Fluticasone Nasal Spray Research Articles

Ayurveda Management of Allergic Rhinitis: Protocol for a Randomized Controlled Trial.

Allergic rhinitis (AR) is the inflammation of the membranes lining the nose due to allergen exposure and is characterized by sneezing, nasal congestion, itching of the nose, or postnasal discharge. The prevalence varies worldwide, perhaps due to the geographic and aeroallergen differences, with 10% to 30% of the world's population experiencing AR. In this study, Anu Taila Nasya, Naradiya Laxmivilas Rasa, and Shirishadi Kwath will be compared to a fluticasone nasal spray. The primary aim is to assess the efficacy of Ayurvedic management for AR (or vataja pratishyaya) by comparing it to a conventional control group. The secondary aims are to determine the mean change in the nasal endoscopy index and the mean change in the laboratory tests. This ongoing study is an open-label randomized controlled interventional trial, with a sample size of 90 both in the trial and standard control group (including dropouts, 20%), and will be carried out for 24 months. Participants in the trial group will receive Ayurvedic treatment, that is, Anu Taila Nasya (6 drops in each nostril for 7 days for 3 consecutive weeks), Naradiya Laxmivilas Rasa (250 mg twice per day), and Shirishadi Kwath (40 ml twice per day for 45 days). The participants in the control group will receive a fluticasone propionate nasal spray (2 sprays once per day for 45 days). The primary outcome will include the mean change in the Control of Allergic Rhinitis and Asthma Test score, and the secondary outcomes will include the mean change in the nasal endoscopy index (assessment of nasal membrane color, pale or hyperemia; rhinorrhea, watery or yellow; and inferior turbinate swelling, hypertrophy) and the mean change in the laboratory tests. As of May 2024, 72 patients have been enrolled in both groups. Data analysis should be completed by February 2025. The study will be reported following standard guidelines for reporting randomized controlled trials. Clinical results will be disseminated through conferences and peer-reviewed publication in a relevant journal. The Ayurvedic approach could be an evidence-based therapeutic tactic for the management of AR. Clinical Trials Registry India CTRI/2023/06/053395; https://tinyurl.com/564d2zz8. DERR1-10.2196/56063.

Clinical Trial to Assess Efficacy of Fluticasone Nasal Spray and Smell Retraining Therapy on Post COVID-19 Anosmia in Suez Canal University Hospital

Clinical Trial to Assess Efficacy of Fluticasone Nasal Spray and Smell Retraining Therapy on Post COVID-19 Anosmia in Suez Canal University Hospital

Effects of oral prednisolone and fluticasone nasal spray in the management of chronic rhinosinusitis with polyposis: A prospective observational study

To study the effects of combination therapy with oral prednisolone and topical fluticasone propionate nasal spray in patients with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP). To study the improvement in symptom scores, Endoscopic and CT scores before and after treatment with combination therapy.This prospective observational study was conducted on 50 patients attending the Outpatient Department of Otorhinolaryngology, J.L.N Hospital and Research Centre, Bhilai (Chhattisgarh), India over a period of 6 months from February 2020 to July 2020. Patients with symptoms of CRSwNP persisting for more than 12 weeks were thoroughly examined clinically along with Nasal endoscopy and Computed Tomography scan of Nose and Paranasal sinuses (CT PNS) and pre-treatment Visual Analog Scale (VAS), Lund & Mackay Scores for Endoscopic and CT findings were noted. Patients were treated with combination therapy of oral prednisolone and fluticasone propionate nasal spray and post treatment scores were noted using similar scales during the follow up visits and the results were statistically analysed.Total mean age of patients suffering from CRSwNP in our study was 47.3 ± 12.58. Males were affected more by CRSwNP than females (76% vs 24%). At the end of 3 months from baseline 48 patients (96%) showed a reduction in nasal discharge, 47 patients (94%) showed a reduction in nasal obstruction, 25 patients (50%) showed improvement in facial pain and 17 patients (34%) showed improvement in hyposmia. Overall post treatment Visual Analog Symptom (VAS) score improved in 42 patients (84%), Nasal endoscopy (Lund - Mackay scoring) improved in 43 patients (86%) and Radiological CT PNS & Nose (Lund - Mackay Scoring) improved in 33 patients (66%).We found that combined therapy with oral prednisolone and fluticasone propionate nasal spray for 3 weeks is very effective in reducing the symptoms of chronic rhinosinusitis along with decrease in nasal secretions, edema and polyp size.

