Comparison of endoscopy and CT scan in diagnosing chronic rhinosinusitis without polyps

Background: Definite diagnosis of Chronic rhinosinusitis (CRS) is challenging mostly because of overlapping symptoms with other disorders. Nowadays it is mostly dependent on cross sectional imaging. When considering the prevalence and cost burden of CRS, reducing the frequency of cross sectional imaging by replacing it with endoscopic evaluation could be a cost effective way if the endoscopic examination proved to be a suitable substitution. Aim: The aim of this study is to compare the endoscopy with CT scan- as gold standard method- in diagnosis of CRS without polyp and to find out how well the results of the two correlate with each other. Methods: Adult patients with symptom criteria compatible with EPOS 2020 entered the study. They were evaluated endoscopically, and then scored by Lund Mackay CT score. Cases with obvious polyps seen on rhinoscopy or endoscopic evaluation were not entered the study. Results: A total of 49 patients entered the study.  Comparing endoscopic findings with CT scan showed the sensitivity of 69.70% and specificity of 50%. Cohen Kappa statistics of 0.191 was obtained. Positive and negative predictive value was 74.19% and 44.44% respectively. Of note, all 8 patients with Kennedy score of 4 showed positive CT results, and, all 4 cases with isolated sinusitis had negative endoscopic results. Pearson correlation coefficient was 0.63, which showed a significant positive correlation between Lund Kennedy and Lund Mackay scores. (p<0.05) Conclusion: Our observations lead us to a possible need for revision in presented endoscopic criteria to increase the diagnostic power of endoscopy in chronic rhinosinusitis sine nasal polyposis

Olfactory and gustatory manifestations in hospitalized patients with COVID-19

Background: Pulmonary involvement is the main clinical and imaging feature of the novel corona virus disease (COVID-19). However, some patients present with upper airway symptoms. Aim: In this study, we report upper respiratory manifestations, specifically focusing on smell and taste disorders in COVID-19. Methods: We performed this cross-sectional prospective study in patients admitted to Masih Daneshvari Hospital, a tertiary referral center in Tehran, Iran, with severe COVID-19 as documented by the polymerase chain reaction assay. Results: We included 268 hospitalized patients, 183 (68.3%) men and 85 (31.7%) women. The average age was 52.8±16.4. The sinonasal symptoms included nasal obstruction (44 [16.4%]), rhinorrhea (31 [11.5%]), sneeze (33 [12.3%]), headache (77 [28.6%]), facial pain (12 [4.5%]), associated with hypogeusia (65 [24.2%]) and olfactory dysfunction (90 [33.5%]). In 35 (38.9%) patients with olfactory symptoms, change in the smell was the sole initial manifestation of COVID-19. On logistic regression, the relationship between the olfactory symptoms and headache (p=0.002), nasal obstruction (p=0.0001) and sneeze (p=0.018) were statistically significant. Conclusion: We report a considerable prevalence of olfactory and gustatory symptoms in hospitalized patients with COVID-19. Not infrequently, these symptoms were the sole initial presenting symptoms in the course COVID-19. During the current pandemic, we suggest that presence of these symptoms should mandate expedited screening for COVID-19, isolation and close monitoring of the patients for evolution of the clinical course

Histopathologic Findings of Olfactory Mucosa in COVID-19 Patients

Background: Olfactory manifestations are common findings during the course of COVID-19, while exact physiopathology is not known Aim: We review histological changes of the nasal olfactory mucosa in COVID-19 non-survivors who died in the ICU. Methods: Sampling was done within 1 hour of death under direct vision. Specimens were taken medial to the middle turbinate in the cribriform area and embedded in paraffin blocks and stained by haematoxylin and eosin. Results: The most frequent histologic finding was the infiltration of inflammatory cells mostly comprised of lymphocytes. Inflammatory infiltration of mucosa was seen in all 11 patients with ulceration in 9 cases and neuritis in 3 cases.  Conclusion: Inflammatory infiltration of olfactory mucosa may be associated with smell manifestations. Further histological studies will clarify the role of the nasal mucosa in the physiopathology of COVID-19 especially olfactory involvement

Otologic Manifestations and Progression in Patients with Wegener’s granulomatosis: A Survey in 55 Patients

