Clinic-epidemiological analysis of an Otorhinolaryngology Emergency Unit Care in a Tertiary Hospital

AbstractEmergencies are common in our Otorhinolaringology specialty. However, the clinical and epidemiological features are not very well known.ObjectivesTo evaluate the clinical and epidemiological profiles of otorhinolaryngological disorders in an emergency unit of a tertiary hospital, and to determine the appropriateness of the level of health care for a tertiary hospital.Materials and methodsAn analytical study using data records of an otorhinolaryngological emergency unit at a tertiary hospital in the Federal District for a year, full time, and no screening. The age, sex, arrival time and clinical diagnosis were evaluated. The entities were separated into cases of pharingolaryngoesthomatology, otology, rhinology, and head and neck surgery. These were evaluated according to the urgency level, the required care, and the arrival time.Results26,584 data records were selected, of which 2,001 were excluded. The group comprised 54.48% women, and 45.51% men. Otological complaints (62.27%) prevailed. 61.26% of cases were considered emergencies. Only 9.7% of those required medium or high complex resources for resolution.ConclusionThe study showed that 61.26% of the otorhinolaryngological cases are emergencies, and only 9.7% required medium or high complexity resources

Transillumination-guided study of the endoscopic anatomy of the lacrimal fossa

A dacriocistorrinostomia é o tratamento de escolha para a obstrução do aparelho lacrimal. No final do século passado, o desenvolvimento da instrumentação endoscópica em cirurgia nasossinusal tornou viável sua realização por via endonasal. Entretanto, variações anatômicas tornam difícil a reprodutibilidade de uma técnica de abordagem endonasal. OBJETIVO: Estudar a anatomia endoscópica da fossa lacrimal através da transiluminação do canalículo comum. FORMA DE ESTUDO: Experimental. MATERIAL E MÉTODO: Foram dissecadas 40 vias lacrimais de 20 cadáveres humanos, constando três etapas: 1 - identificação e dilatação do canalículo lacrimal. 2 - introdução do feixe de fibra óptica; 3 - dissecção endoscópica do saco lacrimal, descrevendo sua posição. RESULTADOS: A posição mais frequente do saco lacrimal foi entre a borda livre do corneto médio e sua inserção e imediatamente abaixo desta. A linha maxilar foi visualizada em 95% dos casos. A septoplastia foi necessária em 12,5%, uncifectomia em 35% e turbinectomia média em 7,5%. CONCLUSÃO: embora o saco lacrimal tenha mostrado uma localização mais frequente, sua posição variou consideravelmente. A transiluminação do canalículo comum mostrou-se útil, resolvendo o problema da variabilidade anatômica.Dacryocystorhinostomy is the treatment of choice for the obstruction of the lachrymal apparatus. At the end of last century, the development of the endoscopic instruments for nasosinusal surgery has made it possible to do it through the endoscopic pathway. Nonetheless, anatomical variations make it difficult to have reproducibility endonasaly. AIM: study the endoscopic anatomy of the lachrymal fossa through transillumination of the common canaliculus. STUDY DESIGN: experimental. MATERIALS AND METHODS: we dissected 40 lachrymal pathways from 20 human cadavers, in three stages: 1. identification and dilation of the lachrymal canaliculus. 2 - Optic fiber beam introduction; 3 - endoscopic dissection of the lachrymal sac, describing its position. RESULTS: the most frequent position of the lachrymal sac was between the free border of the middle turbinate and its insertion immediately underneath it. The maxillary line was seen in 95% of the cases. Septoplasty was needed in 12.5%, unicifectomy in 35% and middle turbinectomy in 7.5%. CONCLUSION: Although the lachrymal sac has a more frequent location, its position varied considerably. The transillumination of the common canaliculus proved useful, solving the problem of the anatomical variability

Percepção dos acadêmicos da Facimed acerca da atuação e do papel do fisioterapeuta no mercado de trabalho