Comparative study between the efficacy of Azelastine-Fluticasone nasal spray combination and Fluticasone nasal spray combined with oral Cetrizine in Allergic Rhinitis

Comparative study between the efficacy of Azelastine-Fluticasone nasal spray combination and Fluticasone nasal spray combined with oral Cetrizine in Allergic Rhinitis

Efficacy of Topical Azelastine and Fluticasone Dipropionate Combination in Children With Adenoid Hypertrophy.

Adenoid hypertrophy (AH) is one of the common childhood diseases. Surgical and non-surgical treatment of AH in children is planned according to the severity of symptoms and associated complications. In recent years, treatment methods with intranasal sprays have been reported quite frequently in uncomplicated cases. We aim to evaluate the effectiveness of a new combination of azelastine - fluticasone (AZE-FLU) (137mcg azelastine and 50mcg fluticasone) nasal spray in children with uncomplicated AH. Sixty-five children diagnosed with AH were included in the study. The mean age of the children was 7.42 ± 2.26 (4-13years). The cohort consisted of 29 males and 36 females. All children were evaluated clinically and endoscopically. AZE-FLU nasal spray was applied to both nostrils twice a day for three months. Adenoid/choana ratio and symptom scores were evaluated before treatment and at the end of the 12th week. At the end of 24weeks of AZE-FLU application, there was a statistically significant decrease in both adenoid/choana ratio and symptom scores. While the initial adenoid/choana (A/C) score was 3.57 ± 0.58, it decreased to 1.74 ± 0.61 following treatment. A dramatic decrease in total symptom scores was observed. The total symptom score average was 15.63 ± 1.28 before treatment, while it was 2.31 ± 1.4 after the treatment with the difference being statistically significant (P < .01). In this study, the effectiveness of AZE-FLU nasal spray on AH was investigated for the first time. This treatment provides an effective alternative to the surgical approach in children with uncomplicated adenoid hypertrophy. Using this protocol, 96% of patients were removed from the surgery list. is IV.

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

INTRACTABLE COUGH CAUSING SPONTANEOUS RECTUS SHEATH HEMATOMA

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cough is a physiologic mechanism that causes airways to be cleared of foreign materials and excess secretions. The violent expiration is associated with rapid contraction of the diaphragm and the abdominal wall muscles leading to an increase in intraabdominal pressures. Longstanding untreated cough can lead to spontaneous abdominal wall hematomas. (1) CASE PRESENTATION: A 65-year-old gentleman presented to the Emergency Room with right lower quadrant abdominal pain of one-week duration. He had no past medical history. He was noted to have a persistent intractable cough for one month. Prior to the onset of cough, he had one week of loss of taste and smell, nasal congestion, nasal discharge and postnasal drip. According to him, the cough was so bad that he felt like he was going to burst. Although his family insisted, he did not get the cough evaluated. His vital signs were stable. Physical examination showed ecchymosis, a small palpable mass and tenderness in the right lower quadrant. Lung exam was unremarkable. Lab work unremarkable with normal platelet count and coagulation profile. Computed Tomography (CT) of the abdomen/pelvis showed an intramuscular vascular mass of 9 cm within the right rectus abdominis suggestive of a hematoma which was managed conservatively. Of note, he was not on any anticoagulants. On 1 month follow-up, he had complete resolution of abdominal pain, ecchymosis, mass and tenderness in the right lower quadrant. However, he continued to have a persistent cough for which he was referred to pulmonology. He visited the pulmonary clinic after 5 months of referral. At that time, he had become dependent on over-the-counter (OTC) oral decongestants and antihistamines. He had no reflux symptoms, no allergies, was a lifetime nonsmoker, employed as a banker and had a Labrador for 11 years. CT chest showed normal lung parenchyma. Pulmonary function tests revealed features of mild obstructive lung disease. His OTC medications were stopped and he was given a course of oral prednisone along with fluticasone and azelastine nasal spray with dramatic improvement and complete resolution of cough. DISCUSSION: Sustained cough results in over contraction and overstretching of abdominal muscles with an increase in intra-abdominal pressures. (2) Vigorous coughing plausibly generates shear forces high enough to tear superior and inferior epigastric vessels along the posterior aspect of long rectus muscle which results in rectus sheath hematomas. Almost 29% of spontaneous rectus sheath hematomas are the result of sustained cough the risk of which increases with the use of anticoagulants. (3) While these hematomas are conservatively managed, patients should undergo a thorough evaluation and treatment of cough to prevent its recurrence. CONCLUSIONS: This case highlights the potential of sustained vigorous cough to cause abdominal wall hematomas even in the absence of anticoagulants. REFERENCE #1: 1. Fuller RW, Jackson DM. Physiology and treatment of cough. Thorax. 1990;45(6):425-430. doi:10.1136/thx.45.6.425 REFERENCE #2: 2. Kodama K, Takase Y, Yamamoto H, Noda T. Cough-induced internal oblique hematoma. J Emerg Trauma Shock. 2013;6(2):132-134. doi:10.4103/0974-2700.110789 REFERENCE #3: 3. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006;85(2):105-110. doi:10.1097/01.md.0000216818.13067.5a DISCLOSURES: No relevant relationships by Fady Jamous, source=Web Response No relevant relationships by Swaminathan Perinkulam Sathyanarayanan, source=Web Response

Comparison of the Effects of Azelastine and Fluticasone Nasal Sprays in the Treatment of Allergic Rhinitis.

Allergic rhinitis is a highly prevalent, allergen-induced disease. Intranasal corticosteroids are currently the first-line therapy for these patients. It is uncertain whether intranasal antihistamines have comparable efficacy. This study compares effects of Azelastine and Fluticasone nasal spray in patients with allergic rhinitis. Prospective comparative study including 240 patients with allergic rhinitis was conducted with 120 each in fluticasone and azelastine group. Nasal sprays were given for period of three months along with an oral antihistamine. Follow up was done after three months. Pre and post treatment symptom assessment were done using Total nasal symptom score. The median TNSS in pre and post treatment of group A (fluticasone) is 10(4) and 1(3) which shows statistical significance with p value < 0.001. Median TNSS in pre and post treatment of group B (azelastine) is 9(4) and 1(2) which shows statistical significance with p value < 0.001. The median TNSS in pre and post treatment value between Group A and B shows no statistically significant difference between two groups with p value 0.56 and 0.06 respectively. Intranasal azelastine and fluticasone had comparable efficacy in symptom control in patients with allergic rhinitis. Azelastine due to its lesser side effects, can be safely used in children, patients with glaucoma and cataract. Azelastine may be considered as a safer replacement to fluticasone for long term use in patients with allergic rhinitis. A larger multicentric study with a bigger sample size may be required to confirm the efficacy and safety profile of azelastine nasal spray.

Efficacy of Post-Operative Oral Prednisolone for the Control of Disease in Allergic Fungal Sinusitis

Background: Ambiguity persists regarding the dosage, frequency, and duration for the use of oral steroids in Allergic Fungal Sinusitis (AFS). Objective: To assess the efficacy of post-operative oral steroid (prednisolone) for the control of disease in Allergic Fungal Sinusitis. Methodology: This was a comparative study, conducted at Bahawal Victoria Hospital, Bahawalpur from January 2019 to March 2019. A total of 40 patients, aged 18 or above with weight over 50 kilograms, having proved Allergic Fungal Sinusitis (AFS) as per criteria defined by Deshazo and Swain, were recruited for this study. All the patients were enrolled within 14 days of excisive sinus surgery adopting endoscopic sinus surgery with or without open methods. Group A (n=20) received oral steroids while Group B (n=20) received a placebo. Patients of both groups also used fluticasone nasal spray and oral itraconazole. Evaluation of all the patients was done at the time of enrollment, 6 and 12 weeks. Data were analyzed by SPSS version 21. Results: Out of a total of 40 patients, 17 (42.5%) were males. After 6 weeks of continuous therapy in both the study groups, 14 (70%) patients of Group A showed complete relief of symptoms in comparison to none in Group B (p-value = 0.001). After 12 weeks of therapy having tapering off in both study groups, all patients in Group A had complete relief of symptoms in comparison to only one (5%) in Group B (p-value = 0.001). Conclusion: Oral steroids of prednisolone, along with inhaled steroids therapy for a minimum of 12 weeks after excisive sinus surgery were found efficacious for the control of disease in patients with Allergic Fungal Sinusitis.

