Overuse of diagnostic tools and medications in acute rhinosinusitis in Spain: a population-based study (the PROSINUS study).

Objectives Acute rhinosinusitis (ARS) has a high incidence. Diagnosis is clinical, and evolution is mostly self-limited. The aim of this study was to describe the sociodemographic characteristics and use of diagnostic tools and medications in patients with ARS. Design This is a prospective observational study in real-life clinical practice. Setting Patients with clinical diagnosis of ARS (n=2610) were included from ear, nose and throat clinics in Spain. A second visit at resolution was done. Participants Patients were classified according to the duration of symptoms: viral ARS (≤10 days), postviral ARS (>10 days, ≤12 weeks) and chronic rhinosinusitis (>12 weeks). Main outcome measures Sociodemographic characteristics, symptoms, disease severity, quality of life (Sino-Nasal Outcome Test-16), used diagnostic tools and medications, and the management performed by primary care physicians (PCPs) and by otorhinolaryngologists (ORLs) were assessed. Results Of the patients 36% were classified as having viral ARS, 63% postviral ARS and 1% as chronic rhinosinusitis. Working in a poorly air-conditioned environment was a risk factor (OR: 2.26, 95% CI 1.27 to 4.04) in developing postviral ARS. A higher number of diagnostic tools (rhinoscopy/endoscopy: 80% vs 70%; plain X-ray: 70% vs 55%; CT scan: 22% vs 12%; P<0.0001) were performed in postviral than viral cases. PCPs performed more X-rays than ORLs (P<0.0001). Patients, more those with postviral than viral ARS, received a high number of medications (oral antibiotics: 76% vs 62%; intranasal corticosteroids: 54% vs 38%; antihistamines: 46% vs 31%; mucolytic: 48% vs 60%; P<0.0001). PCPs prescribed more antibiotics, antihistamines and mucolytics than ORLs (P<0.0068). More patients with postviral than viral ARS reported symptoms of potential complications (1.5% vs 0.4%; P=0.0603). Independently of prescribed medications, quality of life was more affected in patients with postviral (38.7±14.2 vs 36.0±15.3; P=0.0031) than those with viral ARS. ARS resolution was obtained after 6.04 (viral) and 16.55 (postviral) days, with intranasal corticosteroids being associated with longer (OR: 1.07, 95% 1.02 to 1.12) and phytotherapy with shorter (OR: 0.95, 95% CI 0.91 to 1.00) duration. Conclusions There is a significant overuse of diagnostic tools and prescribed medications, predominantly oral antibiotics, by PCPs and ORLs, for viral and postviral ARS

Management of Allergic Diseases During COVID-19 Outbreak

Coronavirus infections; Rhinitis, Allergic; Drug hypersensitivityInfecciones por coronavirus; Rinitis alérgica; Hipersensibilidad medicamentosaInfeccions per coronavirus; Rinitis al·lèrgica; Hipersensibilitat medicamentosaPurpose of review: The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19. Recent findings: There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care

Statistical knowledge of biology education students in Malang

Statistical knowledge is a basic competency which must be possessed by Biology Education students before conducting research. Unfortunately, Statistics is often considered a difficult subject by biology students. The purpose of this survey research was to explore the statistical knowledge of Biology Education students. A total of 40 students in the Universitas Muhammadiyah Malang were involved in this research. The data were collected using a questionnaire containing 12 statements. Descriptive statistics was used to analyze the research data. The results showed that the mean score of students' statistical knowledge was 77.92 ± 17.96; meanwhile, 52.5% of students’ knowledge was categorized as good. In addition, the accuracy of student answers on several items reached over 90%, even though there were also items in which the answers were only 50% accurate. Therefore, innovation in Statistics lecture needs to be carried out to optimize the empowerment of statistical knowledge for Biology Education students

The Syrian Crisis Impact on the Area and the Production: A Case Study of Vegetables Crop