Introduction: Granulomatosis with polyangiitis (GPA; also known as Wegener’s granulomatosis) is a primary systemic vasculitis involving the ear, nose and throat system (ENT) and lower respiratory tract. Because of the lack of knowledge regarding the clinical findings of GPA due to the limited number of studies, the current study was designed to investigate the prevalence and nature of the otology manifestations in the disease course.   Materials and Methods: In the current prospective study, patients with a diagnosis of GPA from 2012–2016 were included.  A definitive diagnosis was made based on the history, physical examination (otomicroscopy, Rinne and Weber test), audiometry, tympanometry, cytoplasmic and perinuclear anti-neutrophil cytoplasmic antibody (C-ANCA and P-ANCA) investigations, and pathologic studies.   Results: Twenty-seven male and 28 female patients aged 41.6±15.3 years were enrolled. Ear involvement was found in 20 patients (36.3%), and the most prevalent symptom was loss of hearing followed by otalgia and tinnitus. Tinnitus improved in none of the patients. The most prevalent sign was otitis serous followed by mastoiditis and external otitis. The most important audiometry finding was sensorineural hearing loss. Pathological studies using pulmonary samples were more useful for diagnosis.   Conclusions: Precise clinical examination is crucial for the early diagnosis of GPA. Otological manifestations are common, especially loss of hearing and otitis serous, and can be the first sign of this disease. Early diagnosis can lead to better treatment of Wegener’s granulomatosis

The Effect of Using the Surgical Mask on the Status of Cerebral Oxygen Saturation and End-Tidal Carbon Dioxide in Health Care Workers

Background: With the outbreak of the new coronavirus (SARS-COV-2), one of the challenges ahead has been to control the prevalence of the disease in the world. However, because the main way the virus enters the host is through the respiratory tract, the use of a mask is more necessary than in other cases. The medical staff who are in contact with these patients in closed environments in the operating room and other places are forced to use the mask continuously to prevent infection. Aim: Considering the necessity of using a mask in the prevalence of COVID 19, especially in the medical staff and the possible effects of this use on tissue oxygen and exhaled carbon dioxide, the present study investigates the effect of using a mask on health care. the present study investigates the effect of using a mask on health care. Methods: Twenty healthy members of the medical staff (staff working at Masih Daneshvari Hospital in Tehran) entered the study voluntarily according to the inclusion criteria. Everyone wore a mask for 2 hours a day. Brain oxygen delivery percentage was measured using cerebral oximetry and petCO2 with capnogram at 0, 60 and 180 minutes. Demographic information of participants about the age, sex and underlying diseases were also recorded in a pre-prepared questionnaire. Independent t-test, paired t-test and chi-square were used to compare the clinical features of the participants. P-value less than 0.05 was considered to show statistical significance. Results: The average of petCO2 in time 2 was significantly higher than time 1 and zero (P=0.001). Likewise, the average petCO2 factor at time one is significantly higher than at time zero. The relationship between BMI and changes in the studied indices shows that the left cerebral oxygenation factor, at times 0-60’ and 30’-60’ and also the right cerebral oxygenation factor at times 0’-60’, have a direct and significant relationship with BMI. Conclusion: Based on the results of the present study, it can be said that the use of surgical masks has significantly increased petCO2 in individuals, while the Pao2 index in some individuals has been associated with a downward trend

COVID-19 vaccines breakthrough infection and adverse reactions in medical students: a nationwide survey in Iran

IntroductionThere are different types of COVID-19 vaccines approved worldwide. Since no national studies focus on vaccine-related adverse reactions and breakthrough cases, this study aimed to investigate the rate of adverse events and COVID-19 infection in medical students in Iran.MethodsThis retrospective cohort study included Iranian medical students who received two doses of COVID-19 vaccines. The medical team gathered the demographic characteristics, comorbidities, type of vaccine, adverse events following vaccination, and history of COVID-19 infection data through a phone interview. The frequency of adverse events and breakthrough infection was stratified by vaccine type (ChAdOx1-S, Gam-COVID-Vac, and BIBP-CorV).ResultsA total of 3,591 medical students enrolled in this study, of which 57.02% were females, with a mean age of 23.31 + 4.87. A PCR-confirmed and suspicious-for-COVID-19 breakthrough infection rate of 4.51 and 7.02% was detected, respectively. There was no significant relation between breakthrough infection and gender, BMI, blood groups, and comorbidities. However, there was a significant difference in breakthrough infection rate among different types of vaccines (p = 0.001) and history of COVID-19 infection (p = 0.001). A total of 16 participants were hospitalized due to COVID-19 infection after vaccination for reasons such as dyspnea, abnormal imaging, or decreased oxygen saturation. No severe infection or death was observed in the studied population.ConclusionVaccination prevented severe COVID-19 infection, although a high breakthrough infection rate was evident among Iranian medical students during the Delta variant’s peak. Vaccine effectiveness may be fragile during emerging new variants and in high-exposure settings. Moreover, adverse events are rare, and the benefits of vaccination outweigh the side effects. However, many limitations challenged this study, and the results should be cautious