Olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps is associated with clinical-cytological grading severity

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder, affecting about 4% of the worldwide population and strongly impacting the quality of life. CRSwNP is still a challenge for ENT specialists in terms of its unknown pathogenesis, difficulty in management and frequent relapse. Olfactory impairment frequently affects CRSwNP patients. We tested the hypothesis that clinical-cytological grading (CCG) could be associated with olfactory dysfunction. The study was cross-sectional, enrolling 62 patients (37 males, 25 females, mean age 49 years, range 18-83) suffering from newly diagnosed CRSwNP. Olfactory dysfunction was very frequent (about 90%) and did not depend on nasal obstruction as assessed by both polyp size and nasal airflow limitation. A CCG > 4 was the best cutoff value to suspect olfactory dysfunction [area under the ROC curve of 0.831 (0.715 to 0.914)]; in addition, the statistical risk of having dysosmia was over 7-fold higher in subjects with CCG > 4 compared with subjects reporting a CCG < 4 (adjOR 7.46). The present study underlines that olfactory dysfunction is common in CRSwNP patients and demonstrates an association between olfactory dysfunction and inflammation, suggesting that CCG could be useful in the work-up of CRSwNP patients and in suspecting olfactory impairment

Teleneuroriabilitazione cognitiva per le funzioni di vita quotidiana: applicazione nella disabilità intellettiva e nelle demenze

Presentazione fatta da V. Catania a Innovabiomed 2021

Dental Disorders and Salivary Changes in Patients with Laryngopharyngeal Reflux

Background: Laryngopharyngeal reflux (LPR) is a common inflammatory condition of the upper aerodigestive tract tissues related to the effects of gastroduodenal content reflux, characterized by a wide variety of clinical manifestations. The aim of our study was to evaluate the possible association between dental disorders and LRP, focusing on the role of salivary changes. Methods: Patient’s dental status was evaluated according to Schiff Index Sensitivity Scale (SISS), Basic Erosive Wear Examination (BEWE) and Decayed, Missing, and Filled Teeth (DMFT) scores. Reflux-associated symptoms were assessed according to Reflux symptom index (RSI). A qualitative and quantitative examination of saliva was performed. Results: Patients suffering from LPR had a higher incidence of dental disorders, regardless the presence of salivary pepsin, and thus, statistically significant higher scores of RSI (p = 0.0001), SISS (p = 0.001), BEWE (p < 0.001) and VAS (p < 0.001). Moreover, they had lower salivary flow compared with healthy patients. Conclusions: The finding of demineralization and dental caries on intraoral evaluation must raise the suspicion of LRP. Reflux treatments should also be aimed at correcting salivary alterations, in order to preserve the buffering capacity and salivary pH, thus preventing mucosal and dental damage

Functional Living Skills: A Non-Immersive Virtual Reality Training for Individuals with Major Neurocognitive Disorders

The loss of functional living skills (FLS) is an essential feature of major neurocognitive disorders (M-NCD); virtual reality training (VRT) offers many possibilities for improving FLS in people with M-NCD. The aim of our study was to verify the effectiveness of a non-immersive VRT on FLS for patients with M-NCD. VRT was carried out for 10 to 20 sessions, by means of four 3D apps developed in our institute and installed on a large touch screen. The experimental group (EG) and the control group (CG) included 24 and 18 patients with M-NCD, respectively. They were administered the in vivo test (in specific hospital places reproducing the natural environments) at T1 (pre-training) and T3 (post-training); at T2, only EG was administered VRT. Statistically significant differences between EG and CG in all the in vivo tests were found in the number of correct responses; during VRT, the number of correct responses increased, while the execution times and the number of clues decreased. The improvement in the in vivo tests appeared to be related to the specific VRT applied. The satisfaction of participants with the VRT was moderate to high

Idiopathic eosinophilic parotitis in an eight-year-old boy: a case report

<p>Abstract</p> <p>Introduction</p> <p>A number of medical conditions, some of them recently reported, are associated with an increased production of eosinophils. We report the first case of eosinophilic parotitis in the literature.</p> <p>Case presentation</p> <p>The patient was an eight-year-old Caucasian boy who presented with a two-year history of recurring acute parotitis with no fever. He had had a total of five episodes with no response to antibiotics, but remission had been achieved with oral corticosteroid therapy. We performed allergy tests for inhalant and food allergens and for haptens, but the results were all negative. The results of echography ruled out sialodochitis. Instead, a swab from the parotid duct led to the detection of a high number of eosinophils.</p> <p>Conclusions</p> <p>This report is first in the literature to describe a case of eosinophilic parotitis, and we suggest that a cytological assessment, which is quite simple yet rarely used by physicians, be performed when patients with parotitis of uncertain origin are under evaluation.</p