Comparative nasal airflow with loratadine-pseudoephedrine and fluticasone nasal spray for allergic rhinitis

BackgroundAlthough it is known that oral antihistamine-pseudoephedrine combination tablets have a faster onset than intranasal corticosteroid sprays in the treatment of allergic rhinitis after the first dose, the magnitude of change has not been measured in a comparative manner. Furthermore, the sensation of sprayed liquid in the nose may lead patients to mistakenly believe that intranasal steroid sprays work instantly. ObjectiveTo evaluate, numerically, nasal airflow changes provided by a single dose of loratadine-pseudoephedrine tablet (LP) and fluticasone propionate nasal spray (FP) in participants experiencing allergic rhinitis symptoms, including nasal congestion. MethodsThis single-center, double-blinded, placebo-controlled, crossover study evaluated objective nasal airflow changes in patients with a documented sensitivity to ragweed pollen. Participants were randomized to receive 1 of 4 treatment sequences, and their peak nasal inspiratory flow (PNIF) was measured in a span of 4 hours after pollen exposure in an environmental exposure unit. ResultsAverage change in PNIF was 31% with LP in the course of the study, significantly greater than with placebo and FP (12% and 15%, respectively; P < .001). Nevertheless, FP did not produce a significant change compared with its placebo. At hour one post-dose, LP had a clinically significant 31% increase in PNIF, whereas FP only yielded an 8.6% increase (P < .001). Measurable nasal airflow improvements are associated with the opening of nasal passages, allowing congested patients to breathe more freely. ConclusionA single dose of LP quickly and significantly (P < .001) improved nasal airflow after ragweed pollen challenge in an environmental exposure unit. Comparatively, FP did not display this same benefit. Trial RegistrationClinicalTrials.gov Identifier: NCT03443843.

Oral Corticosteroids Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis Without Nasal Polyposis

Although oral corticosteroids are commonly prescribed following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) without nasal polyposis, there are little data to suggest that this is a beneficial practice. To assess the efficacy of oral corticosteroids following ESS in CRS without polyps. This prospective double-blinded, placebo-controlled, randomized noninferiority clinical trial conducted in a single academic tertiary rhinology practice included adults with CRS without polyps undergoing ESS. Of 81 patients recruited, 72 completed the study. Patients were randomized into 2 treatment groups: a 12-day postoperative taper of oral prednisone vs matched placebo tablets. All study patients also received a uniform 2-week postoperative regimen of oral antibiotics, fluticasone nasal spray, and saline rinses. The primary outcome measures were Sinonasal Outcome Test-22 (SNOT-22) scores and Lund-Kennedy endoscopy scores, collected preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. Scores were compared between treatment groups at each time point using longitudinal difference between treatment groups and analyzed using 2-way, repeated measures analysis of variance. Secondary outcome measures included treatment-related adverse effects. Overall, 72 patients (mean [SD] age, 49.4 [14.9] years; 36 men, 36 women) completed the study, with 33 in the prednisone arm and 39 in the placebo arm. When comparing longitudinal differences between treatment groups, there was no clinically meaningful difference observed in SNOT-22 total (F[4254] = 1.71, η2 = 0.01 [95% CI, 0.00-0.05]) or Lund-Kennedy scores (F[4247] = 1.23, η2 = 0.02 [95% CI, 0.00-0.50]). In SNOT-22 subdomain analyses, there was no clinically meaningful difference between treatment groups for rhinologic, extranasal rhinologic, ear/facial, or sleep subdomains. However, the prednisone group had worse longitudinal scores for psychological dysfunction compared with the placebo group (F[4254] = 3.18, η2 = 0.05 [95% CI, 0.02-0.09]). Reported adverse effects were similar between the 2 treatment groups. In this randomized clinical trial of patients with CRS without polyps, oral prednisone following ESS conferred no additional benefit over placebo in terms of SNOT-22 total scores, SNOT-22 rhinologic subscores, or Lund-Kennedy endoscopy scores up to 6 months after surgery. Patients receiving prednisone, however, did demonstrate worse SNOT-22 psychologic subdomain scores. These results suggest that the risks of oral corticosteroids may outweigh the benefits; thus use of oral corticosteroids after ESS for CRS without polyps should be carefully considered. ClinicalTrials.gov Identifier: NCT02748070.

The outcome of fluticasone nasal spray on anosmia and triamcinolone oral paste in dysgeusia in COVID-19 patients

BackgroundTo study the outcome of fluticasone nasal sprays in smell disorders and triamcinolone paste in taste dysfunction in a population of laboratory-confirmed SARS-CoV-2 patients as the test group. The control group will not be given any intervention and only monitoring of these symptoms will be done to compare the recovery time. MethodsThis prospective interventional study was conducted from June to Nov 2020 at, Datta Meghe University during the COVID-19 outbreak. The 120 enrolled patients were tested at days 1 and 5 after proven infection by RT-PCR test. ResultThe mean age for all cases is 50.88 ± 15.93 years, whereas for the controls mean age is 51.2 ± 14.89. 2. Among cases 45 (75%) were males and 15 (25%) were females, among controls 43 (71.66%) were males and 17 (28.33%) were females. Among the case group, after the use of fluticasone spray in the nose and triamcinolone paste in the mouth there was a statistically significant improvement in recognizing all the odours and taste on day 5 compared to day 1. On comparing the smell and taste of cases and control group, either there is no improvement or worsening in smell or taste on day 5 in the control group. ConclusionThe use of fluticasone nasal spray and triamcinolone paste had immensely influenced the basic senses such as smell and taste. Our study showed that olfactory and taste function significantly improved in patients with COVID-19. For all anosmia and dysgeusia cases who received fluticasone nasal spray and triamcinolone medications the recovery of smell senses and the taste was within a week.

English

BACKGROUND Allergic rhinitis is a fairly common condition. A large number of patients of allergic rhinitis are usually found in daily ENT practice. Symptoms of allergic rhinitis are still a major problem, which can affect day to day activities of an individual. Intranasal corticosteroid has potent anti-inflammatory actions and is believed to exert its beneficial effects by inhibiting several types of cells and chemicals involved in immune and inflammatory responses. Present study determines the efficacy of intra nasal corticosteroid over placebo in patients of allergic rhinitis. METHODS A single blinded non-randomised trial was conducted among patients attending allergy clinic of ENT out-patient department of a Tertiary Medical College &amp; Hospital of West Bengal, India from March 2008 to May 2008. Two groups of patients were selected from the total sample size of 100 patients by alternate sampling technique. One group (Gr-F) was treated by intranasal corticosteroid (fluticasone nasal spray) and the other group (Gr-P) by placebo (normal saline aqueous spray) for 6 consecutive weeks. Patients were asked about their subjective feeling of symptoms and relevant examinations &amp; investigations were carried out. Improvements following treatment were judged by total nasal symptoms scoring. Collected data were analysed using SPSS version 20. McNemar’s test was carried out on paired nominal data and p value of &lt; 0.05 was considered to be statistically significant. RESULTS The present study revealed that 69 % male and 31 % female were suffering from allergic rhinitis. Most common symptom was nasal discharge followed by sneezing and nasal obstruction. 41 % had family history of allergic rhinitis. It was seen that inflamed nasal mucosa reverts back to normal in 35 % in fluticasone group after 6 weeks of treatment. Study also showed the decrease of blood eosinophil count in 60 % of patients in fluticasone group. 92 % of patients in the fluticasone group revealed that they improved after taking the drug, whereas 88 % of patients in placebo group did not improve after taking spray. CONCLUSIONS It can be concluded from the present study that intra nasal corticosteroid spray is more effective than placebo for treatment of allergic rhinitis. KEYWORDS Allergic Rhinitis, Intranasal, Fluticasone, Corticosteroid, Normal Saline, Efficacy

A MASS COMPATIBLE UPLC METHOD FOR THE QUANTIFICATION OF IMPURITIES IN FLUTICASONE PROPIONATE NASAL SPRAY

Objective: The objectives of the present study were to develop and validate a mass compatible ultra-performance liquid chromatography (UPLC) method to quantify the impurities in fluticasone nasal spray, and to establish a suitable container-closure system for the formulation.&#x0D; Methods: A gradient method was optimized with a flow rate of 0.5 ml/min, detector wavelength-240 nm, run time-25 min and 0.1% Trifluoroacetic acid (TFA) in water as solvent A and Methanol as solvent B.&#x0D; Results: The developed method was linear over the range of 0.07-1.10 µg/ml for impurity-I, 0.16-2.47 µg/ml for impurity-II, 0.67-10.0 µg/ml for impurity-III, and 1.29-19.3 µg/ml for impurity-IV. The limit of quantification (LOQ) and limit of detection (LOD) were established as 0.07 and 0.02 µg/ml, 0.14 and 0.05 µg/ml, 0.59 and 0.19 µg/ml, 1.06 and 0.35 µg/ml for impurities I-IV respectively. The percent relative standard deviation (%RSD) of the replicate analysis for impurities I-IV, was within the acceptance criteria (0.4, 0.2, 0.3, and 0.1% respectively) that proved the precision of the method. The accuracy of the method was studied from 50%-150% of test concentration and the results ranged from 100.3% to 109.4%. The container-closure compatibility study revealed that the solution stored in the glass container system did not generate any additional peaks in the chromatogram.&#x0D; Conclusion: Hence, the developed method can be employed by quality testing laboratories to quantify impurities in fluticasone propionate nasal spray. The study also suggests that glass containers could serve as a compatible system for the storage of fluticasone propionate nasal solution.

Emesis- Football

HISTORY: An 18-year-old NCAA D-I football athlete developed emesis during exercise. During his freshman season, he had recurrent URIs and emesis during practice. The vomiting appeared to be post-tussive during intense exercise. The athlete has not experienced this before but has a history of asthma and allergies. Symptoms improved temporarily with a non-sedating antihistamines and a H2 blocker. But, after one week, the vomiting returned. A PPI, fluticasone nasal spray and albuterol were then added, which appeared to help. Symptoms returned in the spring and montelukast was added to his regimen. He continued to complain of mucus accumulating in his throat that would cause him to gag which would occur with intense exercise and then even while trying to sleep. An EGD was performed which was normal. The athlete was then referred for allergy testing and immunotherapy. PHYSICAL EXAMINATION: Afebrile. Pulse ox 98% on room air. NAD, A&O. Nasal mucosa is pale, boggy and swollen with clear d/c; TM clear bilaterally; OP with posterior cobble stoning; no tonsillar exudate or erythema. No cervical LAN. CV: RRR. Lungs CTAB. Abdomen ND, BS (+), mild epigastric TTP, and no rebound or mass. DIFFERENTIAL DIAGNOSIS: 1. Sinusitis 2. Allergic rhinitis 3. GERD 4. Gastritis 5. asthma TESTS AND RESULTS: Chest radiograph: normal Spirometry Testing: - normal FVC - FEF max was decreased - Increased RV/TLC - diffusion 68% of predicted EGD: normal Allergy testing: (+) ragweed pollen, several weed pollens, tree pollens, several grasses, dust mites, cockroach, animal dander FINAL/WORKING DIAGNOSIS: Allergic rhinitis accompanied by emesis due to hypersensitive gag reflex stimulated by postnasal drip TREATMENT AND OUTCOMES: 1. Continue antihistamines and fluticasone nasal spray 2. Weekly immunotherapy injections 2. Dust mite bed covers to reduce exposure 3. Medication compliance With the above measures, the athlete’s symptoms were controlled and he continues to play football without difficulty.

Anterior Knee Pain In A Runner

HISTORY: 40 yo F runner with bilateral, right, anterior, aching, intermittent, 3-10/10 knee pain. Wakes at night. Worse with going down stairs, running, fast walking. Better with rest and ibuprofen. ROS negative. PMHx: DVT, PE, depression, endometriosis, sleep apnea. PSHx: C-section, IVC filter. Meds: ibuprofen prn, citalopram, fluticasone nasal spray, Coumadin. FHx: DVT in father. SocHx: +tobacco, no alcohol or drug use; desk job; recreational runner. No recent immobilization/long travel. PHYSICAL EXAMINATION: BMI 38, vitals stable. Knee Exam: No malalignment, bruising, erythema, or obvious swelling; gait normal. Full AROM without pain; + patellar j sign; + patellar crepitus; 5/5 strength without pain; Neurovascularly intact. Negative patellar apprehension; equivocal patellar inhibition. positive patellar grind bilaterally. Full AROM. Negative bounce test, McMurray. Minimal tenderness of medial joint line. Palpable, firm 4cm mass in the right popliteal fossa that is mildly tender to palpation. No overlying skin changes. No ligamentous instability, calf pain, swelling, tenderness, warmth, erythema. Negative Homan’s sign. DIFFERENTIAL DIAGNOSIS: For mass: synovial/baker’s cyst, ganglionic cyst, meniscal cyst, DVT, aneurysm, muscular deformity, soft tissue mass TEST AND RESULTS: -2-view knee x-ray: ill-defined soft tissue sclerosis in the posteomedial right knee which could be a bone forming soft-tissue tumor, Moderate bilateral tricompartmental knee OA. -Knee MRIt: Round, lobular mass measuring 3 x 3 x 3.6 cm adjacent to the distal semimembranosus myotendinous junction. Central ossification and a thin rim of peripheral enhancement.A bone forming tumor, benign or malignant, is a possibility. -Bone tumor surgeon notified and patient seen. Felt unrelated to symptoms and likely secondary to prior trauma. CT knee and CXR. CXR normal. -CT without contrast: Soft tissue calcified lesion medial to the patient's small Baker's cyst partially surrounds the semitendinosus tendon. Tissue sampling is recommended to exclude a matrix forming neoplasm. Knee OA. -Sarcoma Tumor Board: benign; treat underlying knee pain. FINAL WORKING DIAGNOSIS: Benign soft tissue calcified lesion of the knee TREATMENT: symptomatic treatment, quit smoking, weight loss OUTCOME: asymptomatic at 2-months

Efficacy of Bimin decoction for patients with perennial allergic rhinitis: an open-label non-inferiority randomized controlled trial

BackgroundAllergic rhinitis (AR) is a common allergic disease. It affects people worldwide and traditional Chinese medicine is becoming popular among AR patients because it has a definite clinical effect and there are few adverse reactions. Lung qi deficiency and cold syndrome (LQDCS) is a frequent type of AR, and the Chinese herbal medicine bimin decoction (BMD) is prescribed for it. This study compared the clinical efficacy of BMD for AR patients with LQDCS to the conventional medicine loratadine and fluticasone nasal spray.MethodsThe study was an open-label non-inferiority randomized controlled trial. A total of 108 AR patients with LQDCS aged 19 to 60 were randomly allocated in a 1:1 ratio to the BMD group or the control group by the central computer system in Beijing Hospital of Traditional Chinese Medicine from January 2017 to April 2018. In total, 98 participants completed the study (BMD group n = 51 and control group n = 47). Patients in the BMD group received BMD while those in the control group received fluticasone nasal spray and loratadine tablets for 4 weeks. The primary outcome was the change in the Total Nasal Symptom Score (TNSS) between the baseline and the end of treatment. Changes in the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal resistance, and acoustic rhinometry parameters were secondary outcomes. All side effects due to the treatments were recorded.ResultsAfter the 4-week treatment, the total TNSS was significantly reduced in both groups compared to the baseline (P < 0.05). No significant between-groups differences were observed for changes in TNSS scores [− 0.298 (95% confidence interval −0.640 to 0.140)], which was within the defined non-inferiority margin. RQLQ in both groups decreased significantly (P < 0.001) from baseline, though a more obvious reduction was observed for the BMD group (P < 0.001). There were no significant differences in nasal resistance, nasal volume, or nasal minimum cross-sectional area between groups after treatment (P > 0.05).ConclusionsThese findings indicate that BMD helps relieve the symptoms of perennial AR and improves rhinitis-related quality of life. Our study indicates that BMD is non-inferior to loratadine tablets and fluticasone nasal spray for AR patients with LQDCS.Trial registrationChinese Clinical Trial Registry, ChiCTR-INR-16010063. Registered on 2 December 2016.

Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps

IntroductionThe antiinflammatory effects of macrolides, especially clarithromycin, have been described in patients with chronic rhinosinusitis without polyps and also other chronic inflammatory airway diseases. There is no consensus in the literature regarding the effectiveness of clarithromycin in patients with chronic rhinosinusitis with sinonasal polyposis and the national literature does not report any prospective studies on the efficacy of clarithromycin in chronic rhinosinusitis in our population. ObjectiveTo evaluate the effect of clarithromycin in the adjunctive treatment of recurrent chronic rhinosinusitis with sinonasal polyposis refractory to clinical and surgical treatment. MethodsOpen prospective study with 52 patients with chronic rhinosinusitis and recurrent sinonasal polyposis. All subjects received nasal lavage with 20 mL 0.9% SS and fluticasone nasal spray, 200 mcg / day, 12/12 h for 12 weeks; and clarithromycin 250 mg 8/8 h for 2 weeks and, thereafter, 12/12 h for 10 weeks. The patients were assessed by SNOT 20, NOSE and Lund-Kennedy scales before, immediately after treatment and 12 weeks after treatment. The patients were also evaluated before treatment with paranasal cavity computed tomography (Lund-Mackay) and serum IgG, IgM, IgA, IgE and eosinophil levels. The outcomes evaluated were: SNOT-20, NOSE and Lund-Kennedy. ResultsMost patients were women, aged 47 (15) years (median / interquartile range), and 61.5% (32/52) had asthma. All patients completed the follow-up after 12 weeks and 42.3% (22/52) after 24 weeks. Treatment resulted in a quantitative decrease in the SNOT-20 [2.3 (1.6) vs. 1.4 (1.6); Δ = −0.9 (1.1); p < 0.01]; NOSE [65 (64) vs. 20 (63); Δ = −28 (38), p < 0.01] and Lund-Kennedy [11 (05) vs. 07 (05); Δ = −2 (05); p < 0.01] scores. SNOT-20 showed a qualitative improvement (>0.8) in 54% (28/52, p < 0.04) of patients, a group that showed lower IgE level [108 (147) vs. 289 (355), p < 0.01]. The group of patients who completed follow-up 12 weeks after the end of treatment (n = 22) showed no worsening of outcomes. ConclusionLong-term adjuvant use of low-dose clarithromycin for chronic rhinosinusitis patients with recurrent sinonasal polyposis refractory to clinical and surgical treatment has resulted in improved quality of life and nasal endoscopy findings, especially in patients with normal IgE levels. This improvement persisted in the patient group evaluated 12 weeks after the end of the treatment.

Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/or diabetic patients

BackgroundAllergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic.Patients and MethodsA total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months.ResultsPatients of group B were better clinically and also by endoscopic examination.ConclusionItraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.

A Randomized Clinical Trial of Elemental Zinc Add-on Therapy on Clinical Outcomes of Patients with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP).

Recent studies suggest a relationship between zinc deficiency and inflammation. In the present study, we studied the effect of oral zinc supplementation on clinical improvement of chronic rhinosinusitis with nasal polyposis. In this single-blind randomized controlled trial, 44 patients with chronic rhinosinusitis with polyposis referring to ENT clinic of the Loghman Hakim hospital during 2013-2014 were randomly allocated in two groups. The treatment group (n = 28) was treated with a four-drug fixed-dose regimen (FD_FDR) consisting of oral dexamethasone (0.02 mg/kg), fluticasone nasal spray, fexophenadine 60 mg daily, montelukast 10 mg daily plus 220mg zinc sulfate capsules containing 55 mg elemental zinc, b.d., and the control group (n = 16) received the FD_FDR without supplemental zinc, for six weeks. After sixth week, two groups were compared regarding clinical outcomes based on theSNOT20 (Sinonasal outcome test) questionnaire, the general health questionnaire (SF12), the Lund-Mackay, and the Lund-Kennedy scoring systems. In the treatment group, serum zinc levels were significantly increased compared to those at the baseline (1.33 fold-increase; p = 0.0002). Within groups analysis revealed a significant reduction (p < 0.01) in LM and LK in both treatment (55% LM; 50% LK) and control groups (45% LM; 53% LK). Incontrast, between groups analysis revealed no significant differences in the LM and LK. The treatment group showed a mild superiority in general health improvement compared to that of the control group. Add-on therapy with supplemental zinc sulfate was not associated with significant improvement in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). The advantage of zinc supplementation on the general health improvement of the patients with CRSwNP requires further assessments.