Vegetable crops cannot be dispensed with to meet the nutritional needs of the population in Syria, and it is suffering from large price fluctuations. The impact of the current crisis has a significant impact on these changes on the prices of the product itself, competing for crops, or production requirements, which is directly reflected in the areas cultivated and its production. In this research, a seek has been made to analyze the area and production of the vegetables crop in Syrian agriculture before and after the crisis. The results of the study show that for vegetables crop (irrigated and rain-fed) there has been a decrease in the cultivated area during the crisis compared to the period before it 302.299 and 427.760 hectares, respectively. Besides, in terms of production, we note that there has been a negative impact of the crisis on vegetables crop (irrigated and rain-fed) of 2911.522, 579.368 tons, respectively. Keywords: Vegetable crops, Syrian Crisis, Production, Area JEL Classifications: M11, Q13 DOI: https://doi.org/10.32479/irmm.910

Therapeutic management of allergic rhinitis: a survey of otolaryngology and allergology specialists

Purpose: To describe the current management of allergic rhinitis (AR) in Spain's specialized care according to the next-generation ARIA guidelines. Methods: An ad hoc online survey was distributed to AR specialists to appraise their perceptions of pathology management, knowledge of next-generation ARIA guidelines (including four case clinics), and their views on the principal barriers and the actions to proper AR management. Results: one hundred nine specialists (38.5% allergists and 61.5% otolaryngologists) completed the study survey. Most respondents (87.2%) had read all or part of the Next-Generation ARIA Guidelines, and 81.6% stated that they considered the patient’s treatment choice preferences. However, only 20.2% of specialists answered according to the recommendations in at least three of the four case clinics. Most participants failed to fulfill the treatment duration according to the guidelines. They regarded the lack of multidisciplinary teams (21.7%) and the lack of patients’ AR treatment adherence (30.6%) as the most critical healthcare system- and patient-related barriers to the correct management of AR, respectively. Promoting patients’ education was considered the most crucial action to improve it. Conclusion: Despite specialists’ awareness, there is a gap between the evidence-based guidelines’ recommendations and their implementation in clinical practice

Economic Analysis of an Optimized Irrigation System: Case of Sant’ Arcangelo, Southern Italy

Owing to its climate diversity and abundant natural resources, the Mediterranean basin is considered one the greatest areas for agricultural activities. Although, the Mediterranean agriculture plays an important role in the economic development of several countries by providing food and raw material for industrialization, it confronts a number of issues amongst them, water scarcity that has been increasing as a results of climate change affecting the seasonal fluctuation of rainfalls, and  anthropogenic impact delineated by overexploitation and pollution. Accordingly, targeting the most efficient water use is crucial to sustain economically important irrigated crops under the mentioned circumstances. In this paper, we tried to ensure an optimal and sustainable productivity for farmers by analysing different scenarios in order to achieve the most suitable decision that fulfils the desired goals in terms of efficient water use. This analysis is performed with the software GAMS (General Algebraic Modeling System), which is a static and non-linear optimization model. It allows from intergrating different data to reach a maximizing farmer’s utility that gives the optimal cropping pattern close to the real one. Considering several possible constraints and by using an optimisation software (GAMS), we obtained the optimal cropping pattern giving the maximum profit to the farmers within the study area of Sant’ Arcangelo

COVID-19 as a turning point in the need for specialized units for the sense of smell

Coronavirus infections; Olfaction disorders; OtolaryngologistsInfecciones por coronavirus; Trastornos del olfato; OtorrinolaringólogosInfeccions per coronavirus; Trastorns olfactius; OtorinolaringologiaThe high prevalence of olfactory dysfunction (OD) by SARS-CoV-2 has revealed the lack of specialized units [1,2]. The main objective is to know the new olfactory units (OU) since the COVID-19 pandemic, and to evaluate the tests used for diagnosis, management and treatment of OD and providing up-to-date data on the current practice in Spain. Due to the increase in COVID-19 and other diseases related to OD, the creation of new OUs is necessary, considering that OD is a predictive symptom of these diseases that affects all ages [3]. To our knowledge this is the first study on OU and no studies were found in other countries. A prospective cross-sectional study, carried out by means of a survey that contains 17 items (supplementary file 1). The survey was developed by 6 experts and was distributed to all members of Spanish ENT and Allergy societies through the Google platform. We considered the "OU" to be a team (ENT or Allergist) with the infrastructure and staff to perform the assigned functions (validated test, well ventilated cabin with controlled humidity and temperature). Statistical analysis was performed with STATA using Shapiro Wilk test, chi-2 test and Spearman correlation analysis. Finally, 136 facilities were included (112/82.4% otolaryngologist and 24/17.6% allergists)

