A Comparison of the Bacterial Culture Results of Maxillary Sinus Mucosa and Pus Collections for Chronic Maxillary Rhinosinusitis

Objective: Although maxillary antral taps are the standard for collecting pus for bacterial culture, they sometimes reveal no growth. Intraoperative mucosal cultures are another method to collect pathogen samples. This study compared aerobic bacterial cultures from maxillary sinus mucosa and pus collected from chronic maxillary rhinosinusitis patients. Methods: A prospective study of 22 chronic maxillary rhinosinusitis patients was conducted. Antral pus and mucosa collected during endoscopic sinus surgery were immediately sent to a microbiological laboratory. The degree of concordance between maxillary sinus mucosa aerobic bacterial cultures and pus cultures was then analyzed. Results: Twenty-seven specimens were obtained for the cultures. The proportions of positive mucosal and pus cultures were 40.74% and 51.85%, respectively. The common aerobic pathogens from the two culture techniques were Pseudomonas aeruginosa and Staphylococcus aureus. A concordance between the pus and mucosal cultures was demonstrated by 19 out of 27 specimens (70.37%). Compared with the pus cultures, the mucosal cultures had a specificity of 84.62% (95% CI, 54.55%-98.08%), a sensitivity of 57.14% (95% CI, 28.86%-82.34%), a predictive value of a positive result of 80% (95% CI, 50.83%-93.93%), and a predictive value of a negative result of 64.71% (95% CI, 48.96%-77.80%). Conclusion: Similar pathogenic bacteria were recovered from the mucosa and pus. Given the high degree of similarity of the bacteria found, the good concordance rate, and the high specificity and positive predictive value of the mucosal cultures compared with the pus cultures, mucosal cultures should be a reference standard and an option when pus is unavailable, especially with immunocompromised patients

Enhanced Susceptibility of Nasal Polyp Tissues to Avian and Human Influenza Viruses

BACKGROUND: Influenza viruses bind and infect respiratory epithelial cells through sialic acid on cell surface. Differential preference to sialic acid types contributes to host- and tissue-tropism of avian and seasonal influenza viruses. Although the highly pathogenic avian influenza virus H5N1 can infect and cause severe diseases in humans, it is not efficient in infecting human upper respiratory tract. This is because of the scarcity of its receptor, α2,3-linked sialic acid, in human upper airway. Expression of sialic acid can be influenced by various factors including inflammatory process. Allergic rhinitis and nasal polyp are common inflammatory conditions of nasal mucosa and may affect expression of the sialic acid and susceptibility to influenza infection. METHODOLOGY/PRINCIPAL FINDING: To test this hypothesis, we detected α2,3- and α2,6-linked sialic acid in human nasal polyp and normal nasal mucosal tissues by lectin staining and infected explants of those tissues with avian influenza viruses H5N1 and seasonal influenza viruses. We show here that mucosal surface of nasal polyp expressed higher level of α2,3- and α2,6-linked sialic acid than normal nasal mucosa. Accordingly, both H5N1 avian influenza viruses and seasonal influenza viruses replicated more efficiently in nasal polyp tissues explants. CONCLUSIONS/SIGNIFICANCE: Our data suggest a role of nasal inflammatory conditions in susceptibility to influenza infection, especially by avian influenza viruses, which is generally inefficient in infecting human upper airway. The increased receptor expression may contribute to increased susceptibility in some individuals. This may contribute to the gradual adaptation of the virus to human population

The Contribution of Outdoor Fine Particulate Matter to Indoor Air Quality in Bangkok Metropolitan Region, Thailand – Are Indoor Dwellers Safe?

Objective: This study aimed to analyze the relationship between indoor and outdoor fine particulate matter (PM2.5) concentrations and to characterize factors that may contribute to domestic PM2.5 concentrations, including smoking, printer/copier, and cooking activities. Methods: We measured the ambient and indoor PM2.5 concentrations from 7 sampling sites in Bangkok Metropolitan and vicinity area, Thailand by using PM2.5 concentrations sensor (SN-GCHA1, Panasonic Photo & Lighting Co., Ltd). Real-time PM2.5 concentrations, temperature, and relative humidity (RH) measurements were recorded hourly for two consecutive days during February 20th to March 2nd, 2018. We collected real-time indoor and outdoor PM2.5 mass concentrations at the same time. Factors influencing domestic PM2.5 production in the indoor environment were recorded. Results: The mean indoor PM2.5 concentrations from each site ranged from 20.05-45.85 μg/m3 and the mean outdoor PM2.5 concentrations ranged from 9.42-56.56 μg/m3. The ambient and indoor PM2.5 mass concentrations curves tended to fluctuate in a similar trend. There was a significantly positive correlation between the average ambient and the average indoor PM2.5 mass concentrations in all studied places. The correlation coefficient (r) varied from 0.6 to 0.833. Five from seven sites demonstrated a strong correlation (r ≥ 0.7), whereas, two from seven sites demonstrated a moderate correlation (0.5 ≤ r < 0.7). The average indoor/ambient PM2.5 concentration ratio from each place ranged from 0.37 to 3.57. Conclusion: The indoor PM2.5 concentrations are correlated with the ambient PM2.5 concentrations. The concentrations of PM2.5 in most sampling sites were higher than the recommended threshold. Hence, indoor dwellers are still at risk for health impacts from PM2.5. Besides public management of the ambient PM2.5, the interventions dealing with the indoor PM2.5 should be promoted concurrently

A Comparison of the Bacterial Culture Results of Maxillary Sinus Mucosa and Pus Collections for Chronic Maxillary Rhinosinusitis

Objective: Although maxillary antral taps are the standard for collecting pus for culture, they sometimes reveal no growth. Intraoperative mucosal cultures are another method to collect pathogen samples. This study compared aerobic bacterial cultures from mucosa and pus from chronic maxillary rhinosinusitis patients. Methods: A prospective study of 22 chronic maxillary rhinosinusitis patients was conducted. Antral pus and mucosa collected during endoscopic sinus surgery were immediately sent to a microbiological laboratory. The degree of concordance between maxillary sinus mucosa aerobic bacterial cultures and pus cultures was then analyzed. Results: Twenty-seven specimens were obtained for the cultures. The proportions of positive mucosal and pus cultures were 40.74% and 51.85%, respectively. The common aerobic pathogens from the two culture techniques were Pseudomonas aeruginosa and Staphylococcus aureus. A concordance between the pus and mucosal cultures was demonstrated by 19 out of 27 specimens (70.37%). Compared with the pus cultures, the mucosal cultures had a specificity of 84.62% (95% CI, 54.55%-98.08%), a sensitivity of 57.14% (95% CI, 28.86%-82.34%), a predictive value of a positive result of 80% (95% CI, 50.83%-93.93%), and a predictive value of a negative result of 64.71% (95% CI, 48.96%-77.80%). Conclusion: Similar pathogenic bacteria were recovered from the mucosa and pus. Given the high degree of similarity of the bacteria found, the good concordance rate, and the high specificity and positive predictive value of the mucosal cultures compared with the pus cultures, mucosal cultures should be a reference standard and an option when pus is unavailable, especially with immunocompromised patients

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity