Treatment Of Chronic Sinusitis Research Articles

Efficacy of different biologics for treating chronic rhinosinusitis with nasal polyps: a network meta-analysis.

Currently, there is a debate around the use of biological agents in the treatment of chronic sinusitis with nasal polyps. Therefore, this study's purpose was to assess the effectiveness of various biologics in the treatment of chronic rhinosinusitis with nasal polyps. A systematic and manual search was conducted for all relevant studies from inception to December 20, 2023. Two independent authors carried out the search, screening, assessment, and data extraction. Network meta-analysis was conducted using STATA 14 software. Our analysis includes a comprehensive set of 19 studies. These studies compared the efficacy of four distinct biologic treatments. The results of reticulated Meta-analysis showed that Dupilumab (MD = -1.85, 95% CI: -2.47, -1.24), Omalizumab (MD = -1.30, 95% CI: -1.90, -0.70), Benralizumab (MD = -0.84, 95% CI: -1.66, -0.03) and Mepolizumab (MD = -1.48, 95% CI: -2.22, -0.74) were superior to placebo from the nasal polyp score(NPS), Dupilumab (MD = -12.56, 95% CI: -22.49,-2.63) was superior to placebo from the Sino-Nasal Outcome Test-22(SNOT-22)score, and Dupilumab (MD = -0.84, 95% CI: -1.08, -0.59) and Omalizumab (RR = -0.51, 95% CI: -0.83, -0.19) were superior to placebo from the nasal congestion severity(NCS). In terms of cumulative sorting under the surface of the curve (SUCRA) values, Dupilumab was the best performer in the NPS (0.92), SNOT-22 score (0.70), and NCS (0.93); Four different biologics outperformed placebo in the NPS, SNOT-22 score, and NCS. In patients with CRSwNP, based on the efficacy (NPS, (SNOT-22) score, NCS) and, dupilumab is the most efficacious for CRSwNP.

Mendelian randomization analysis of the causal relationship between asthma, allergic rhinitis, and chronic sinusitis

Objective: To explore the causal relationship between asthma, allergic rhinitis (AR), and chronic sinusitis (CRS), using two sample Mendelian randomization (MR) analysis, thereby providing foundational evidences for the pathogenesis and treatment of CRS. Methods: The genetic variations in AR and asthma were used as instrumental variables, with genetic data from the Integrated Epidemiology Unit (IEU) Open database. A total of 14 283 asthma and 18 934 AR cases were included, with 98 300 and 64 595 corresponding normal control cases, respectively. For CRS, there were 3 236 CRSwNP and 8 524 CRSsNP, respectively, with 167 849 and 167 849 corresponding normal control cases, respectively. The genetic data were analyzed using the inverse variance weighting method (IVW), MR Egger method, weighted median method, and Cochran's Q-test. Results: The IVW analysis showed that asthma increased the risk of both CRSwNP (OR=482.8, 95%CI: 57.18-4 077.78, P<0.001) and CRSsNP (OR=25.73, 95%CI: 9.79-67.56, P<0.001); AR significantly increased the risk of CRSsNP (OR=5.40, 95%CI: 1.68-17.26, P=0.004), but not CRSwNP (OR=7.38, 95%CI: 0.80-67.73, P=0.077). Conversely, neither CRSwNP nor CRSsNP increased the risk of asthma or AR. Conclusion: According to Mendelian genetic laws, asthma is a risk factor for CRSwNP and CRSsNP, while AR is a risk factor for CRSsNP.

The role of potassium ion channels in chronic sinusitis.

Chronic sinusitis is a common inflammatory disease of the nasal and sinus mucosa, leading to symptoms such as nasal congestion, runny nose, decreased sense of smell, and headache. It often recurs and seriously affects the quality of life of patients. However, its pathological and physiological mechanisms are not fully understood. In recent years, the role of potassium ion channels in the regulation of mucosal barrier function and inflammatory cell function has received increasing attention. In chronic sinusitis, there are often changes in the expression and function of potassium channels, leading to mucosal damage and a stronger inflammatory response. However, the related research is still in its early stages. This article will review the role of the potassium channel in the pathological and physiological changes of chronic sinusitis. The studies revealed that BK/TREK-1 potassium channel play a protective role in the nasal mucosal function through p38-MAPK pathway, and KCa3.1/Kv1.3 enhance the inflammatory response of Chronic rhinosinusitis by regulating immune cell function, intracellular Ca2+ signaling and ERK/MAPK/NF-κB pathway. Because ion channels are surface proteins of cell membranes, they are easier to intervene with drugs, and the results of these studies may provide new effective targets for the prevention and treatment of chronic sinusitis.

What Questions Do Patients Ask About Biologic Therapies for Chronic Sinusitis With Nasal Polyps?

Objective: The objective of this study is to explore the questions commonly asked online about biologic therapies for use in treatment of chronic sinusitis with nasal polyps (CRSwNP) and the quality of the available content. Methods: Most common search terms were identified via Google Trends. People Also Ask (PAA) questions were identified and extracted with their associated website using an online data-scraping program [Search Engine Optimization (SEO) Minion, Keywords Everywhere]. Sources were evaluated using Flesch Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE, higher number = better) score for readability; Journal of American Medical Association (JAMA) Benchmark criteria for quality assessment (0-4, 4 = all criteria met). Results: A total of 143 unique PAA questions and unique websites were identified. Questions were organized into 3 categories: questions about biologic therapies overall (38.46%), about CRSwNP (37.76%), and about treatment options for CRSwNP (23.78%). Websites answering PAA questions were from commercial (60.14%), medical practice (13.99%), academic (13.29%), and government (12.59%) sources. FKGL scores found the average reading level to be at approximately a 12th grade level (SD = 3.297) alongside a low reading ease FRE score of 37.6 (SD = 16.77). Mean JAMA criteria scores were 0.9895 (SD = 0.848), indicating largely low-quality materials. Conclusion: Biologic therapies are a novel treatment option for CRSwNP, and participants are seeking more information about these treatments and disease state. Online resources regarding biologics should be presented at a lower reading level. Sources with evidence-based information are needed. Physicians should be aware of these limitations in online material and counsel accordingly by curating and directing patients to good sources.Level of Evidence: Step 4.

Management of Chronic sinusitis through Siddha Treatment - A Case Report

Inflammation of one or more of the paranasal sinuses is called sinusitis. Sinusitis is classified 4 types based on symptoms persist. Bacterial or fungal infections are common causes for Chronic sinusitis One of the eight Indian peoples are affected by chronic sinusitis. According to siddha literature sinusitis is correlated with the symptoms of Peenisam, which is also called mukkataippu. 08/03/2022 a 27- year male patient attend our Muthu Siddha Hospital Seranmahadevi with the complaints of cold, rhinitis, nasal congestion, sneezing at every morning, itching present in both nasal cavity, pain present in nearby both maxillary region since last one month. A patient had a previous history of Chronic sinusitis. Symptoms are significantly reduced were observed under the siddha medicines such as a combination of siddha Sastric chooranam (Thalisathi chooranam, Palagarai parpam, Pavala parpam, Muthucippi parpam), Vasanthakusamakaram tablet for internal and Chukku Thailam is used for external use in oil bath. No recurrence of any chronic sinusitis clinical features like sneezing, nasal congestion and pain was observed during the five months of follow-up of siddha intervention done. To conclude this case report showed siddha medicines are very effective in the treatment of chronic sinusitis.

A pyocele of the frontal sinus as a complication of chronic sinusitis – a case report

Introduction: Pyocele is a rare complication of sinusitis that is usually associated with stenosis of the ostium of the sinus caused by inflammation, trauma. Case report: A 68-year-old woman was admitted to the Otolaryngology Clinical Department of the University Hospital in Krakow, Poland because of a tumor of the right frontal bone which was painful during palpation. In anamnesis the patient reported previous laryngological surgeries associated with the treatment of chronic sinusitis. The conducted medical imaging presented the destruction of the walls of both the right and left frontal sinuses caused by pathological changes penetrating to the orbit and adhering to the dura mater. The clinical and radiological picture suggested the diagnosis of empyema of the paranasal sinus (pyocele). The patient was scheduled for bilateral endoscopic frontoethmoidectomy and the surgery ended without complications. Nowadays, the patient remains under follow-up in the outpatient otolaryngology clinic. Discussion: The main disease entity, which should be included in the differential diagnosis of pyocele is the retention cyst of the sinus. The vast majority of pyocele cases are caused by superinfection of a mucocele by bacteria (in the described case the bacterial culture of the lesion content revealed the presence of Citrobacter koseri). An efficient and sufficient method of treatment of pyocele of paranasal sinuses is their endoscopic drainage. Conclusion: In the diagnosis of pyocele, the most important are data from anamnesis, physical examination and results from computed tomography and magnetic resonance imaging. Treatment is mainly based on properly performed surgery, pharmacotherapy and consecutive rehabilitation. Endoscopic surgery is an effective procedure and its early use often prevents serious complications resulting from the expansion of the lesion.

Systematic review and Meta-analysis of efficacy and safety of Biyuan Tongqiao Granules in treatment of chronic sinusitis

The present study conducted a systematic review and Meta-analysis on the efficacy and safety of Biyuan Tongqiao Granules in the treatment of chronic sinusitis. CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science were searched for randomized controlled trials(RCTs) of Biyuan Tongqiao Granules in the treatment of chronic sinusitis. The quality of the included RCTs was assessed according to the Cochrane risk-of-bias assessment tool and the final included trials underwent Meta-analysis with RevMan 5.4.1. Fifty-four RCTs were included, with a total sample size of 7 278 cases. The results of Meta-analysis showed that the clinical efficacy of Biyuan Tongqiao Granules alone or in combination in the experimental group in the treatment of chronic sinusitis was superior to that in the control group with conventional western medicine, Chinese medicinal preparations, or surgery only(RR=1.19, 95%CI[1.15, 1.24], P&lt;0.000 01). The combined use of Biyuan Tongqiao Granules on the basis of the control group was superior to the control group in improving the main symptoms and signs of chronic sinusitis [RR_(nasal congestion)=1.33, 95%CI[1.21, 1.45], P&lt;0.000 01, RR_(runny nose)=1.28, 95%CI[1.18, 1.40], P&lt;0.000 01, RR_(turbinate congestion or swelling)=1.28, 95%CI[1.16, 1.41], P&lt;0.000 01]. Biyuan Tongqiao Granules alone or in combination could effectively reduce the Snot-20 score, which was superior to the control group(MD=-2.94, 95%CI[-3.60,-2.28], P&lt;0.000 01). Biyuan Tongqiao Granules alone and in combination could effectively reduce the VAS score, which was superior to the control group(MD_(total score)=-4.44, 95%CI[-6.05,-2.82], P&lt;0.000 01; MD_(nasal congestion VAS score)=-0.99, 95%CI[-1.38,-0.60], P&lt;0.000 01; MD_(runny nose VAS score)=-1.19, 95%CI[-1.62,-0.76], P&lt;0.000 01; MD_(dysosmia VAS score)=-0.96, 95%CI[-1.26,-0.65], P&lt;0.000 01; MD_(head and face pain VAS score)=-0.73, 95%CI[-0.98,-0.47], P&lt;0.000 01). The combined use of Biyuan Tongqiao Granules could effectively reduce the sinus CT score and the Lund-Mackey score of the endoscopic mucosal morphology(MD_(sinus CT score)=-3.68, 95%CI[-5.47,-1.88], P&lt;0.000 1, MD_(endoscopic mucosal morphology score)=-3.06, 95%CI[-5.53,-0.59], P=0.02). Compared with the control group with conventional western medicine, Chinese medicinal preparations, or surgery only, combined use of Biyuan Tongqiao Granules did not increase the occurrence of adverse reactions(RR=0.68, 95%CI[0.26, 1.77], P=0.43). As demonstrated by the existing evidence, Biyuan Tongqiao Granules can improve the clinical efficacy of chronic sinusitis, relieve the clinical symptoms and signs, and reduce the Snot-20 score, VAS score, and Lund-Mackey score, without inducing serious adverse reactions, indicating that Biyuan Tongqiao Granules alone or in combination are more effective and safe in the treatment of chronic sinusitis than conventional western medicine, Chinese medicinal preparations, or surgical treatment. Since the quality of the included trials was generally low, large-scale, high-quality, rigorous, multi-center, and blinded-designed RCTs that meet international standards should be adopted in the future to increase the strength and level of evidence.

Effects of Endoscopic Sinus Surgery Combined with Budesonide Treatment on Nasal Cavity Function and Serum Inflammatory Factors in Patients with Chronic Sinusitis.

In this article, we have explored the effects of endoscopic sinus surgery together with budesonide treatment on nasal function and serum inflammatory factors on patients with chronic sinusitis. We retrospectively analyzed 120 patients with chronic sinusitis who were admitted to our hospital from March 2018 to March 2021 and were eligible for this study. They were separated into 2 groups according to different treatments, that is, the control group (treated with endoscopic surgery alone) of 58 cases and observation group (treated with endoscopic sinus surgery combined with budesonide) with 62 cases. Treatment efficacy, surgical status, overall symptom score before and after treatment, nasal mucociliary clearance function, serum eosinophils (EOS), serum immunoglobulin E (IgE), serum inflammatory factors, and occurrence of adverse reactions of both groups were recorded and compared. Total effective rate in the observation group presented strikingly more positive compared with that among patients in control group (P<0.05), as well as the data recorded in terms of operation time, blood loss during surgery and postoperative improvement time of patients (P<0.05). Overall symptom score, nasal mucociliary clearance, EOS, IgE and serum inflammatory factors in both groups were improved notably after treatment, while the observation group held a more obvious improvement. And it also had a markedly lower incidence of adverse reaction (P<0.05). Endoscopic sinus surgery combined with budesonide in the treatment of chronic sinusitis could effectively improve the clinical symptoms of patients, reestablish the function of the nasal cavity and improve their inflammation level. Meanwhile, it was of high safety and is worthy of clinical promotion.

S100A4/TCF Complex Transcription Regulation Drives Epithelial-Mesenchymal Transition in Chronic Sinusitis Through Wnt/GSK-3β/β-Catenin Signaling.

Epithelial-mesenchymal transition (EMT) is thought to be involved in the tissue remodeling and long-term inflammatory process of chronic sinusitis (CRS), but the driving mechanism is still unclear. Using high-resolution mass spectrometry, we performed a proteomic screen of CRS nasal mucosal tissue to identify differentially expressed proteins. Data are available via ProteomeXchange with identifier PXD030884. Specifically, we identified S100 calcium binding protein A4 (S100A4), an effective factor in inflammation-related diseases, and its downstream protein closely related to tissue fibrosis collagen type I alpha 1 chain (COL1A1), which suggested its involvement in nasal mucosal tissue remodeling. In addition, stimulation of human nasal epithelial cells (HNEpCs) with lipopolysaccharide (LPS) mimicked the inflammatory environment of CRS and showed that S100A4 is involved in regulating EMT and thus accelerating tissue remodeling in the nasal mucosa, both in terms of increased cell motility and overexpression of mesenchymal-type proteins. Additionally, we further investigated the regulation mechanism of S100A4 involved in EMT in CRS. Our research results show that in the inflammatory environment of CRS nasal mucosal epithelial cells, TCF-4 will target to bind to S100A4 and regulate its transcription. The transcription of S100A4 in turn affects the execution of the important signaling pathway in EMT, the Wnt/GSK-3β/β-catenin pathway, through the TCF-4/β-catenin complex. In conclusion, this study confirmed that the expression of S100A4 was significantly increased during the progressive EMT process of CRS mucosal epithelial cells, and revealed that the transcriptional regulation of S100A4 plays an important role in the occurrence and development of EMT. This finding will help us to better understand the pathogenesis behind the remodeling in CRS patients, and identify target molecules for the treatment of CRS.

Analysis of Process Costing for the Use of Navigation Systems in Functional Endoscopic Sinus Surgery

(1) Background: The use of navigation systems is rarely necessary for routine sinus surgery. They may prove to be advantageous for difficult operations, for example, in finding structures that are difficult to reach, in the treatment of cancers, or in revisional surgery. Navigation systems are also said to have positive effects on the self-confidence of surgeons in stressful situations and in the training of doctors. (2) Methods: This retrospective study included patients who underwent surgical treatment for chronic sinusitis from 2012 to 2016 at the ENT clinic of the University Hospital, Erlangen. Two groups were formed; one includes patients without navigated sinus surgery, the other includes those with navigation. The incision–suture times of both groups and cost analysis are compared. An appropriate cost estimate for sinus surgery is determined. (3) Results: From the available results, no economically efficient navigation systems in sinus surgery at the ENT clinic can be shown. The main reason is that lengthening the operating time leads to higher costs. (4) Conclusions: Although the use of a navigation system for endonasal sinus surgery cannot be economically justified, it is an important tool, especially in cases with complex anatomical conditions, and the system is essential for training purposes.

Challenges and opportunities in the treatment of chronic rhinosinusitis in children

Paediatric chronic rhinosinusitis (PCRS) is a common disease in children. It is defined as continuing inflammation of the nasal cavity and sinuses for ≥12 weeks. Because of the compound aetiology and pathophysiology of this disease in children, it is extremely important for the physician to consider the differential diagnosis before planning treatment. The aim of the review was to present the guidelines from The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) and promising treatment options of CRS in the paediatric population. The authors of the guidelines proposed a new division of chronic sinusitis (CRS). Chronic sinusitis has a greater impact on deteriorating the quality of life of patients than acute sinusitis. CRS is a syndrome with a multifactorial aetiology, resulting from an abnormal interaction between particular environmental factors and the host's immune system. The mucosa is chronically penetrated by the inflammatory process, which in many cases leads to tissue remodelling and clinical symptoms. EPOS 2020 recommendations are based on the use of proper nasal hygiene, sinus saline irrigations and topical corticosteroids. Surgical intervention is considered for patients with CRS who have failed appropriate medical therapy. However, there are new promising therapies on the horizon. The EPOS 2020 guidelines signaled the impact of immunomodulation on the development of the disease. In addition to the standard therapy recommended by EPOS 2020, new therapeutic options, such as low-dose macrolide (LDM) therapy and biological treatment, that may have a potential impact on improving CRS treatment in children, should be investigated.

Application of Minimally Invasive Surgery in the Treatment of Chronic Sinusitis Complicated with Polyps

Application of Minimally Invasive Surgery in the Treatment of Chronic Sinusitis Complicated with Polyps

The role of intranasal steroid therapy in the treatment of chronic sinusitis with nasal polyps

Polypoid rhinosinusitis (PRS) is a form of chronic rhinosinusitis (CRS), which is a heterogeneous group of pathological conditions based on a chronic inflammatory process of the nasal cavity and paranasal sinuses (PNS), leading to polypoid tissue formation. In most cases, T2-inflammation underlies the pathogenetic mechanism of PRS. In the presence of T2-associated conditions, the course of PRS is usually severe. The main aim of PRS treatment is to control symptoms, prolong the recurrence-free period, and restore the aeration of the PNS. The basic therapy of PRS involves the use of intranasal glucocorticosteroids (InGCS), which have a nonspecific anti-inflammatory effect by acting on different points of the pathological inflammatory process. The level of evidence for the use of InGCS is Ia: the drugs are included in Russian and foreign clinical guidelines for the treatment of polypoid rhinosinusitis. InGCS have high topical activity at low steroid doses. Mometasone furoate has an important place among this group of drugs because of its high efficacy, long-lasting therapeutic effect and optimal safety profile. The drug is officially registered for the treatment of PRS. Long-term use of mometazone furoate has been clinically observed to cause almost no atrophic nasal mucosal changes. It can be administered as monotherapy and in combination therapy over long periods of time in all phases of the treatment of PRS.

Ways to prevent acute viral infection and its bacterial complications

Viruses of the ARVI group that are tropic to the epithelium of the upper respiratory tract are able to inhibit the function of the mucociliary system to a certain extent, which contributes to the attachment of bacterial infection. Thus, in respiratory inflammatory diseases, the infection is often combined. This means, that the question about approaches to treatment at the stage of prevention of the development of complications of ARVI arises. A significant increase in the relapse of chronic sinusitis has been observed over the past 10 years. According to A.I. Kryukov et al. the relapse of inflammatory diseases of the paranasal sinuses, the chronic process has no tendency to decrease, aided by the unfavorable ecological situation, the growth of allergic and viral respiratory diseases, poor nutrition to which the body is not evolutionarily adapted. Worsening of chronic sinusitis contributes to many factors, but the starting point is almost always viral infections. Relapse, as a rule, begins with viral rhinitis, which is rarely an independent disease. Most often, a runny nose is a symptom of ARVI or ARI (influenza, parainfluenza, adenovirus infection, etc.). The entrance gate of infection is the epithelial cells of the respiratory tract. The main pathological process in sensitive cells develops both as a result of the penetration of the virus from the outside, and due to the activation of latent or chronic viral infection under the influence of various factors, including other infection.The appointment of drugs with anti-inflammatory, immunomodulatory, adaptogenic activity is one of the promising options for the prevention of both primary viral infection and the development of bacterial complications.We have included a drug that combines adaptogenic and immunomodulatory activities in the treatment of chronic sinusitis. Trekrezan belongs to the group of adaptogens – low-toxic compounds, it is recommended as a measure for the treatment and prevention of viral infections and increasing resistance to various stress factors (hypoxia, hypothermia) and adverse environmental effects.

ОБОСНОВАННОСТЬ НАЗНАЧЕНИЯ ПРОТИВОГРИБКОВЫХ СРЕДСТВ ПРИ ЛЕЧЕНИИ ХРОНИЧЕСКОГО СИНУСИТА У ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ

The article provides information on the frequency of detection of fungi of the genus Candida in HIV-positive and HIV-negative patients with chronic sinusitis. Information on the frequency of verification of this microorganism made it possible to calculate the probability of a fungal etiology of chronic inflammatory pathology of the paranasal sinuses and to substantiate the need for the use of antifungal agents in the treatment of chronic sinusitis in immunocompromised individuals. To assess the likelihood of fungal etiology, data on the clinical stage of immunodeficiency and the level of CD4 lymphocytes were used. As a result of the study, the indications for the appointment of antifungal agents in the treatment of chronic sinusitis in HIV-positive patients were determined, taking into account the clinical stage of HIV infection and the number of CD4 lymphocytes.

Anti-biofilm activity of bacteriophages and lysins in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is an otolaryngological disease with a recalcitrant nature, predominantly due to antibiotic resistant bacteria and the biofilm formation. The intracellular residency of Staphylococcus aureus bacteria was observed in CRS. The overall prevalence of CRS is estimated between 5-15% in the human population, and biofilms were formed in sinuses in 40-80% of cases. The bacterial species S. aureus and Pseudomonas aeruginosa are known to form difficult to treat biofilms in CRS. Bacteriophages (phages) or lysins can be alternatives to antibiotics in the biofilm treatment. The application of a P. aeruginosa phage cocktail ex vivo decreased biofilm biomass of bacterial isolates from the sinuses of CRS patients by a median of 70%. Further, animal studies performed on a sheep sinusitis model demonstrated significant reduction in S. aureus and P. aeruginosa biofilm biomass by phage cocktails while maintaining safe prolonged topical application (up to 20 days). Staphylococcal lysin P128 used at a concentration of ≥12.5 µg/ml in vitro against the biofilm of methicillin sensitive S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) isolates from the sinuses of CRS patients demonstrated a significant reduction of the biofilm (up to 95.5%). Staphylococcal lysin CHAP(k) applied in vivo in mice nasal infection caused a significant 2 log reduction of S. aureus suggesting its potential use against bacteria in nasal mucosa. Furthermore, a beneficial effect of phage therapy in the treatment of chronic sinusitis in humans was observed. Here, we summarize the recent, quite scarce data regarding phage application in chronic rhinosinusitis and look further into this phenomenon. Keywords: bacteriophages; biofilm; chronic rhinosinusitis; lysins; phage therapy.

МИКРОБИОЛОГИЧЕСКОЕ ОБОСНОВАНИЕ ВЫБОРА АНТИБАКТЕРИАЛЬНОГО ЛЕКАРСТВЕННОГО СРЕДСТВА ПРИ ПУНКЦИОННОМ МЕТОДЕ ЛЕЧЕНИЯ ХРОНИЧЕСКИХ СИНУСИТОВ У ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ

Purpose: to substantiate the choice of an antibacterial agent when using the puncture method for the treatment of chronic sinusitis in HIV-infected patients. Material. Microbiological studies were carried out in 108 HIV-infected patients with chronic sinusitis. The microbiological spectrum of pathogens of chronic inflammation of the paranasal sinuses in HIV-infected persons was determined, as well as the sensitivity of microorganisms to antibacterial agents. Results. The most frequently detected microorganisms in HIV-infected patients with chronic inflammatory pathology of the paranasal sinuses are gram-positive cocci (89,7 ± 2,9), including staphylococci (75,7 ± 4,1) and streptococci (14,0 ± 3,3). The verified microflora showed low sensitivity to antibiotics of the penicillin group (less than 65 % of sensitive strains), which limits the possibility of their use. A method for the treatment of chronic sinusitis in HIV-infected patients has been developed, based on the introduction into the sinus of an etiologically substantiated drug with a prolonged action. Conclusion. The revealed features of the spectrum of pathogens and the sensitivity of microorganisms in chronic sinusitis in HIV-infected patients made it possible to scientifically substantiate and develop a treatment method based on the introduction of a polyethylene oxide-based ointment containing chloramphenicol and methyluracil into the sinus.

Endoscopic endonasal repair of a cerebrospinal fluid leak secondary to a meningoencephalocele using a posterior – based middle turbinate flap

Cerebrospinal fluid leaks are rare but remain an important differential diagnosis for patients presenting with persistent, unilateral rhinorrhoea. This case describes a middle-aged female with persistent left sided rhinorrhea. She was minimally responsive to treatment for chronic sinusitis. On re-evaluation, a cerebrospinal fluid leak secondary to a meningoencephalocele was identified. This was subsequently repaired with a pedicled, vascularized graft using an endoscopic endonasal approach. The discussion which follows reviews the management of CSF rhinorrhoea with an emphasis on the available surgical options as well as the materials used for repair.

Enhanced production of recombinant serratiopeptidase in Escherichia coli and its characterization as a potential biosimilar to native biotherapeutic counterpart

BackgroundSerratia marcescens, a Gram-negative nosocomial pathogen secretes a 50 kDa multi-domain zinc metalloprotease called serratiopeptidase. Broad substrate specificity of serratiopeptidase makes it suitable for detergent and food processing industries The protein shows potent anti-inflammatory, anti-edemic, analgesic, antibiofilm activity and sold as an individual or fixed-dose enteric-coated tablets combined with other drugs. Although controversial, serratiopeptidase as drug is used in the treatment of chronic sinusitis, carpal tunnel syndrome, sprains, torn ligaments, and postoperative inflammation. Since the native producer of serratiopeptidase is a pathogenic microorganism, the current production methods need to be replaced by alternative approaches. Heterologous expression of serratiopeptidase in E. coli was tried before but not found suitable due to the limited yield, and other expression related issues due to its inherent proteolytic activity such as cytotoxicity, cell death, no expression, minimal expression, or inactive protein accumulation.ResultsRecombinant expression of mature form serratiopeptidase in E. coli seems toxic and resulted in the failure of transformation and other expression related issues. Although E. coli C43(DE3) cells, express protein correctly, the yield was compromised severely. Optimization of protein expression process parameters such as nutrient composition, induction point, inducer concentration, post-induction duration, etc., caused significant enhancement in serratiopeptidase production (57.9 ± 0.73% of total cellular protein). Expressed protein formed insoluble, enzymatically inactive inclusion bodies, and gave 40–45 mg/l homogenous (> 98% purity) biologically active and conformationally similar serratiopeptidase to the commercial counterpart upon refolding and purification.ConclusionExpression of mature serratiopeptidase in E. coli C43(DE3) cells eliminated the protein expression associated with toxicity issues. Further optimization of process parameters significantly enhanced the overexpression of protein resulting in the higher yield of pure and functionally active recombinant serratiopeptidase. The biological activity and conformational features of recombinant serratiopeptidase were very similar to the commercially available counterpart suggesting it-a potential biosimilar of therapeutic and industrial relevance.

Effects of electroacupuncture combined with interleukin‑10 on chronic sinusitis in mice.

Electroacupuncture (EA) has been documented as a form of therapy for chronic sinusitis (CRS). The present study aimed to assess the effects of EA combined with interleukin‑10 (IL‑10) overexpression on CRS in mice, and to investigate the associated mechanisms. A mouse model of CRS was established by the administration of ovalbumin (OVA), and overexpression of IL‑10 was induced using virus‑encoded IL‑10. The experimental groups were as follows: i)Control group; ii)OVA group; iii)OVA+EA group; iv)OVA+empty vector group; v)OVA+vector+EA group; vi)OVA+IL‑10 group; and vii)OVA+IL‑10+EA group. Pathological changes and nasal mucus were analyzed using hematoxylin and eosin staining. Interferon‑γ(IFN‑γ) and IL‑10 were detected via reverse‑transcription quantitative PCR and western blot analyses. The pseudostratified epithelium of the mucosa of the nasal sinus was impaired following the induction of CRS. Treatment with EA and/or IL‑10 reversed the injury. Combination treatment with EA and IL‑10 induced synergistic effects. No infiltration of inflammatory cells was observed in the submucosa following EA and IL‑10 treatment. Compared with the control group, the expression of IFN‑γ and IL‑10 in the OVA group was reduced. By contrast, EA or the overexpression of IL‑10 inhibited this reduction. Furthermore, the combined application of EA and IL‑10 had a significantly more potent inhibitory effect on the reduction of IFN‑γ expression, but not IL‑10. Collectively, EA combined with IL‑10 induced specific effects on CRS in mice, likely through the upregulation of IFN‑γ and IL‑10. The current study presented mechanistic implications for the application of EA as an alternative treatment for CRS.