients on ≥ 1 chronic antihypertensive medication are also randomized to either of the two blood pressure management strategies, which differ in the management of patient antihypertensive medications on the morning of surgery and on the first 2 days after surgery, and in the target mean arterial pressure during surgery. Outcome adjudicators are blinded to the blood pressure treatment allocation. Patients are followed up at 30 days and 1 year after randomization. Discussion Bleeding and hypotension in noncardiac surgery are common and have a substantial impact on patient prognosis. The POISE-3 trial will evaluate two interventions to determine their impact on bleeding, cardiovascular complications, and mortality. Trial registration ClinicalTrials.gov NCT03505723. Registered on 23 April 2018

Negative effect of antiretroviral therapy on spermogram values in HIV-positive men

The study objective is to analyze spermogram values in HIV-positive men receiving antiretroviral therapy (ART).Materials and methods. The prospective case-controlled study included 115 men: the main group consisted of 51 patients with HIV, control group consisted of 64 patients with negative serological test for HIV and normal spermogram values. In total, 97 and 111 sperm samples were analyzed. HIV status was evaluated based on disease stage and phase, viral load, CD3+, CD4+, CD8+ lymphocyte counts and ART duration.Results. History of HIV varied between 2 and 9 years (median 5 years). All patients were receiving ART. Median duration of drug administration was 1.5years. In 48.4 % of HIV-positive patients, normozoospermia was observed. In the structure of pathological zoospermia, teratozoospermia was the most prevalent (40 %), and the percentage of pathological forms of spermatozoa in HIV-positive men was significantly higher than in HIV-negative men (97 (96—98) and 96 (95—96) %, р = 0.0001, respectively). Ejaculate volume (2.7 (2.0—3.4) and 3.1 (2.3—4.0) ml, р = 0.003), total count (89.1 (47.3—153.0) and 198.8 (138.5—272.8) million, р = 0.0001), concentration (36 (21—52) and 63.5 (46—91) million/ml, р = 0.0001), percentage of progressive motile (40 (31—53) and 55 (48.7—62.2) %, р = 0.0001) and viable sperm (78 (71.5—81.0) and 84 (82—87) %, р = 0.0001) were significantly lower, and the number of immotile forms (50 (39—55.5) and 38 (31.7—42.2) %, р = 0.0001) significantly higher in HIV-positive patients than in men without HIV. Negative correlations between the number of abnormal spermatozoa and CD4+ lymphocyte count (r = —0.362, р = 0.026), disease duration and sperm concentration (r = —0.242, р = 0.020), percentage of progressive motile sperm (grade B) and disease duration (r = —0.241, р = 0.024) were established. ART duration negatively correlated with the percentage of progressive motile sperm (grade B) (r = —0.224, р = 0.036). Percentage of sperm with fragmented DNA was significantly higher in HIV-positive patients compared to HIV-negative men (15.8 (12.4—23.0) and 9.95 (7.3— 12.4) %, р = 0.001, respectively).Conclusion. In HIV-positive patients receiving ART, sperm DNA fragmentation and the number of pathological forms are increased. Percentage of abnormal forms is higher for lower CD4+ lymphocyte counts. Sperm concentration decreases, and percentage of immobile forms increases with duration of HIV infection. ART negatively affects sperm motility

Endonasal infrared thermometry for the diagnosis of allergic inflammation of the nasal mucosa in patients with bronchial asthma

© 2017, Nizhny Novgorod State Medical Academy. All rights reserved. Bronchial asthma (BA) is often associated with chronic inflammatory processes in the nasal mucosa; these processes give rise to allergic rhinitis, chronic rhinosinusitis, adenoiditis, and polypous rhinosinusitis. Due to their multiple symptoms, these diseases of the upper respiratory tract, especially allergic rhinitis, are often difficult to verify in patients with asthma. The aim of the study was to evaluate the diagnostic potential of endonasal IR thermometry in BA patients suspected of allergic rhinitis. Materials and Methods. Fifty children diagnosed with both BA and allergic rhinitis and 15 healthy children, matched by gender and age, participated in the study. The endonasal temperature determined with contactless IR thermometry was confronted with the symptoms of allergic rhinitis and sinusitis assessed with the TNSS and SNOT-20 questionnaires. The results were compared with the severity of nasal obstruction as determined through the anterior active rhinomanometry. Results. The nasal temperature in patients with asthma and allergic rhinitis was 33.77 [33.37; 34.17]°С, which was significantly lower than that in the group of healthy children (34.98 [34.57; 35.39] °С; p=0.0006); the body temperature did not differ between the groups (36.55 [36.45; 36.65] and 36.58 [36.40; 36.76] °С, respectively; p=0.5). We found a negative correlation between the values of nasal temperature and the sinusitis symptom scores in patients with BA and allergic rhinitis (R=–0.32; p=0.02). Conclusion. Patients with both BA and allergic rhinitis showed a decreased endonasal temperature in comparison with healthy children; the endonasal temperature can serve an indicator of allergic inflammation of the nasal mucosa