Inicialmente a atuação do fisioterapeuta era focada na reabilitação física. Ao longo dos anos a profissão expandiu seus serviços para várias áreas, apesar das mudanças ocorridas a percepção da população sobre esse profissional ainda é influenciada pela sua origem, sendo visto como um profissional reabilitador que tem como foco a atuação na Traumatologia, Ortopedia e Neurologia. O objetivo do presente estudo foi analisar a percepção dos acadêmicos do primeiro período da FACIMED – de Cacoal/RO que estudam na Unidade I, acerca da atuação e do papel do fisioterapeuta no mercado de trabalho. Trata-se de um estudo descritivo, exploratório, quantitativo e transversal, onde foram aplicados dois questionários, um no modelo de entrevista com 11 perguntas sobre a atuação do fisioterapeuta e outro sociodemográfico. A amostra consistiu em 59 acadêmicos maiores de 18 anos, que cursavam o 1° período da Unidade I da FACIMED de Cacoal/RO. Todos os entrevistados já tinham ouvido falar sobre a fisioterapia, entretanto o conhecimento dos acadêmicos voltou-se a aspectos reabilitativos, como o tratamento de fraturas, lesões osteomusculares, alterações posturais, atendimento de deficientes físicos e idosos. As áreas de atuação mais reconhecidas foram a Hidroterapia, Traumato-Ortopedia e Terapia Intensiva e os recursos mais utilizados foram, exercícios peso e bola, massagem, Reeducação Postural Global (RPG) e alongamento. Nota-se um conhecimento ainda superficial em relação à profissão, entretanto algo que chama a atenção é que 66% afirmaram que gostariam de saber mais sobre a fisioterapia. Dessa forma, evidencia-se a necessidade de estratégias para maior divulgação dos campos de atuação da fisioterapia

Position statement of the Brazilian Academy of Rhinology on the use of antihistamines, antileukotrienes, and oral corticosteroids in the treatment of inflammatory sinonasal diseases

Introduction: Inflammatory conditions of the nose and paranasal sinuses are very prevalent in the general population, resulting in marked loss of quality of life in affected patients, as well as significant work, leisure, and social activity losses. These patients require specific and specialized treatment. A wide range of oral medications are available. Objective: The present document is aimed to clarify, for professionals treating patients with inflammatory sinonasal diseases, both specialists and general practitioners, specific oral therapies in noninfectious nasal inflammatory conditions. Methods: The methodology used to create this article included the search for the key words: oral corticosteroids, antihistamines, antileukotrienes, rhinitis, rhinosinusitis in the MEDLINE and EMBASE databases in the last 5 years. Since no relevant article was found for the text on the subject of interest in the last 5 years, the search was extended for another 5 years, and so on, according to the authors' needs. Results: Relevant literature was found regarding the use of antihistamines, antileukotrienes and oral corticosteroids in these conditions. The Brazilian Academy of Rhinology emphasizes, after extensive discussion by the collegiate, key points in the treatment with these drugs. Conclusion: There is support in the literature for the use of these drugshowever, final considerations about the role of each of them have been made. (C) 2017 Published by Elsevier Editora Ltda. on behalf of Associacao Brasileira de Otorrino-laringologia e Cirurgia Cervico-Facial.Univ Sao Paulo, Disciplina Otorrinolaringol, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Dept Otorrinolaringol, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Otorrinolaringol, Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Ciencias Saude, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Otorrinolaringol, Sao Paulo, SP, BrazilUniv Fed Minas Gerais, Fac Med, Belo Horizonte, MG, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Ribeirao Preto, SP, BrazilUniv Fed Bahia, Fac Med, Disciplina Otorrinolaringol, Salvador, BA, BrazilHosp Inst Paranaense Otorrinolaringol, Centro Rinite & Alergia, Curitiba, PR, BrazilUniv Estado Rio De Janeiro, Rio De Janeiro, RJ, BrazilUniv Brasilia, Fac Med, Brasilia, DF, BrazilUniv Fed Sao Paulo, Dept Otorrinolaringol & Cabeca & Pescoco, Sao Paulo, SP, BrazilUniv Luterana Brasil, Fac Med, Otorrinolaringol, Canoas, RS, BrazilMt Sinai Hosp, Dept Othorhinolaryngol, Toronto, ON, CanadaUniv Sao Paulo, Fac Med, Ciencias, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Oftalmol Otorrinolaringol & Cirurgia Cabeca, Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Ciencias Saude, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Otorrinolaringol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Otorrinolaringol & Cabeca & Pescoco, Sao Paulo, SP, BrazilWeb of Scienc

