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- ItemAcesso aberto (Open Access)Asma ocupacional(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-05-01) Fernandes, Ana Luisa Godoy [UNIFESP]; Stelmach, Rafael; Algranti, Eduardo; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Fundação Jorge Duprat Figueiredo de Segurança e Medicina do TrabalhoWork-related asthma is one of the principal occupational respiratory diseases in terms of prevalence. Innumerable chemical substances used in various production processes can cause or aggravate occupational asthma. This chapter contains a brief description of the definition and classification of work-related asthma, as well as the epidemiological repercussions, natural course, diagnostic criteria, progression and legal aspects of the disease, with the objective of raising an alert regarding this disease and its implications for workers.
- ItemAcesso aberto (Open Access)Avaliação da rinussinusite bacteriana aguda em pacientes asmáticos com base em parâmetros clínicos, exame otorrinolaringológico e estudo de imagem(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-06-01) Faure, Alecsandra Calil Moises [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; Fernandes, Artur da Rocha Correa [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. METHODS: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. RESULTS: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. CONCLUSIONS: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.
- ItemAcesso aberto (Open Access)Can we use the questionnaire SNOT-22 as a predictor for the indication of surgical treatment in chronic rhinosinusitis?(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2017) Marambaia, Pablo Pinillos; Lima, Manuela Garcia; Guimaraes, Marina Barbosa; Gomes, Amaury de Machado; Marambaia, Melina Pinillos; dos Santos, Otavio Marambaia; Gomes, Leonardo Marques [UNIFESP]Introduction: Chronic rhinosinusitis is a prevalent disease that has a negative impact on the lives of sufferers. SNOT-22 is considered the most appropriate questionnaire for assessing the quality of life of these patients and a very effective method of evaluating therapeutic interventions
- ItemAcesso aberto (Open Access)Comparação das características in vitro e perfil de expressão gênica entre células-tronco mesenquimais derivadas de pólipos nasais e da medula óssea(Universidade Federal de São Paulo (UNIFESP), 2018-11-07) Oliveira, Pedro Wey Barbosa De [UNIFESP]; Gregorio, Luis Carlos [UNIFESP]; http://lattes.cnpq.br/0512614520137100; http://lattes.cnpq.br/6030505570897126; Universidade Federal de São Paulo (UNIFESP)Introduction: Chronic rhinosinusitis (CRS) is clinically defined as persistent inflammation of the nasal mucosa and paranasal sinuses lasting at least 12 weeks;; Chronic rhinosinusitis with nasal polyposis is a disease with its pathophysiological mechanism not yet fully known;; it is believed that nasal polyps are formed by an imbalance in the inflammatory response and an imbalance of tissue remodeling. Classically, we observe a decrease in TGF beta and Treg determining a low immune response and an intense inflammatory response, especially an eosinophilic TH2 response. At the same time, we have an altered tissue repair mechanism with decreased fibrosis formation and intense mucosal edema, resulting in an altered extracellular matrix with elevation of hydrostatic pressure and possibly the formation of polyps. Mesenchymal stem cells (MSCs) are progenitor adult stem cells with the primary goal of supporting the tissue function in which they are in, but they also exhibit immunomodulation and tissue repair characteristics in the healing process. Therefore, we believe that it is fundamental to understand the behavior of the MSCs, especially the the MSC of the nasal polyp, in an attempt to elucidate the mechanism of its formation. Objective: To compare the in vitro characteristics and gene expression profile of mesenchymal stem cells of the nasal polyp (PO-MSC) with the mesenchymal stem cells of the bone marrow (BM-MSC). Materials and methods: We isolated the PO-MSC and BM-MSC and submitted the two groups to in vitro cell differentiation, immunophenotyping, proliferation and co-culture with lymphocytes and finally gene expression profile analysis of the two groups. Results and Discussion: The two groups showed fibroblastoid morphology and a similar potential for osteogenic / adipogenic differentiation, immunophenotyping showed that CTM-PN had a lack of molecules associated with the immune system. Co-cultures of peripheral blood and CTMs also showed a lower ability of CTM-PN to modulate the immune response. We detected in CTM-PN a distinct gene expression profile compared to CTM-MO. CTM- PN expressed higher levels of specific markers of progenitor stem cells (eg, CD133 and ABCB1), whereas the CTM-MO showed high expression of cytokines and growth factors (eg, FGF10, KDR and GDF6). Gene ontology analysis showed that the most expressed genes in the CTM-PN were related to the matrix remodeling process, hexose and glucose transport. CTM-MO showed highly expressed genes related to a distinct biological behavior such as angiogenesis, blood vessel morphogenesis, cell-cell signaling, and regulation of response to external stimuli. Conclusion: CTM-PN and CTM-MO are different sub-populations of CTMs, with distinct transcription profiles that reflect specific biological properties, compatible with the anatomical location of the tissue from which they were extracted. CTM-PN clearly has a lower immunomodulation capacity when compared to CTM-MO;; resulting in a reduced ability to control the local inflammatory process. The genes most significantly expressed in the CTM-PN are partially related to the process of tissue remodeling, extracellular matrix metabolism and tissue regeneration process;; physiopathological basis of RSCcPN. CTM-PN plays an important role in the development of nasal polyps.
- ItemSomente MetadadadosEffectiveness of balloon sinuplasty in patients with chronic rhinosinusitis without polyposis(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2014-11-01) Abreu, Cassiana Burtet; Balsalobre, Leonardo [UNIFESP]; Pascoto, Gabriela Robaskewicz; Pozzobon, Moacir; Fuchs, Sandra Costa; Stamm, Aldo Cassol [UNIFESP]; Univ Toronto; Univ Fed Rio Grande do Sul; Complexo Hosp Edmundo Vasconcelos; Universidade Federal de São Paulo (UNIFESP)Introduction: Balloon sinuplasty is a minimally invasive endoscopic procedure, developed with the aim of restoring patency of the paranasal sinuses ostia with minimal damage to the mucosa.Objective: To evaluate the effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis.Methods: This was a prospective cohort study comprising 18 patients with chronic rhinosinusitis without polyposis who underwent balloon sinuplasty. Patients were evaluated for clinical criteria, quality of life (Sino-Nasal Outcome Questionnaire Test-20 [SNOT-20]), and computed tomography of the sinuses (Lund-Mackay staging) preoperatively and three to six months after the procedure.Results: Out of 18 patients assessed, 13 were included, with a mean age of 39.9 +/- 15.6 years. Ostia sinuplasty was performed in 24 ostia (four sphenoid, ten frontal, and ten maxillary sinus). At the follow-up, 22 (92%) ostia were patent and there was no major complication. There was symptomatic improvement (SNOT-20), with Cronbach coefficients for consistency of the questionnaire items of 0.86 (95% CI: 0.73-0.94) preoperatively and of 0.88 (95% CI: 0.77-0.95) postoperatively, the difference being statistically significant (p < 0.001). in addition, there was marked reduction of the computed tomography signs, an average of 4.2 point score (p < 0.001).Conclusion: Sinuplasty is effective in reducing symptoms and improving quality of life as a treatment option for chronic rhinosinusitis in selected patients. (C) 2014 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
- ItemSomente MetadadadosThe expression of dendritic cell subsets in severe chronic rhinosinusitis with nasal polyps is altered(Elsevier B.V., 2014-09-01) Pezato, Rogerio [UNIFESP]; Perez-Novo, Claudina A.; Holtappels, Gabriele; De Ruyck, Natalie; Van Crombruggen, Koen; De Vos, Geert; Bachert, Claus; Derycke, Lara; Univ Ghent; Universidade Federal de São Paulo (UNIFESP); AZ ST Lucas HospBackground: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized as a Th2-driven disease.Activated dendritic cells (DCs) are the main T-cell activators; their role in the chronic inflammatory process of nasal polyposis is still unclear.Methods: the regulation of DC subsets was analyzed in nasal polyp tissue from CRSwNP patients and compared to inferior turbinate tissue from healthy subjects. Tissue localization and expression of both plasmacytoid and myeloid DCs were assayed by means of immunohistochemistry and flow cytometry. Plasmacytoid DCs were also assayed by PCR, and tissue homogenates were assayed for various inflammatory markers.Results: the number of plasmacytoid (pDCs) and myeloid (mDCs) dendritic cells was significantly increased in nasal polyp tissue when compared to non-inflamed nasal mucosa. the number of pDCs, but not mDCs, was down-regulated in more severe cases (nasal polyps with asthma) and varied with the cytokine milieu. the amount of pDCs was significantly decreased in IL5+IFN gamma - nasal polyp tissue compared to tissues with high IFN gamma levels (IL5+IFN gamma+). Furthermore, levels of indoleamine 2,3-dioxygenase were increased in nasal polyp compared to inferior turbinate tissue and correlated negatively with the number of pDCs.Conclusions: There is an altered balance of pDC and mDC numbers in nasal polyp tissue. pDCs seem to be more susceptible to an inflammatory cytokine milieu and may play a crucial role in disease severity. (C) 2014 Elsevier GmbH. All rights reserved.
- ItemAcesso aberto (Open Access)Fatores preditivos de rinossinusite crônica em pacientes asmáticos(Universidade Federal de São Paulo (UNIFESP), 2016-09-27) Bongiovanni, Giuliano [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; http://lattes.cnpq.br/9771826548166046; http://lattes.cnpq.br/9425558576538048; Universidade Federal de São Paulo (UNIFESP)Introduction: Chronic rhinosinusitis (CRS) and asthma have several mutual factors that associate each other. CRS is a risk factor for severe asthma, increasing the frequency of exacerbations and reducing its level of disease control. Objective: To identify predictive factors of chronic rhinosinusitis (CRS) in patients with asthma, among clinical history and physical examination?s data. Method: Observational cross-sectional study with asthmatic patients from the UNIFESP asthma clinic. Patients underwent ENT evaluation with nasal endoscopy to identify CRS with and without nasal polyps (CRSwNP and CRSsNP). Results: A hundred and ninety nine patients were included. Thirty-three (16.9%) asthmatic patients presented CRSwNP; 16 (8.2%) patients have CRSsNP; and 146 (74.9%) did not meet CRS criteria. Chronic nasal obstruction, hyposmia and anterior rhinorrhea were related to CRSwNP, whereas higher SNOT-22 scores were related to CRSsNP. Conclusion: CRS was highly related to asthma, comprising prevalence of 25.1% in the present sample. Chronic nasal obstruction, hiposmia, anterior rhinorrhea and high values of SNOT-22 scores are predictive factors for CRS in asthmatics.
- ItemSomente MetadadadosInfluência do polimorfismo -1347 T > C na região regulatória do gene do TGF–β1 na rinossinusite crônica(Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Mendes Neto, Jose Arruda [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the influence of the c. – 1347 T> C polymorphism of the TGF – β1 gene on chronic rhinosinusitis (CRS). Methods: Patients requiring nasal surgery with CRS for failure of drug therapy were stratified into the groups: CRS group with nasal polyp (tRSCcP), phenotype exacerbated by non-hormonal anti-inflammatory drugs (DREA), asthma + CRS phenotype. non-intolerant polyp (ARSCcP), CRP phenotype with identified non-comorbid polyp (niRSCc), CRP-free polyp group (tRSCsP), CRP-free asthma phenotype (ARSCsP), CRP phenotype without identified comorbidity (niRSCsP). The tRSCcP and tRSCsP groups were formed by the gathering of all individuals with polyp and without polyp, respectively. The CSR group was formed by the gathering of all patients with tRSCcP and tRSCsP. The variables evaluated were: Bell nasal outcome test 22 (SNOT22), Lund-Kennedy endoscopic classification (LK) and Lund-Mackay tomography (LM), atopy, CRS groups and phenotypes, associated diseases (asthma, smoking, and intolerance to anti-inflammatory drugs), nasal (Et) and serum (Es) eosinophilia, serum IgE and nasal TGF – β1 concentration. Results: All groups were in genetic balance. Patients with ARSCsP had a significantly higher frequency of TC genotype than niRSCsP patients (P = 0.05). In the CRS group, there were significantly lower rates of SNOT and LK in the CC genotype (for CC x TC + TT; P = 0.05 and P = 0.05, respectively). In the CRS group, patients with CC genotype had significantly lower Es and IgE (for CC x TC; P = 0.013; P = 0.028; for CC x TC + TT; P = 0.014, P = 0.031, respectively). Still in the CRS group, there was a statistically lower frequency of asthma in the CC genotype (for CC x TC; P = 0.03; for CC x TC + TT, P = 0.04). In the DREA phenotype, patients with CC genotype had significantly lower scores in the LM classification (CC x TC + TT; P = 0.016). In the tRSCcP group, there was a significantly lower IgE concentration in the CC genotype (for CC x TC + TT, P = 0.0045; for CC x TC, P = 0.0095, for CC x TT, P = 0.03) . In the DREA phenotype, there was a significantly lower LM index in the CC genotype (for CC x TC + TT, P = 0.016). In the tRSCsP group, patients with CC genotype had significantly lower rates of SNOT (for CC x CT, xviii P = 0.027) and tissue eosinophilia (for CC x TC, P = 0.03). In the niRSCsP phenotype there was a statistically lower tissue and blood eosinophilia (for CC x TC + TT, P = 0.03 and P = 0.0023, respectively). Non-smoking asthmatics (DREA + ARSCcP + ARSCsP) with CC genotype had significantly lower TGF – β1 nasal concentration (for CCxTT, P = 0.05). Patients with CRS (tRSCcP + tRSCsP) with Et <10 per large field increase with CC genotype had significantly higher TGF – β1 nasal concentration than those with Et> 10. There was no influence of polymorphism on atopy. Conclusions: Patients with c. – 1347 CC genotype have a disease with better quality of life indices, less endoscopic and tomographic extension, and less local and systemic inflammatory impairment. The c.– 1347 T> C polymorphism is involved in the pathogenesis of asthma and may also modulate the TGF – β1 tissue concentration in CRS.
- ItemAcesso aberto (Open Access)Propriedades angiogênicas do pólipo nasal no modelo experimental da membrana corioalantóica de embrião de galinha(Universidade Federal de São Paulo (UNIFESP), 2019-12-18) Goes, Hallyson Andre Nascimento De [UNIFESP]; Pezato, Rogerio [UNIFESP]; Gomes, Lígia Ferreira [UNIFESP]; http://lattes.cnpq.br/4950570091832315; http://lattes.cnpq.br/8850675385685321; http://lattes.cnpq.br/5391537042617179; Universidade Federal de São Paulo (UNIFESP)Introduction: Nasal polyps are benign, semi-translucent, edematous masses that develop with anomalous growth from the mucosa lining the paranasal cavity, usually originating from the middle meatus mucosa. The participation of angiogenesis in nasal polyposis is fundamental for tissue growth, being proposed based on the positive regulation of proangiogenic factors in polyps, resulting from inflammation, edema or epithelial rupture. Objective: To investigate the potential of nasal polyp tissue to promote or modify angiogenesis. Methods: The effects of the implantation of 12 middle turbinate polyp fragments and 10 intact middle meatus nasal mucosa tissue fragments on the embryo chorioallantoic membrane were studied. The effects on embryonic development were described and correlated with the observed effects on chorioallantoic membrane vessel angiogenesis in 57 embryonic eggs divided into three experimental groups according to the type of tissue implanted: “control”; “Mucosa” and “polyp”. Angiogenesis was assessed by digitized membrane images, by the area and branching index of the medium and large vessels. Embryonic development was evaluated by weight, length and stage according to Hamilton and Hamburger. Results: The implanted tissues differentially modified membrane angiogenesis and embryo development. Nasal polyps, but not mucosal tissues, demonstrated the potential to promote or modify angiogenesis in the embryonated egg of Gallus Domesticus during the studied period (E6-E8). Polyp tissue implants were compatible with the normal development of Gallus Domesticus; mucosal implants induced delays in embryo development. Conclusion: Nasal polyp tissue has a higher angiogenic capacity than normal nasal mucosa tissue, favoring the nutrition and development of polypoid tissue.
- ItemAcesso aberto (Open Access)Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2016) Kosugi, Eduardo Macoto [UNIFESP]; Moussalem, Guilherme Figner [UNIFESP]; Simoes, Juliana Caminha [UNIFESP]; Felici de Souza, Rafael de Paula e Silva [UNIFESP]; Chen, Vitor Guo [UNIFESP]; Neto, Paulo Saraceni [UNIFESP]; Mendes Neto, Jose Arruda [UNIFESP]Introduction: Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. Objective: To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. Methods: Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1 mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. Results: Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p = 0.006) and Lund-Kennedy mean scores (8.8-5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. Conclusion: High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores. (C) 2015 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.
- ItemAcesso aberto (Open Access)Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis(Associação Brasileira de Divulgação Científica, 2005-02-01) Monteiro, Virginia r.s.g. [UNIFESP]; Sdepanian, Vera Lucia [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Fagundes-Neto, Ulisses [UNIFESP]; Morais, Mauro Batista de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Gastroesophageal reflux (GER) disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males) was 7.4 ± 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2%); total number of acid episodes (<50 episodes); number of reflux episodes longer than 5 min (3 or less), and duration of the longest reflux episode (<9.2 min). One patient (1/10, 10%) presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10% of chronic rhinosinusitis surgeries can be eliminated.