Aspects of etiopathogeny and cell therapy in the treatment of recurrent and chronic rhinosinusitis in children

Department of Otorhinolaryngology, Laboratory of Tissue Engineering and Cells Cultures Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Chronic rhinosinusitis is an important problem of otolaryngology, its treatment being so far below the expected level. The incidence of rhinosinusitis in the last decades has increased almost 3 times, while there is a clear tendency to increase the frequency of recurrent and chronic forms of sinusitis. The study of the etiology, pathogenesis and development of effective sinusitis treatment principles is also due to the appearance, in some cases, of severe pansinusitis with orbital or intracranial complications with the development of septic states. At the same time, chronic inflammatory pathology of the nasal cavity and paranasal sinuses often leads to body allergies, the development of bronchopulmonary pathologies and the dysfunction of several organ systems. Thus, a new research is needed regarding the study of the pathogenesis of chronic sinusitis and the pathogenetic basis of the new complex treatment principles of inflammatory rhinosinusal pathologies using cell therapy with the application of autologous mononuclear cells, cell strain, drug-carrying nanoparticles and antioxidants. Aim of the study. Studying specialized literature in order to carry out a research of the etiopathogenesis oriented to the optimization of the treatment of recurrent and chronic rhinosinusitis in children, through cell therapy. Materials and methods. This article analyzes the data from the literature on the etiopathogeny and the importance of cell therapy in the treatment of rhinosinus inflammatory pathology. The bibliographic databases Cohrane, PubMed, Medline were accessed. Results. A study of sixty-seven patients with chronic low-level CD8 + T lymphocyte rhinosinusitis were investigated and analyzed according to demographic data, disease progression and bacteriological culture, which were compared with a group of 480 patients with CRS with nasal polyposis. The medium CD8 + level in the CRS / CD8 population was 0.15 × 10 (9) / L (range, 0.20-1.5 × 10 (9) / L). There was no difference between the two groups regarding the history of allergy, asthma, eczema, acetylsalicylic acid (ASA) intolerance or smoking. The bacteriology was similar between the two groups (S. aureus: CRS / Low CD8 +: 35%; CRS 32%, p = 0.643). The disease progression was slightly easier in CRS / Low CD8 +, with fewer patients requiring surgery, and the first surgery was performed at an older age. However, antibiotic use was higher in CRS / Low CD8 +. Analysis of subgroups limited to CRS with nasal polyposis (CRSwNP) / low CD8 or CRS without nasal polyposis (CRSsNP) / low CD8 phenotypes did not substantially change these results. Another multicenter study of systemic administration of bone marrow-derived mesenchymal cell preparation (MSC) (Prochymal; Osiris Therapeutics Inc) in patients with moderately severe chronic obstructive bronchopneumopathy (COPD) in the United States has demonstrated to be safety without acute infusion toxicity and no attributable mortality or serious adverse reactions over a follow-up period of two years. Several laboratory studies show that Stem cells derived from adipose tissue (AUC) have the ability to regenerate mucosal lesions of the vocal cords. Professor Danilov L. (2016) proposed a new method of local immunocorrection (with autologous mononuclear cells) in the conservative complex treatment of compensated chronic tonsillitis in children which has been shown to be very effective, through the positive clinical effect, the normalization of the preimmune resistance status of the body, obvious decrease of the increased rates of allergic reactions, decrease of the levels of specific cellular sensitization to streptococcal, pneumococcal antigens, increase of the total lymphocyte content, increase of the levels and functional activity of the T and B lymphocytes, efficiency of the cytokine profile, decrease of the cytokine levels (IL-8, IL-1β) and increased serum concentrations of anti-inflammatory cytokine (IL-4).Conclusions. The studies presented in this review argue the need for further research into the etiopathogenesis of rhinosinusitis and cell therapy methods for the treatment of chronic inflammatory diseases of the nose and paranasal sinuses

Prospects of cell therapy in the treatment of recurrent and chronic rhinosinusitis in children

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Chronic rhinosinusitis is an important public health issue, the incidence and prevalence of which has been constantly growing in both the developing and the developed countries, having a negative impact on the quality of life and bringing about significant costs for the diagnosis and treatment. The management of recurrent ting and chronic rhinosinusitis represents a major concern for the otorhinolaryngology service. Traditionally, the treatment of recurrent and chronic rhinosinusitis has been performed by administering antibiotics, nasal irrigation with saline solution, decongestant nasal sprays, topical and systemic corticosteroids, antihistamines, antileukotrienes, and surgery as needed. Unfortunately, these methods are not free of risks and adverse effects. At the same time, the efficiency of standard treatment is lower than expected

