Difficulty In Nasal Breathing Research Articles

Rhinosinusitis in children with acute respiratory infection: quality of life and features of drug therapy

BACKGROUND: The relevance of the study is due to limited information on the impact of various forms of rhinosinusitis that have arisen against the background of acute respiratory infection on the quality of life of children and effective treatment methods. AIM: To conduct a clinical assessment of the effect on the recovery time and quality of life in children with acute rhinosinusitis and exacerbation of polypous rhinosinusitis that occurred against the background of a respiratory infection, including antiviral drugs in complex treatment in the early stages. MATERIALS AND METHODS: A simple controlled randomized comparative clinical trial was conducted, involving 74 children aged 15 to 18 years. The clinical efficacy and safety of the use of antiviral drugs in complex therapy, which are neuraminidase inhibitors on the 5th, 7th and 10th days of treatment, were evaluated in comparison with groups receiving pentanedioic acid imidazolylethanamide. The inclusion criterion was acute rhinosinusitis and exacerbation of chronic polypous rhinosinusitis against the background of acute respiratory infection. To establish the diagnosis, an examination of ENT organs, computed tomography of the nose and paranasal sinuses were performed, patients subjectively assessed clinical complaints and quality of life in the Russian version of the standard form of the SF-36 questionnaire. RESULTS: Positive dynamics was noted in the early stages in the 2nd subgroup of the 1st group who took neuraminidase inhibitors in addition to complex therapy. Manifested by a decrease in the average score for VAS to 80.0%, difficulty in nasal breathing to 1.7 points on the 10th day of treatment, relative to those taking imidazolylethanamide pentanedioic acid, where there was a decrease in the average score for VAS by 22.4%, difficulty in nasal breathing to 2.54 points. A similar pattern was observed with nasal congestion, rhinorrhea, and quality of life indicators according to the SF-36 questionnaires. CONCLUSION: Improvement of clinical symptoms and quality of life indicators at an earlier date in children with polypous rhinosinusitis and acute rhinosinusitis against the background of a previous respiratory infection with the inclusion of neuraminidase inhibitors in complex therapy confirmed higher efficacy.

DENTAL STATUS OF PATIENTS WITH NEW CORONAVIRUS INFECTION COVID-19.

The aim of the investigation was to clarify the features of the clinical symptoms of patients with the new coronavirus infection COVID-19.
 Material and methods: A total of 156 patients undergoing treatment in COVID-hospitals were examined. The examination included the determination of the prevalence of: COVID 19 clinical symptoms, COVID 19 clinical manifestations in the oral cavity, concomitant diseases.
 Results. In the structure of general symptoms, complaints of hyperthermia, general weakness and cough (more often dry) played a leading role, which were noted by the overwhelming majority of the examined. Two-thirds of the patients reported body pain. The leading symptoms were also anosmia (in 68.6% of cases) and sweating (64.1%).More than half of the patients complained of shortness of breath (60.2%), difficulty in nasal breathing (55.1%), a feeling of tickling (58.3%) and pain (60.2%) in the throat. Among dental pathology, loss of taste (57.5%) and hyposalivation (38.5%) were the most common in patients. Bleeding gums were detected in 22.4% of the examined patients, which is most likely due to violations of the rheological properties of blood and changes in the hemodynamic provision of the periodontal during Covid19. Clinical manifestations of periodontal pathology do not occur immediately, but in the form of long-term complications. In this regard, it seems necessary to dynamically monitor the condition of patients who have undergone COVID-19 in different time periods.
 Conclusions. Hemostasis disorders characteristic of the new COVID-19 coronavirus infection certainly have an impact on the state of dental status, further destroying periodontal tissues. However, clinical manifestations of pathological effects may not occur immediately, but in the form of long-term complications. In this regard, it is necessary to dynamically monitor the condition of patients who have undergone COVID-19 in different time periods.

Management of Posttraumatic Cerebrospinal Fluid Leak with Secondary Diffuse Pneumocephalus Complicated by Meningitis and Communicating Hydrocephalus – Illustrative Case Report

Rhinorrhea is a possible complication after different types of traumatic brain injury or neurosurgical procedures, such as skull base operations. Pneumocephalus is a rarely noted complication after severe traumatic brain injury, and it may be accompanied by meningitis and ventriculitis, especially when treatment has been delayed. Treatment of these entities includes conservative and surgical approaches. Pneumocephalus may result in neurologic disturbances threatening a life. Therefore, active patient management with a multidisciplinary team is required to prevent poor outcomes. In the literature, limited cases of rhinorrhea and pneumocephalus are available, including in our country. Pneumocephalus may also occur spontaneously. In 2015, Pishbin et al. identified 10 cases of spontaneous pneumocephalus. The precise incidence of diffuse pneumocephalus after traumatic brain injury is unknown, reported as <1% of cases with rare complications. In this case, a 41-year-old male patient presented at a tertiary university hospital with the chief complaint of headache. A month prior to admission, the patient was discharged from another hospital with multiple skull and facial fractures, pneumocephalus, and traumatic subarachnoid hemorrhage in the left frontal lobe due to fights (Le Fort III). During the second hospitalization, the patient’s clinical status deteriorated. A repeated brain CT demonstrated diffuse pneumocephalus. Rhinorrhea was still present. The external lumbal drainage procedure was performed without stopping the cerebrospinal fluid leak. In children, pediatric inferior turbinate hypertrophy is a frequent cause of nasal breathing difficulties. In this case, no such hypertrophy was observed. It should be considered a nasal obstructive disease not necessarily related to adult entities, frequently associated with other nasal or craniofacial disorders. Early diagnosis and endoscopic management of rhinorrhea, nasal obstruction, and associated complications is vital, as delays can lead to life-threatening issues like hydrocephalus/meningitis. Eventually, the patient developed meningitis and acute communicating hydrocephalus. Right ventriculostomy with a programmable ventriculoperitoneal shunt placement was done (pressure 110 cm H<sub>2</sub>O), stopping the rhinorrhea. This is an extremely rare case where a patient, after cerebrospinal fluid (CSF) leakage, develops severe complications, including pneumocephalus, meningitis, ventriculitis, and acute communicating hydrocephalus. In the literature, we did not come across case reports presenting all the complications as in this case. This case report will raise knowledge and awareness of such entities, adding to the rare, similar cases reported so far.

Parallels between clinical and genetic characteristics in children with primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that leads to chronic inflammatory damage to the airways and auditory organs. This article presents current information and a study aimed at investigating parallels between the course of PCD and clinical and genetic variant of the disease, which contributes to a timely diagnosis and enables personalized treatment approach.The aim of the study was to identify phenotypic characteristics and chronological patterns of PCD course depending on the genotype.Methods. The study was conducted at the Veltischev Research Clinical Institute of Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University (Pirogov Medical University), Ministry of Health of Russia. The study included children with PCD who underwent next generation sequencing (NGS) of the exome.Results. Significant differences were found in the course of PCD based on clinical and genetic characteristics. Children with defects in the genes encoding central pair proteins are characterized by an earlier onset of daily productive cough and recurrent respiratory infections. A similar pattern is typical for patients with defects in the genes encoding the cilia assembly proteins. The first episode of respiratory infection occurs later in patients with defects in the genes encoding dynein handle proteins. Patients who do not have defects in PCD-associated genes are characterized by a late onset of persistent difficulty in nasal breathing, productive cough and respiratory diseases.Conclusion. Identification of clinical and genetic variants of PCD allows prediction of chronological features of the course of the disease.

Tomo-PIV in a patient-specific model of human nasal cavities: a methodological approach

The human nose serves as the primary gateway for air entering the respiratory system and plays a vital role in breathing. Nasal breathing difficulties are a significant health concern, leading to substantial healthcare costs for patients. Understanding nasal airflow dynamics is crucial for comprehending respiratory mechanisms. This article presents a detailed study using tomo-Particle Image Velocimetry (PIV) to investigate nasal airflow dynamics while addressing its accuracy. Embedded in the OpenNose project, the work described aims to provide a validation basis for different numerical approaches to upper airway flow. The study includes the manufacturing of a transparent silicone model based on a clinical CT scan, refractive index matching to minimize optical distortions, and precise flow rate adjustments based on physiological breathing cycles. This method allows for spatial high-resolution investigations in different regions of interest within the nasopharynx during various phases of the breathing cycle. The results demonstrate the accuracy of the investigations, enabling detailed analysis of flow structures and gradients. This spatial high-resolution tomo-PIV approach provides valuable insights into the complex flow phenomena occurring during the physiological breathing cycle in the nasopharynx. The study’s findings contribute to advancements in non-free-of-sight experimental flow investigation of complex cavities under nearly realistic conditions. Furthermore, reliable and accurate experimental data is crucial for properly validating numerical approaches that compute this patient-specific flow for clinical purposes.

Cytokine profile of nasal polyps and clinical characteristics of patients with polypous rhinosinisitis at different degree of therapeutic control and disease severity

The issues of recurrencies in chronic rhinosinusitis with nasal polyps (CRSwNP) still remain unresolved. Therefore, detection patients with uncontrolled clinical course of CRSwNP is required.The aim of the present study was to assess cytokine profile in nasal polyps as well as clinical characteristics of patients with CRSwNP at varying levels of therapeutic control.The study included 99 patients with chronic rhinosinusitis. The contents of interferon IFNγ, interleukin IL- 1β, IL-4, IL-5, IL-13, tumor necrosis factor TNFα, transforming growth factors TGF-β1, TGF-β2, TGF-β3 were measured in polyp tissue samples by means of multiplex analysis. The patients were treated according to a stepwise СRSwNP therapeutic algorithm [9]. Following observation for 5 years, all patients were divided into groups, as based on medical control degree. Group 1 included patients with mild CRSwNP, who mainly received stage I and II treatment for the entire observation period. Group 2 was presented by moderate- severity CRSwNP, with stage II or III therapy according to the referred algorithm. Group 3 included the patients with severe CRSwNP who received one or more stage IV courses. The patients underwent repeated SNOT-22 questionnaire, endoscopic examination, clinical assessment. In case of bronchial asthma (BA), ACQ-7 was repeated. Initial cytokine profile of nasal polyps was analyzed by the mentioned clinical groups.Results:After 5 years of observations in group 1 (mild CRSwNP), we found a minimal decrease in quality of life (SNOT-22), severity of nasal congestion, or smell impairment. Bronchial asthma duration in these patients was significantly lower compared to group 3, the patients had better asthma control level. Cytokine profile of nasal polyps was characterized by the highest IL-4 concentration, average values IL-1β, TNFα, IFNγ and minimal TGF-β1 values.In group 2 (moderate CRSwNP), we noted more pronouced impairment of smell, nasal congestion and quality of life. Bronchial asthma was less controlled than in group 1. The maximal concentrations of IFNγ, IL-1β, TNFα, IL-5, TGF-β1, TGF-β2 were registered.In group 3 with poor CRSwNP control, the highest SNOT-22 scores, severity of difficulty in nasal breathing, impaired sense of smell were revealed. Duration of bronchial asthma was longer, with lowest levels of medical control. In nasal polyps, minimal levels of IFNγ, IL-1β, TNFα, IL-4, IL-5, TGF-β2, TGF-β3 were noted.Treatment of patients depending on the clinical phenotypes of CRSwNP in the presence/absence of allergic rhinitis or bronchial asthma may improve control and reduce incidence of relapses in CRSwNP.

On the comparison between pre- and post-surgery nasal anatomies via computational fluid dynamics

Nasal breathing difficulties (NBD) are widespread and difficult to diagnose; the failure rate of their surgical corrections is high. Computational fluid dynamics (CFD) enables diagnosis of NBD and surgery planning, by comparing a pre-operative (pre-op) situation with the outcome of virtual surgery (post-op). An equivalent comparison is involved when considering distinct anatomies in the search for the functionally normal nose. Currently, this comparison is carried out in more than one way, under the implicit assumption that results are unchanged, which reflects our limited understanding of the driver of the respiratory function. The study describes how to set up a meaningful comparison. A pre-op anatomy, derived via segmentation from a CT scan, is compared with a post-op anatomy obtained via virtual surgery. State-of-the-art numerical simulations for a steady inspiration carry out the comparison under three types of global constraints, derived from the field of turbulent flow control: a constant pressure drop (CPG) between external ambient and throat, a constant flow rate (CFR) through the airways and a constant power input (CPI) from the lungs can be enforced. A significant difference in the quantities of interest is observed depending on the type of comparison. Global quantities (flow rate, pressure drop and nasal resistance) as well as local ones are affected. The type of flow forcing affects the outcome of the comparison between pre-op and post-op anatomies. Among the three available options, we argue that CPG is the least adequate. Arguments favouring either CFR or CPI are presented.

Chronic Vasomotor Allergic Rhinitis

In recent years, there has been a significant increase in the prevalence of diseases of the nose and paranasal sinuses (NPS). Inflammatory diseases of the nasal mucosa (rhinitis) are accompanied by difficulty in nasal breathing and nasal discharge. Chronic forms of rhinitis affect 10–20% of the population, and in epidemiological studies, 40% of respondents report symptoms of rhinitis. In this article, specific aspects of chronic vasomotor allergic rhinitis and treatment methods are considered

Unusual Presentation of SET::NUP214-Associated Concomitant Hematological Neoplasm in a Child-Diagnostic and Treatment Struggle.

Simultaneous multilineage hematologic malignancies are uncommon and associated with poorer prognosis than single-lineage leukemia or lymphoma. Here, we describe a concomitant malignant neoplasm in a 4-year-old boy. The child presented with massive lymphoproliferative syndrome, nasal breathing difficulties, and snoring. Morphological, immunocytochemical, and flow cytometry diagnostics showed coexistence of acute myeloid leukemia (AML) and peripheral T-cell lymphoma (PTCL). Molecular examination revealed a rare t(9;9)(q34;q34)/SET::NUP214 translocation as well as common TCR clonal rearrangements in both the bone marrow and lymph nodes. The disease showed primary refractoriness to both lymphoid and myeloid high-dose chemotherapy as well as combined targeted therapy (trametinib + ruxolitinib). Hence, HSCT was performed, and the patient has since been in complete remission for over a year. This observation highlights the importance of molecular techniques for determining the united nature of complex SET::NUP214-positive malignant neoplasms arising from precursor cells with high lineage plasticity.

Septoplasty- Does It Change the Quality of Life in Patients Having Nasal Obstruction?

Introduction: Deviated nasal septum (DNS) is one of the most common causes of nasal obstruction. However, there are several other etiologies which cause difficulty in nasal breathing. The definitive treatment of symptomatic DNS is septoplasty. The efficacy of septoplasty remains controversial as there are no solid tools for clinical evaluation of patients for establishment of reliable statistical data. Our aim was to evaluate patients who have undergone septoplasty for symptomatic DNS, by following them up with the NOSE questionnaire for predicting the surgical efficacy of septoplasty. Materials and Methods: This was a prospective observational study, conducted over 1 year. 50 cases of either sex of 18-65 years, having symptomatic DNS not relieved by medical management, and corrected by isolated septoplasty were included. The primary outcome was measured by the NOSE questionnaire, applied before surgery, and 6th week and 12th week after the procedure from which the 12th week nasal score was taken into consideration. Results: The paired T test done among the variables showed a clear significance, proving the efficacy of the NOSE score in predicting the symptom reducing efficiency of septoplasty Conclusion: The NOSE score can be used as a regular quality scoring system in analysing the outcomes of septoplasty.

Features of preoperative diagnosis of chronic lymphoproliferative syndrome of ENT organs in young children

Introduction. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, a comprehensive examination is necessary. Herpesvirus infection (HVI) plays an important role in the etiology of hypertrophy of lymphoid formations of the pharynx.Purpose. To evaluate the results of preoperative diagnosis of chronic lymphoproliferative syndrome in children in early childhood.Materials and methods. In 96 patients aged 1 to 3 years 11 months with lymphoproliferative syndrome more than 3–6 months, endoscopy, otomicroscopy, impedance, ultrasound examination of abdominal organs, cervical and submandibular lymph nodes, serological and molecular genetic analyses of markers of EBV, CMV, HCV-6 in the blood; PCR in pharyngeal tonsil scrapings were performed.Results and discussion. The clinical picture in children with chronic lymphoproliferative syndrome of younger age was dominated by complaints of difficulty in nasal breathing, snoring in 42% of children, recurrent otitis in 58%, manifestations of asthenovegetative and intoxication syndromes and frequent acute respiratory viral infections in 70% of patients. A high degree of infection of children of the younger age group was revealed – HCV-6 in 87%, CMV in 63% of children, 46% – EBV. And high activity of the infectious process in 31% of patients for all three GVI, more often for EBV in 27%. A combination of two or three GVI was detected in 83% of patients. During instrumental examination, a high degree of hypertrophy of the nasopharyngeal tonsils (adenoid vegetations of 2–3 degrees – 67% and 3 degrees – 18%, combined with hypertrophy of the palatine tonsils in 27% of cases), an increase in neck lymph nodes of more than 16mm, including lymph node packs in 28% of younger children and reactive hepatosplenomegaly in 17.7% of patients.Conclusion. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, it is important to assess the severity of lymphoproliferative syndrome according to the clinical picture and instrumental research methods (nasopharyngeal endoscopy, ultrasound examination of neck and abdominal lymph nodes) in combination with laboratory data and characteristics of the stage of activity of the infectious process of herpesvirus etiology.

Влияние назальной обструкции на газово-электролитный баланс организма

According to statistics, the most common complaint to an ENT doctor is difficulty in nasal breathing. The leading cause of such complaints is the curvature of the nasal septum, vasomotor and hypertrophic rhinitis. These conditions cause changes in the quality of life in the human body, and most importantly, the development of chronic diseases. The purpose of the study: to identify general patterns in patients with nasal obstruction, to develop recommendations for managing patients in the postoperative period. Patients and methods. In the period from 2018 to 2020, we examined 96 people aged 20 to 40 years: 72 of them were men, 24 were women with varying severity of nasal obstruction syndrome. The control group consisted of 16 people who did not complain of difficulty in nasal breathing. The patients were divided into two groups: those who received conservative treatment, and the group that was planned to undergo a surgical intervention aimed at eliminating nasal obstruction. Further, in patients of both groups, indicators of the acid-base state of venous blood were evaluated. Results. Indicators of the acid-base state of venous blood in patients of the group treated with a course of nasal decongestants and intranasal glucocorticosteroids remained practically unchanged after the treatment. Recovery of indicators of the acid-base state of venous blood in patients who underwent surgery is fully determined by the third month after the surgical treatment. Conclusions: The prevalence of diseases, including the hypoxic component, determines the need to study and understand the mechanisms of hypoxia, as well as the issues of eliminating oxygen deficiency, the process of adaptation to it.

A Case Study: Ayurvedic Management of Nasarshaw.s.r to Nasal Polyp

Nasais the most important organ ofUrdhwajatrugatabhagaand is the gateway for headas well as respiratory system. Nasarshas is one among the thirty-one Nasagata Rogasmentioned in our classics. Nasarshascan be correlated to nasal polyps. Nasal polyps are non-neoplastic masses of nasal or sinus mucosa. Prolonged use of antihistamines and antibiotics leads to drug resistance and decreases immunity, Fear of surgery, its complications and cost have restricted many patients from undergoing surgery and allopathic medicines. In this study a case of 31years male Patient presented with difficulty in nasal breathing, mouth breathing especially at night, sneezing, nasal discharge, headache since 9 months was taken for study. Present case study is taken to evaluate the efficacy of Ksharakarmain the management of Nasarshas w.s.r to Nasal Polyp along with internal medications for improve immunity and to reduce its recurrence. Ksharais an excellent medicine in the management of Arsha, as it has Lekhana,Tridoshaghna, Teekshna and Ushnaproperties. Shirovirechanabeing one of the Shodhana Karma,hence Nasyawith Apamarga Kshara Tailafollowed by Yava kshara prathisaranawas planned. Internally, Chitrakadi Vati,Triphala Gugguluand Haridra khanda, Hamsapadi Kashayawas prescribed. There was significant improvement in patient’s complaints and marked reduction in polypoidal mass.

Control of hormonal rhinitis symptoms in patients with hypothyrosis: pathogenetic and clinical aspects

One of the poorly studied sections of the pathology of ENT organs is chronic rhinitis in patients with hypothyroidism, the pathogenesis of which has not been fully understood, the diagnosis causes significant difficulties, and there are no recommendations for treatment. Despite receiving replacement therapy with levothyroxine, the symptoms of rhinitis persist. To study the effectiveness of the use of intranasal glucocorticosteroids in patients with chronic rhinitis and hypothyroidism. Patients with chronic rhinitis and hypothyroidism used mometasone nasal spray 100 mcg 1 time per day for a course of treatment of 2 months (n=60). To assess the symptoms of rhinitis, a visual analog scale (0-10 points), endoscopic examination of ENT organs, anterior active rhinomanometry were used. Evaluation of mucociliary transport was used a saccharin test. The concentration of transforming growth factor (TGF-β1) in nasal secretion and blood serum was studied by ELISA (Enzyme-Linked Immunosorbent Assay), the number of metabolites of NO - nitrites+nitrates (NOx) was recorded by colorimetric method. The use of mometasone nasal spray in patients with hypothyroidism helped to reduce complaints on a visual-analog scale (difficulty in nasal breathing, rhinorrhea) and improve nasal breathing according to anterior active rhinomanometry. The concentrations of TGF-β1 and NOx in nasal secretions before mometasone treatment were higher than after treatment, which probably indicates the contribution of these substances to the formation of edematous hypertrophic changes from the nose in patients with hypothyroidism.

Complex Approach to the Diagnosis of Children with Nasal and Nasopharyngeal Pathology. Key Results

Background. Nasal and nasopharyngeal pathology is one of the most important and widespread challenge in pediatrics and pediatric otorhinolaryngology. Prolonged nasal breathing difficulty can be caused by various diseases and their combinations. It requires multidisciplinary approach to diagnosis with the involvement of modern examination methods and pathogenetic treatment. Objective. The aim of the study is to develop complex technology for the management of children with nasal and nasopharyngeal pathologies. Methods. The study included 240 children aged from 6 to 18 years. All patients were divided into 3 groups, comparable by sex and age: Group 1 – 85 patients with confirmed ENT-organ disease, Group 2 — 104 patients with confirmed allergic disease, control group — 51 somatically healthy patients who did not have any ENT-organ or allergic diseases. Examination procedures: diagnostic nasopharyngeal endoscopy, rhinomanometry (RMM), rhinoresistometry (RRM), olfactometry. Results. The obtained results (RRM, RMM) have shown that air flow rate in nasal cavity increased due to nasal resistance decrease. Nasal resistance was higher and air flow rate was lower in all children with various ENT-organs or allergic diseases compared to the control group. Nasal resistance decreased in all study groups (significantly in children with aggravation of allergic diseases of airways and ENT-organs diseases) as well as air flow rate increased in all study groups (significantly in Group 1 and 2) after anemisation of nasal mucosa with decongestants. Apparently, it can be associated not only with anatomical features (nasal septum deviation), but also with inflammatory features of nasal cavity and nasopharynx (adenoid hypertrophy and inflammation, persistent swelling of nasal mucosa at allergic rhinitis). We would like to present the algorithm for diagnosis of children with nasal and nasopharyngeal pathologies according to the study results. The following practical guidelines have been proposed: 1) all patients with complaints on prolonged nasal breathing difficulties require not only otorhinolaryngologist examination, but also diagnostic endoscopy of nasal cavity and nasopharynx; 2) in case of nasal septum deviation and complaints on prolonged nasal breathing difficulties, it is necessary to perform functional methods for nasal breathing evaluating (RRM, RMM) to choose adequate treatment method; 3) the use of RRM, RMM would help to choose the optimal treatment approach in children with complaints on prolonged nasal breathing difficulties and confirmed diagnosis of allergic disease (allergic rhinitis, hay fever, etc.), also associated with adenoid hypertrophy and/or nasal cavity and nasopharynx inflammatory diseases; 4) all patients with confirmed chronic diseases of ENT-organs should be examined by allergist, and, if necessary, should undergo comprehensive allergological examination. Conclusion. The developed complex approach to the management of children with nasal cavity and nasopharynx pathology is innovative and represents the technology of personalized use of modern, objective methods for diagnosing the nasal cavity and nasopharynx state. The presented diagnostic algorithm and practical guidelines allow us to establish diagnosis and choose the treatment tactics within a short time. The use of these studies in clinical practice will allow to monitor the therapy efficacy (including various pharmacotherapeutic strategies) for nasal cavity and nasopharynx diseases in children. Timely examination and pathogenetic treatment will allow to prevent the chronization of pathological process in ENT-organs. This is especially crucial in childhood as it provides children with the best chance of healthy growth and development.

Nasopharyngeal sarcoidosis: a clinical case

Sarcoidosis is a chronic multisystem inflammatory disease characterized by non-caseous granulomas, most commonly in the lungs and intrathoracic lymph nodes. The nasopharyngeal disease is a rare localization of sarcoidosis. Clinical presentations include difficulty in nasal breathing, rhinophonia, and postnasal syndrome. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging are the main diagnostic methods for detecting lesions in this area. The histological examination provides the diagnosis verification. Considering the frequent secondary spread of sarcoidosis, all patients should consult a rheumatologist to select adequate systemic therapy. We provide a clinical case illustrating the management of a patient with nasopharyngeal sarcoidosis.

The effectiveness of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis

Introduction. In recent years, the world has seen an increase in the number of patients with difficulty in nasal breathing due to nasal obstruction, one of the causes of which are functional disorders of the nasal mucosa in various forms of rhinitis. Frequent use of intranasal decongestants among the population further contributes to the lack of effectiveness of conservative treatment and the need for surgical correction to restore free nasal breathing. This article discusses the possibility of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis to stop the clinical manifestations of the disease and improve the quality of life of patients. Аim. Тo evaluate the effectiveness of a drug containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with vasomotor and chronic subatrophic rhinitis in the complex treatment of nasal obstruction. Мaterials and methods. The study involved 48 adult patients of both sexes, aged 20 to 50 years, diagnosed with vasomotor (idiopathic) rhinitis in 24 and chronic subatrophic rhinitis in 24 patients. The studied preparation containing calendula, witch hazel, esculus, menthol and zinc oxide was smeared on the mucous membrane of the nasal cavity by laying gauze turundas for 5 minutes, 3 times a day, while the course of treatment was 10 days. The efficacy and safety of the drug was assessed by the dynamics of the severity of subjective symptoms, objective clinical data during control examinations by an otorhinolaryngologist in points, as well as by the presence of side effects in the treatment of the disease. Results. Results of the study showed a pronounced positive trend in the form of relief of subjective complaints and the main clinical manifestations of the disease, accompanied by an improvement in the quality of life in patients in both groups examined during treatment. Side effects were not observed in patients in both study groups. Conclusions. Based on the results of the study, conclusions were drawn about the efficacy and safety of using a complex homeopathic preparation containing calendula, witch hazel, esculus, menthol and zinc oxide in an adult group of patients with nasal obstruction, which makes it possible to recommend it for widespread use for the complex treatment of nasal syndrome. obstruction in vasomotor and chronic subatrophic rhinitis, as well as other forms of rhinitis accompanied by nasal obstruction syndrome.

Features of the course of influenza and its co-infection in children at the present stage

Influenza is an acute respiratory infection, mainly affecting the respiratory tract (often the trachea), with a tendency to develop symptoms rapidly and in most cases not requiring hospitalization. All acute respiratory infections are non-specific, with symptoms of intoxication, catarrhal symptoms (nasal congestion, rhinorrhoea, sore throat or pharyngeal discomfort), fever and cough. Improvement and widespread implementation of molecular methods to identify respiratory pathogens has led to the establishment of a higher frequency of co-infections. A literature review of the frequency of influenza co-infections is presented. Clinical cases of monoinfluenza and co-infections of influenza and respiratory syncytial infection are described, demonstrating the antagonistic effect of the two viruses on the course of the disease. In the first case, the patient, 1 year 1 month old, was hospitalised with a fever of 39 ºC in a moderate condition. A nasopharyngeal swab showed RNA of influenza A virus by PCR and was diagnosed with influenza. In the second case, the patient, 2 years old, at the beginning of the disease complained of an increase in body temperature to 38.7 ºC, cough, and difficulty in nasal breathing. On admission, the patient was in moderate condition with a body temperature of 36.6 ºC, clear consciousness and well-being. On auscultation, breathing in the lungs was rigid, single moist rales, scattered on both sides. A nasopharyngeal swab showed RNA of influenza A virus and respiratory syncytial virus by PCR. A viral acute respiratory infection of combined etiology and acute bronchitis was diagnosed. In the third case, a 14-year-old patient presented with complaints of fever up to 39 ºC, headache, weakness, muscle pain, dry cough. The condition was of moderate severity. The diagnosis of influenza A was confirmed by a rapid test for influenza A/B/C. In the treatment and prevention of both monoinfection and co-infections of influenza and other viruses, these clinical examples demonstrate the effectiveness of oseltamivir. These clinical examples highlight some key parameters: respiratory co-infections change the typical clinical picture of the disease, making it difficult to clinically diagnose the infection, highlighting laboratory diagnosis, which in turn facilitates rapid verification of the diagnosis and timely prescription of adequate therapy.

Результати аналізу епідеміологічного дослідження медичних даних щодо ефективності Назірус Синус сироп у комплексній терапії гострого вірусного та поствірусного риносинуситу в дітей

In pediatric practice, the prevalence of rhinosinusitis (RS) depends on age: so, in the age category of 6-7 years old, acute RS at least 1 time per year old affects 8.5% of children, and at the age of 13-14 years old - 14.6%. Acute RS is one of the most common reasons for prescribing antibiotics, so correct treatment is extremely important, given the global crisis of antibiotic resistance. The tactics of treatment of acute RS depends on the form, nature of the inflammatory process and the presence of complications. Purpose - to study the effectiveness of the plant-based dietary supplement Nasirus Sinus syrup in the complex therapy of children 3-11 years old with acute viral and postviral RS. Materials and methods. Were analyzed medical data of 1176 children 3-11 years old who received outpatient therapy with a clinical diagnosis of “Acute viral RS” and “Acute postviral RS” (ICD-10: J01.9). The difference between these patients was only the duration of the disease. Results. It has been established that the use of a plant-based dietary supplement Nasirus Sinus syrup in the complex therapy of children 3-11 years with acute RS helps to reduce subjective (nasal congestion, difficulty in nasal breathing, cough, snoring) and objective (mucous membrane hyperemia, postnasal drainage, rhinorrhea, wheezing, goopiness) manifestations of acute RS in a shorter time compared to the control group. The assessment of the severity of acute viral and postviral RS by Major Sinusitis Severity in absolute numbers in the main group was significantly different from the control group. Conclusions. When using the complex therapy of acute viral and postviral RS in children 3-11 years with the inclusion of a plant-based dietary supplement Nasirus Sinus syrup, the results indicate a decrease in the manifestation of symptoms already on the 3rd day of therapy, reliably demonstrates positive dynamics on the 5th and 7th days. Nasirus Sinus syrup should be recommended for use in children in the complex therapy of RS. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Smoke-related interstitial fibrosis – a case report

Smoking-related interstitial fibrosis (SRIF) is a recently described disease which is common finding in a long-term cigarette smokers.Aim. To acquaint readers with relatively unknown interstitial disease. We describe a case of a smoking patient with a long smoking history and squamous cell carcinomas of the larynx and lung who complained of an unproductive cough, sore throat, hoarseness, difficulty in nasal breathing, and shortness of breath during exercise. Obstructive disorders, lung hyperinflation, and a severe decrease in diffusion capacity reflected the signs of severe emphysema in combination with fibrotic changes found by high resolution computed tomography (CT). X-ray picture and characteristic histological changes made it possible to diagnose SRIF.Conclusion. Diagnostics of the disease should be based on CT-signs, histologic picture and functional data. The prognosis is relatively favorable.