Short-course oral steroids alone for chronic rhinosinusitis

BACKGROUND: This review is one of a suite of six Cochrane reviews looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is a common condition involving inflammation of the lining of the nose and paranasal sinuses. It is characterised by nasal blockage and nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Oral corticosteroids are used to control the inflammatory response and improve symptoms.  OBJECTIVES: To assess the effects of oral corticosteroids compared with placebo/no intervention or other pharmacological interventions (intranasal corticosteroids, antibiotics, antifungals) for chronic rhinosinusitis.  SEARCH METHODS: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 7); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 11 August 2015.  SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing a short course (up to 21 days) of oral corticosteroids with placebo or no treatment or compared with other pharmacological interventions.  DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity, and the adverse event of mood or behavioural disturbances. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse events of insomnia, gastrointestinal disturbances and osteoporosis. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.  MAIN RESULTS: We included eight RCTs (474 randomised participants), which compared oral corticosteroids with placebo or no intervention. All trials only recruited adults with chronic rhinosinusitis with nasal polyps. All trials reported outcomes at two to three weeks, at the end of the short-course oral steroid treatment period. Three trials additionally reported outcomes at three to six months. Two of these studies prescribed intranasal steroids to patients in both arms of the trial at the end of the oral steroid treatment period. Oral steroids versus placebo or no intervention Disease-specific health-related quality of life was reported by one study. This study reported improved quality of life after treatment (two to three weeks) in the group receiving oral steroids compared with the group who received placebo (standardised mean difference (SMD) -1.24, 95% confidence interval (CI) -1.92 to -0.56, 40 participants, modified RSOM-31), which corresponds to a large effect size. We assessed the evidence to be low quality (we are uncertain about the effect estimate; the true effect may be substantially different from the estimate of the effect). Disease severity as measured by patient-reported symptom scores was reported by two studies, which allowed the four key symptoms used to define chronic rhinosinusitis (nasal blockage, nasal discharge, facial pressure, hyposmia) to be combined into one score. The results at the end of treatment (two to three weeks) showed an improvement in patients receiving oral steroids compared to placebo, both when presented as a mean final value (SMD -2.84, 95% CI -4.09 to -1.59, 22 participants) and as a change from baseline (SMD -2.28, 95% CI -2.76 to -1.80, 114 participants). These correspond to large effect sizes but we assessed the evidence to be low quality.One study (114 participants) followed patients for 10 weeks after the two-week treatment period. All patients in both arms received intranasal steroids at the end of the oral steroid treatment period. The results showed that the initial results after treatment were not sustained (SMD -0.22, 95% CI -0.59 to 0.15, 114 participants, percentage improvement from baseline). This corresponds to a small effect size and we assessed the evidence to be low quality.There was an increase in adverse events in people receiving orals steroids compared with placebo for gastrointestinal disturbances (risk ratio (RR) 3.45, 95% CI 1.11 to 10.78; 187 participants; three studies) and insomnia (RR 3.63, 95% CI 1.10 to 11.95; 187 participants; three studies). There was no significant impact of oral steroids on mood disturbances at the dosage used in the included study (risk ratio (RR) 2.50, 95% CI 0.55 to 11.41; 40 participants; one study). We assessed the evidence to be low quality due to the lack of definitions of the adverse events and the small number of events or sample size, or both). Other comparisonsNo studies that compared short-course oral steroids with other treatment for chronic rhinosinusitis met the inclusion criteria. AUTHORS' CONCLUSIONS: At the end of the treatment course (two to three weeks) there is an improvement in health-related quality of life and symptom severity in patients with chronic rhinosinusitis with nasal polyps taking oral corticosteroids compared with placebo or no treatment. The quality of the evidence supporting this finding is low. At three to six months after the end of the oral steroid treatment period, there is little or no improvement in health-related quality of life or symptom severity for patients taking an initial course of oral steroids compared with placebo or no treatment.The data on the adverse effects associated with short courses of oral corticosteroids indicate that there may be an increase in insomnia and gastrointestinal disturbances but it is not clear whether there is an increase in mood disturbances. All of the adverse events results are based on low quality evidence.More research in this area, particularly research evaluating patients with chronic rhinosinusitis without nasal polyps, longer-term outcomes and adverse effects, is required.There is no evidence for oral steroids compared with other treatments