Nasal polyposis: characterization of eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells in individuals with and without asthma

Para identificar, quantificar e correlacionar os eosinófilos, mastócitos, miofibroblastos e células TGF-beta positivas nos pólipos nasais de pacientes com e sem asma foi realizado a imunoistoquímica. A quantidade de eosinófilos, miofibroblastos e células TGF-beta positivas esteve aumentada no pólipo nasal de indivíduos asmáticos. O número de mastócitos não mostrou diferença entre os grupos. O miofibroblasto foi o denominador comum na correlação entre eosinófilos, mastócitos, células TGF-beta positivas e presença de asmaIntroduction: Nasal polyposis is a chronic inflammatory disease of the nasal mucosa or paranasal sinuses characterized by the formation of benign polyps. The pathogenesis is not known, although nasal polyps are associated with several systemic diseases, with asthma being the most frequent. The aim of the present study was to identify, quantify, compare and correlate eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells in nasal polyps of patients with and without asthma. Material and Methods: Seventy-eight subjects with nasal polyps undergoing endoscopic sinus surgery were selected. Control specimens were obtained from eight subjects with a normal sinus mucosa. One group consisted of polyps from 56 patients with asthma and the other of polyps from 22 patients without asthma. Immunohistochemistry was performed using monoclonal antibodies against eosinophil cationic protein to stain eosinophils, against tryptase to stain mast cells, against alpha-smooth muscle actin to stain myofibroblasts, and against TGF-ß to stain TGF-ß-positive cells. Results: The number of eosinophils, myofibroblasts and TGF-ß-positive cells was significantly higher in the asthma group than in the nonasthma group, whereas no significant difference in the number of mast cells was observed between the two groups. The number of eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells was significantly higher in nasal polyps than in the control group. Myofibroblasts showed a significant correlation with eosinophils, mast cells, TGF-ß-positive cells, and asthma. Conclusion: Eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells were identified in all nasal polyps, although the number of eosinophils, myofibroblasts and TGF-ß-positive cells was higher in the asthma group. The number of mast cells was similar regardless of the presence or absence of asthma. Myofibroblasts were a common denominator in the correlation between eosinophils, mast cells, TGF-ß-positive cells, and asthm

Nasal polyposis: characterization of eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells in individuals with and without asthma

Para identificar, quantificar e correlacionar os eosinófilos, mastócitos, miofibroblastos e células TGF-beta positivas nos pólipos nasais de pacientes com e sem asma foi realizado a imunoistoquímica. A quantidade de eosinófilos, miofibroblastos e células TGF-beta positivas esteve aumentada no pólipo nasal de indivíduos asmáticos. O número de mastócitos não mostrou diferença entre os grupos. O miofibroblasto foi o denominador comum na correlação entre eosinófilos, mastócitos, células TGF-beta positivas e presença de asmaIntroduction: Nasal polyposis is a chronic inflammatory disease of the nasal mucosa or paranasal sinuses characterized by the formation of benign polyps. The pathogenesis is not known, although nasal polyps are associated with several systemic diseases, with asthma being the most frequent. The aim of the present study was to identify, quantify, compare and correlate eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells in nasal polyps of patients with and without asthma. Material and Methods: Seventy-eight subjects with nasal polyps undergoing endoscopic sinus surgery were selected. Control specimens were obtained from eight subjects with a normal sinus mucosa. One group consisted of polyps from 56 patients with asthma and the other of polyps from 22 patients without asthma. Immunohistochemistry was performed using monoclonal antibodies against eosinophil cationic protein to stain eosinophils, against tryptase to stain mast cells, against alpha-smooth muscle actin to stain myofibroblasts, and against TGF-ß to stain TGF-ß-positive cells. Results: The number of eosinophils, myofibroblasts and TGF-ß-positive cells was significantly higher in the asthma group than in the nonasthma group, whereas no significant difference in the number of mast cells was observed between the two groups. The number of eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells was significantly higher in nasal polyps than in the control group. Myofibroblasts showed a significant correlation with eosinophils, mast cells, TGF-ß-positive cells, and asthma. Conclusion: Eosinophils, mast cells, myofibroblasts and TGF-ß-positive cells were identified in all nasal polyps, although the number of eosinophils, myofibroblasts and TGF-ß-positive cells was higher in the asthma group. The number of mast cells was similar regardless of the presence or absence of asthma. Myofibroblasts were a common denominator in the correlation between eosinophils, mast cells, TGF-ß-positive cells, and asthm

Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect

Introduction  Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective  To report a case of stage II CMA associated with subclinical visual field defect. Case Report  A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion  CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms

Evaluating the Coronary Artery Disease Consortium Model and the Coronary Artery Calcium Score in Predicting Obstructive Coronary Artery Disease in a Symptomatic Mixed Asian Cohort

Background The utility of a given pretest probability score in predicting obstructive coronary artery disease (CAD) is population dependent. Previous studies investigating the additive value of coronary artery calcium (CAC) on pretest probability scores were predominantly limited to Western populations. This retrospective study seeks to evaluate the CAD Consortium (CAD2) model in a mixed Asian cohort within Singapore with stable chest pain and to evaluate the incremental value of CAC in predicting obstructive CAD. Methods and Results Patients who underwent cardiac computed tomography and had chest pain were included. The CAD2 clinical model comprised of age, sex, symptom typicality, diabetes, hypertension, hyperlipidemia, and smoking status and was compared with the CAD2 extended model that added CAC to assess the incremental value of CAC scoring, as well as to the corresponding locally calibrated local assessment of the heart models. A total of 522 patients were analyzed (mean age 54±11 years, 43.1% female). The CAD2 clinical model obtained an area under the curve of 0.718 (95% CI, 0.668–0.767). The inclusion of CAC score improved the area under the curve to 0.896 (95% CI, 0.867–0.925) in the CAD2 models and from 0.767 (95% CI, 0.721–0.814) to 0.926 (95% CI, 0.900–0.951) in the local assessment of the heart models. The locally calibrated local assessment of the heart models showed better discriminative performance than the corresponding CAD2 models (P<0.05 for all). Conclusions The CAD2 model was validated in a symptomatic mixed Asian cohort and local calibration further improved performance. CAC scoring provided significant incremental value in predicting obstructive CAD

Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update

Introduction: Biologics targeting type 2 inflammation have revolutionized the way we treat patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Particularly in severe and difficult-to-control cases, these drugs have provided a new reality for these patients, allowing for the effective and safe treatment of extensive diseases that were not completely managed with the typical strategy of surgery and topical medications. Objectives: The experience achieved with the approval of these medications by ANVISA for use in CRSwNP and the knowledge obtained regarding outcomes, adverse effects, and the ideal patient profile prompted the update of the previously published guideline, with a detailed review of the most recent scientific literature, the personal experiences of experts, and the adaptation to the reality of the Brazilian healthcare system, both public and private. Results: We proposed a new eligibility criterion for biologics in patients with CRSwNP based on four pillars of indication: the impact of the disease on the patient’s life, whether in the presence of specific symptoms or in overall quality of life; the extent of sinonasal disease; the presence of type 2 comorbidities, considering other associated diseases that may also benefit from anti-T2 biologics, and the presence of biomarkers to define type 2 inflammation, especially those associated with worse disease prognoses. Conclusions: This innovative and pioneering method has two major advantages. First, it ensures a comprehensive evaluation of patients; second, it is flexible, as advancements in our understanding of the disease and changes in cost-effectiveness can be addressed by simply adjusting the required score for indication, without the need to modify the entire evaluation scheme