The contemporary surgical treatment of hypertrophied adenoids at children

State Medical and Pharmaceutical University „Nicolae Testemitanu”, Chisinau, Republic of MoldovaIntroduction: Modern technologies make it possible to improve the quality of medical surgery. Adenoidectomy under endoscopic control provides full view of the surgical field. This surgical intervention gives the possibility to completely remove lymphoid tissue in the nasopharynx with minimal traumatic effect. It also makes it possible to detect simultaneously and correct concomitant pathologies of adjacent structures. Purpose and objectives: Studying literature assessing the effectiveness of different types of adenoidectomy in children. Material and methods: The study was conducted based on available literature, published treaties on diseases studied and materials offered by Internet service MedLine. Results: Adenoidectomy is considered one of the most commonly performed procedures ENT surgical world, being himself made or in combination with other procedures, the number of interventions goes from 65 to 10000 children in the UK and from 50 to 10000 children in the U.S.A.(van den Akker et al., 2004). Adenoidectomy, although it seems to be a very simple surgical procedure, while not devoid of complications. Modern technologies in medicine, implemented over several years, facilitating improvement in the quality of surgery and ENT. Adenoidectomy in endoscopic control provides full view of the field operator. It gives the possibility complete removal of lymphoid tissue in the nasopharynx with minimal traumatic effect. Also in the nasopharyngeal endoscopy can perform simultaneous correction pathology of adjacent structures. This literature study was designed to evaluate the efficacy elimination adenoids transoral endoscopic control, and not about the superiority this method over other methods. To solve this problem we must study randomized controlled trial to compare different methods of removing adenoids. Since adenoids has no capsule, precise removal of hypertrophied adenoids has always been difficult to achieve with any surgical technique . Conclusions: 1. Nasopharynx is an anatomical structure, difficult to see with the naked eye which requires technologies and modern equipment. 2. Traditional adenoidectomy, frequently leads to relapse by virtue integral to achieving the array of surgical children. 3. Endoscopic adenoidectomy is a surgical method of perspective ENT contemporary

Nasal permeability in children with chronic hypertrophic rhinitis

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Chronic hypertrophic rhinitis represents a current and a major problem in otorhinolaryngology, with a frequency of 16-25% of the population in different countries, with a growing prevalence and accounting for about half of the pathology of patients, which is addressed to the Otorhinolaryngologist.Among the methods of diagnosis of chronic hypertrophic rhinitis one of the most representative is acoustic rhinometry. Acoustic rhinometry is a very effective and easy method to determine the degree of nasal obstruction. This method was described by Jackson in 1977 and was first applied by Hilberg (1986) and provides for the writing of nasal fossil geometry. Acoustic rhinometry allows non-invasive evaluation of nasal permeability to be applied to children. Therefore we considered it appropriate to conduct a literature review on the methods of diagnosis of chronic hypertrophic rhinitis

Surgical treatment of nasal septal perforation. our experience

Catedra otorinolaringologie, USMF „Nicolae Testemiţanu”Nasal septum perforation is frequently encountered in practical otorhinolaryngology pathology, where the two nasal cavities communicate, leading to changes in inspired air flow and pressure. The technique Cottle by closed method (for small and medium perforations) or open (for large perforations). was used as a method of treatment the study lasted during the years 2009-2011. It included 31 patients (19 men and 12 women), with the average age 36 . Perforatia septului nazal este o patologie frecvent întîlnită în practica otorinolaringologică, prin care cele două cavităţi nazale comunică, conducînd la modificarea debitului şi presiunii aerului inspirat. Ca principiu de tratament s-a utilizat tehnica Cottle, prin metoda închisă (pentru perforaţiile mici şi medii) sau deschisă (pentru perforatii mari). Studiul a durat pe perioada anilor 2009-2011. A cuprins 31 de pacienţi ( 19 bărbaţi şi 12 femei), vîrsta medie 36 ani

General characteristic of patients with otosclerosis operated in otorhinolaryngological clinic of Central Hospital

Catedra Otorinolaringologie, USMF "Nicolae Testemiţanu"Otosclerosis is an autosomal dominant disease, more common in white people, about 0,25% - 1% of the population suffers from this condition namely the clinical one. It is called otospongiosis because affects otic capsule and osicular chain through an abnormal deposition of bone in the labyrinth capsule and middle ear. The etiology is varied and presents diverse clinical picture, which complicates early diagnosis and treatment. This study will allow more detailed knowledge of this specific disease. Otoscleroza este o boală autosomal dominantă, întâlnită mai frecvent la rasa albă şi aproximativ 0,25% - 1% din populaţie suferă de forma clinică a acestei afecţiuni. Denumită şi otospongioză, ea afectează capsula otică şi lanţul osicular, printr-o depunere anormală de ţesut osos în capsula labirintului şi urechea medie. Etiologia este variată şi tabloul clinic divers, fapt ce complică diagnosticarea precoce şi tratamentul adecvat. Acest studiu ne va permite cunoaşterea mai detaliată a acestei patologii specifice