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

Prevalência e associação de asma e rinite em adolescentes de 13 e 14 anos de Fortaleza, Ceará, Brasil Asthma and rhinitis prevalence and co-morbidity in 13-14-year-old schoolchildren in the city of Fortaleza, Ceará State, Brazil

Objetivou-se avaliar a prevalência e associação de asma e rinite. Trata-se de estudo transversal envolvendo 3.015 adolescentes de 13-14 anos de Fortaleza, Ceará, Brasil, de escolas públicas e privadas, utilizando-se o protocolo do International Study of Asthma and Allergies in Childhood (ISAAC), em 2006/2007. A prevalência de asma foi 22,6%; de rinite, 43,2% e de rinoconjuntivite, 18,7%, predominando no sexo feminino (p = 0,002, p < 0,001 e p < 0,001, respectivamente) e nos adolescentes das escolas privadas (p < 0,001). Entre os adolescentes que relataram asma, a taxa de rinite foi de 64,4% e de rinoconjuntivite, 35,3%. A taxa da associação asma-rinite na população foi de 14,6%, e asma-rinoconjuntivite, 8%, predominando no sexo feminino (p < 0,001 e p < 0,001, respectivamente) e associando-se a sibilos com limite da fala (p = 0,037 e p = 0,004, respectivamente). O estudo pode contribuir para alertar os profissionais de saúde quanto à importância da abordagem integrada dessas enfermidades, considerando o conceito da "via aérea única" e buscando opções de tratamento que atuem nas duas condições quando presentes simultaneamente.<br>This study aimed to measure the prevalence rates for asthma and rhinitis and the association between the two conditions. This was a cross-sectional study of 3,015 adolescents (13-14 years of age) in Fortaleza, Ceará State, Brazil, in public and private schools, using the protocol from the International Study of Asthma and Allergies in Childhood (ISAAC), in 2006-2007. Prevalence rates were 22.6% for asthma, 43.2% for rhinitis, and 18.7% for rhinoconjunctivitis, with a predominance of females (p = 0.002, p < 0.001, and p < 0/001, respectively) and private school students (p < 0.001). Among adolescents that reported asthma, the rhinitis rate was 64.4% and the rhinoconjunctivitis rate was 35.3%. The rates of association were 14.6% between asthma and rhinitis and 8% between asthma and rhinoconjunctivitis, with a predominance of females (p < 0.001 and p < 0.001, respectively) and associated with speech-limiting wheezing (p = 0.037 and p = 0.004, respectively). The study can help call health professionals' attention to the importance of an integrated approach to these illnesses, considering the "single airway" concept and seeking treatment options that act on both asthma and rhinitis when the two conditions present simultaneously

Thresholds of freshwater biodiversity in response to riparian vegetation loss in the Neotropical region

Protecting riparian vegetation around streams is vital in reducing the detrimental effects of environmental change on freshwater ecosystems and in maintaining aquatic biodiversity. Thus, identifying ecological thresholds is useful for defining regulatory limits and for guiding the management of riparian zones towards the conservation of freshwater biota. Using nationwide data on fish and invertebrates occurring in small Brazilian streams, we estimated thresholds of native vegetation loss in which there are abrupt changes in the occurrence and abundance of freshwater bioindicators and tested whether there are congruent responses among different biomes, biological groups and riparian buffer sizes. Mean thresholds of native vegetation cover loss varied widely among biomes, buffer sizes and biological groups: ranging from 0.5% to 77.4% for fish, from 2.9% to 37.0% for aquatic invertebrates and from 3.8% to 43.2% for a subset of aquatic invertebrates. Confidence intervals for thresholds were wide, but the minimum values of these intervals were lower for the smaller riparian buffers (50 and 100 m) than larger ones (200 and 500 m), indicating that land use should be kept away from the streams. Also, thresholds occurred at a lower percentage of riparian vegetation loss in the smaller buffers, and were critically lower for invertebrates: reducing only 6.5% of native vegetation cover within a 50-m riparian buffer is enough to cross thresholds for invertebrates. Synthesis and applications. The high variability in biodiversity responses to loss of native riparian vegetation suggests caution in the use of a single riparian width for conservation actions or policy definitions nationwide. The most sensitive bioindicators can be used as early warning signals of abrupt changes in freshwater biodiversity. In practice, maintaining at least 50-m wide riparian reserves on each side of streams would be more effective to protect freshwater biodiversity in Brazil. However, incentives and conservation strategies to protect even wider riparian reserves (~100 m) and also taking into consideration the regional context will promote a greater benefit. This information should be used to set conservation goals and to create complementary mechanisms and policies to protect wider riparian reserves than those currently required by the federal law. © 2020 British Ecological Societ