Structural relaxation of E' gamma centers in amorphous silica

We report experimental evidence of the existence of two variants of the E' gamma centers induced in silica by gamma rays at room temperature. The two variants are distinguishable by the fine features of their line shapes in paramagnetic resonance spectra. These features suggest that the two E' gamma differ for their topology. We find a thermally induced interconversion between the centers with an activation energy of about 34 meV. Hints are also found for the existence of a structural configuration of minimum energy and of a metastable state.Comment: 4 pages, 2 figures, submitted to Phys. Rev. Let

Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach

La rinosinusite cronica con polipi nasali (CRSwNP) è una malattia cronica nasosinusale, a eziologia infiammatoria, con significativo impatto negativo sulla qualità di vita dei pazienti. La CRSwNP rappresenta ancora oggi una sfida terapeutica per lo specialista ORL, sia per la comprensione della sua eziopatogenesi, sia per il suo controllo clinico ed è questo è testimoniato dalla alta incidenza di recidiva dopo trattamento. Abbiamo voluto verificare lipotesi che un approccio terapeutico nuovo, standardizzato, e individualizzato sul grading clinico-citologico (clinical-cytological grading CCG) consentisse un miglior controllo dei sintomi della malattia, e di ridurre la necessità di ricorrere alla chirurgia. Abbiamo pertanto reclutato 204 pazienti affetti da CRSwNP, di cui 145 hanno regolarmente assunto la terapia rispettando il protocollo proposto, e 59 pazienti, invece, che non hanno assunto la terapia in modo sistematico e sono stati quindi inclusi come controlli. Dopo 5 anni di trattamento standardizzato, abbiamo notato che 15 pazienti su 145 (10,3%) del gruppo con terapia standardizzata avevano avuto un miglioramento dello staging endoscopico, 61 su 145 (42%) si erano mantenuti costanti, mentre 69/145 (47,5%) erano andati incontro a un peggioramento. Nel gruppo di controllo, invece, i pazienti peggiorati erano ben 49 su 59 (83%), con un peggioramento significativo in termini di grading endoscopico di almeno due classi (p < 0,05). I pazienti e i controlli sono stati successivamente stratificati sulla base del CCG in 3 sottogruppi: pazienti con CCG lieve, moderata e grave. Dopo tale suddivisione in classi, è stato possibile evidenziare che nel gruppo con CCG lieve (n = 27), il 92% dei pazienti manteneva negli anni un trend costante, in assenza di peggioramenti e senza necessità di ricorrere alla chirurgia nei 5 anni di osservazione, mentre nel gruppo di controllo, 1 paziente su 59 (1,6%; p = <0,05) ricorreva a chirurgia. Nel gruppo con CCG moderato (n = 83), invece, il 44% dei pazienti standardizzati non aveva avuto un peggioramento di grading endoscopico, con un 3,6% di pazienti che aveva avuto necessità di ricorrere alla chirurgia, contro il 13,6% del gruppo controllo (p < 0,05). Nel gruppo dei pazienti con CCG grave (n = 35), anche se nessun paziente riusciva a ottenere un miglioramento del grading endoscopico, il 40% dei pazienti veniva comunque giudicato controllato da un punto di vista clinico. Nel gruppo dei pazienti con CCG grave, ben il 5,7% dei pazienti necessitava di trattamento chirurgico, ma anche in questo caso, la percentuale dei pazienti operati era significativamente maggiore (p = 0,0000) nel gruppo di controllo (49%). Infine, lanalisi statistica effettuata ha dimostrato chiaramente che, da un punto di vista obiettivo, le dimensioni dei polipi nasali tendevano ad aumentare a una velocità maggiore nel gruppo controllo che nel gruppo standardizzato, con incrementi proporzionali nelle tre classi di CCG (lieve, moderato e grave). Lo studio attuale fornisce le basi per lo sviluppo e ladozione di un nuovo approccio per la gestione della CRSwNP sulla base di uno score clinico e citologico (CCG) che permetta di stimare con accuratezza la gravità della CRSwNP e di adattarne il trattamento. Tale approccio limita luso degli steroidi sistemici alle sole classi CCG di entità moderata-grave con dosi di steroidi inferiori rispetto a quanto precedentemente suggerito in letteratura. Il nostro protocollo può migliorare pertanto laderenza terapeutica dei pazienti, il tasso di controllo della malattia e può ridurre il ricorso alla chirurgia nel corso degli anni

Clinical-cytological-grading and phenotyping in patients with chronic rhinosinusitis with nasal polyps: The relevance in clinical practice

Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients