Search Results (56)

This study contributes to the broader sustainability discourse by evaluating public knowledge, awareness, and practices regarding air pollution among residents of Hanoi, Vietnam, focusing on its causes, health impacts, and mitigation strategies. A cross-sectional survey was conducted with 521 individuals in suburbs around Hanoi. A multistage sampling technique, combining cluster and simple random sampling, was used for participant recruitment. Three central and three suburban districts of Hanoi were randomly selected as clusters. One individual from each household was invited to participate and answer a structured survey, which assessed perceptions of air pollution, its human-induced causes, recognised health impacts, and individual and community-level mitigation behaviours. Nearly all participants (98.3%) were aware of air pollution, with 65.3% attributing it to human activities and 61.2% recognising specific air pollutants as primary contributors. The majority (93.9%) acknowledged health impacts, citing respiratory infections (55.1%) and sinus issues (51.2%) as prevalent concerns. Vulnerable groups, such as children under 5 (82.3%) and adults over 65 years old (77.4%), were identified as disproportionately affected. Social media (68.9%) and television (58.3%) were the dominant sources of information. Despite a recognition of air pollution’s importance (98.5%), there was limited engagement in systemic sustainability actions, such as supporting renewable energy initiatives. Most participants (84.3%) reported personal mitigation efforts, including energy-saving practices (35.5%) and walking instead of driving a car or bike (35.3%). While awareness of air pollution and its health impacts is high among Hanoi residents, proactive engagement in systemic solutions remains limited. Policymakers should prioritise community-based programs, public–private partnerships, sustainability education, and culturally tailored policy interventions to bridge gaps between awareness and action. Tailored interventions addressing demographic and cultural factors are essential to fostering socio-environmental sustainability in rapidly urbanising contexts. Full article

Objectives: Odontogenic sinusitis (ODS) is common but frequently overlooked condition that differs from rhinogenic sinusitis (CRS) and should be suspected in each case of unilateral sinusitis. Clinical symptoms such as foul smell, congestion, rhinorrhea, and unilateral maxillary sinus opacification with overt dental pathology on radiological scans are more suggestive of ODS than CRS, but the distinctive microbiological flora are another clinical factor in diagnosis. The aim of this study was to compare the microbiological load of ODS and CRS and their clinical presentation for better disease recognition and its predisposing factors. Methods: Adult patients scheduled for endoscopic sinus surgery were included in the study. Clinical data and radiological images were analyzed. The otolaryngologist assessed nasal endoscopy for mucopurulence or edema in middle meatus or sinuses, whereas dental specialist confirmed or ruled out the dental cause. Microbiological samples were collected after endoscopic maxillary antrostomy. After irrigation with 0,9% saline, the aspirated rinse was collected into sterile sets and sent for culturing. Results: The study group consisted of 84 patients, 55 with CRS and 29 with ODS. Streptococcus spp prevailed in the CRS group, whereas Staphylococcus spp prevailed in the ODS group. Statistically significant differences between the groups were found in type of discharge, degree of edema, and presence of polyps. However, no statistical correlations were noted for presence of bacteria in the culture and endoscopic or radiological findings. Conclusions: ODS and CRS share some common features: ODS more often presents with purulent discharge, localized maxillary involvement, and the presence of oral pathogens, and Staphylococcus spp in microbial profile. Full article

Background: Chronic rhinosinusitis (CRS) affects 5.5–28% of the population and is primarily an inflammatory disease, with microbiota potentially playing a key role. Understanding microbial pathogens and resistance patterns is crucial for effective management. This study aimed to evaluate the incidence of Gram-negative rods in CRS in adults as a part of a prospective microbiological study. Methods: Over one year, paranasal sinus mucosa samples from CRS patients and nasal concha samples from controls were analyzed. Cultivable bacterial flora was assessed using culture-based methods. Biofilm formation was evaluated via a microtiter-plate assay, and antibiotic susceptibility was tested using the disk diffusion method. Results: Tissue samples from 74 CRS patients and 47 controls yielded 198 bacterial strains. Gram-positive cocci dominated, while Gram-negative rods accounted for 17.6%, with Escherichia coli, Klebsiella oxytoca, and Citrobacter spp. being most common. All Gram-negative rods formed biofilms in vitro. They were susceptible to cefotaxime, aztreonam, ciprofloxacin, and meropenem but showed varying sensitivity to ampicillin (20–67%), tigecycline (40–57%), and amoxicillin/clavulanic acid (73–83%). Conclusions: The result of this study underlines that treatment of CRS should be based on the result of drug susceptibility testing of the isolated microorganism. Full article

Background and Clinical Significance: Acute pediatric rhinosinusitis is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The involvement of Enterobacter species is rare and typically linked to chronic or nosocomial infections. Typical cases of acute rhinosinusitis in children present with abundant nasal discharge, headache, and fever and are generally managed with systemic antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), mucolytics, and topical intranasal treatment. Atypical presentations prompt heightened clinical attention, and depending on the symptoms and patient status, surgical interventions might be considered. Case Presentation: We report the case of a previously healthy 5-year-old boy presenting with painful unilateral palpebral edema, minimal ipsilateral nasal discharge, and persistent headache despite standard rhinosinusitis therapy. Imaging tests revealed complete right maxillary sinus opacification. As the clinical response to ceftriaxone and dexamethasone was minimal, we opted for endoscopic sinus surgery. A nasal swab culture identified Enterobacter spp. in the nasal discharge. Conclusions: Unusual pathogens like Enterobacter spp. can cause acute sinusitis in children without prior risk factors. Early surgical intervention and culture-adjusted antimicrobial therapy remain critical for favorable outcomes. Full article

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition, primarily affecting young individuals, with a significant impact on their quality of life due to recurrent, painful nodules, abscesses, and oozing sinus tracts, primarily affecting intertriginous areas. The pathogenesis of HS is multifactorial, involving a complex interplay between genetic predisposition, immune dysregulation, microbial, and environmental factors. While it is known that cutaneous and gut microbiome contribute to innate immune dysregulation in HS, their precise involvement in disease pathogenesis remains unclear. Despite several studies investigating the microbiome of HS lesions, either by culture-dependent or independent methods, there is no data available on the interplay between bacterial virulence profiles, clinical manifestations, and the host immune response. This study aimed to explore the phenotypic and genotypic resistance and virulence profiles of microorganisms isolated from HS lesions (including the expression of soluble virulence factors and the ability to develop biofilms), with a special focus on Staphylococcus aureus (S. aureus), one of the most frequent infectious agents of HS. A total of 92 bacterial strains, belonging to 20 different bacterial species, were isolated from the HS lesions of 23 patients. The strains of Staphylococcus, Corynebacterium, and Enterococcus expressed the highest levels of soluble virulence factors, such as hemolysins, lecithinase, and lipase, which are involved in bacterial persistence, local invasivity, and tissue damage. Moreover, a significant variation among bacterial species was noted regarding the capacity to develop biofilms, with a potential impact on disease chronicization, bacterial tolerance to antibiotics, and immune defense mechanisms. The genetic characterization of methicillin-resistant staphylococci revealed the presence of adhesins, hemolysin and enterotoxin genes as well as methicillin and macrolides resistance genes. Our findings highlight the critical role of virulence determinants, including bacterial biofilms, in HS pathogenesis, emphasizing the need for targeted therapeutic strategies to disrupt biofilms and mitigate infection severity. Full article

Backgrounds: Designed to measure symptoms and quality-of-life impacts, the chronic rhinosinusitis patient-reported outcome (CRS-PRO) questionnaire is a novel instrument tailored to CRS patients. This study aimed to translate the CRS-PRO into Hebrew, adapt it cross-culturally, and assess its reliability and validity. Methods: A prospective study was conducted with 127 participants across three groups: CRS, functional endoscopic sinus surgery (FESS), and control groups (healthy individuals). Participants completed the Hebrew CRS-PRO at baseline and one month later. The Hebrew version was developed according to the International Society for Pharmacoeconomics and Outcomes Research guidelines for translation and cross-cultural adaptation. Results: Of the 127 participants (mean age 47.3 ± 17.7 years, range 18–93), 77 were males (60.6%), and 50 were females (39.4%). The Hebrew CRS-PRO demonstrated high internal consistency (Cronbach’s alpha 0.936) and strong discriminant validity among the three groups. Baseline mean scores were 7.2 for the control group, 25.2 for the FESS group, and 27.1 for the CRS group, which subsequently decreased to 6.5, 12.9, and 20.4, respectively, after one month (ANOVA, p < 0.001). Test–retest reliability, supported by Pearson’s correlation (p < 0.01) and intraclass correlation (p < 0.0001), demonstrated the questionnaire’s effectiveness in identifying CRS-related symptoms and monitoring improvement after FESS. Conclusions: The adaptation and validation of the CRS-PRO into Hebrew resulted in a reliable instrument in patients with CRS. It exhibited robust reliability, internal consistency, and strong discriminant validity, effectively differentiating between healthy individuals and CRS patients and those who are pre- and post-FESS. Additionally, the Hebrew CRS-PRO questionnaire may be effective for evaluating patients before and after FESS surgery. Full article

Background: The chronic rhinosinusitis patient-reported outcome (CRS-PRO) is a newly developed, disease-specific questionnaire designed for patients with CRS. This study focused on translating the CRS-PRO into Arabic, conducting cross-cultural adaptation and validation of the questionnaire, and assessing its reliability and validity. Methods: This prospective study involved 112 patients divided into CRS, functional endoscopic sinus surgery (FESS), and control groups. Participants completed the questionnaire at enrollment and again after one month. The Arabic version of the CRS-PRO was created following the International Society for Pharmacoeconomics and Outcomes Research guidelines for translation and cross-cultural adaptation. Results: This study included 74 males (66.1%) and 38 females (33.9%), with an average age of 37.4 ± 14.8 years. The Arabic CRS-PRO questionnaire has high internal consistency and reliability (Cronbach’s alpha 0.97). It also has strong discriminant validity in distinguishing between groups (ANOVA, p < 0.001). The assessment of test/retest symptom scores and their consistency over time confirmed the reliability of the CRS-PRO in differentiating CRS patients from healthy individuals and in monitoring surgical outcomes. This was validated through Pearson’s correlation coefficients (p < 0.01) and intraclass correlation (p < 0.0001). Conclusions: The Arabic version of the CRS-PRO proved simple, reliable, and valid. It showed high internal consistency, reliability, and strong discriminant validity in distinguishing between healthy individuals, CRS patients, and those pre- and post-FESS. Full article

Anterior nasal septum abscess is not a rare clinical disease entity. In terms of the etiologies of the disease, bacteria are obviously more common than fungi. Fungal culture and pathological examination are essential for diagnosis of a fungal abscess of the anterior nasal septum and the basis of prescription of antifungal agents. We report a 57-year-old male patient who came to our outpatient clinic due to refractory nasal congestion for 3 weeks despite receiving treatments by a local medical doctor. Radical surgery with postoperative adjuvant radiotherapy for the right buccal cancer was carried out 14 years ago. The patient has diabetes mellitus and the blood sugar level has been well controlled by oral hypoglycemic agents over the past several years. Computed tomography revealed an abscess in the anterior septum along with rhinosinusitis. Incision and drainage of the nasal septum abscess and functional endoscopic sinus surgery were carried out. Fungal culture and pathological examination confirmed a fungal abscess in the anterior nasal septum and fungal ball rhinosinusitis. Antibiotics and an antifungal agent were given, and the postoperative course was uneventful. A dialectical argument was made regarding the causal relationship between the fungal abscess of the anterior nasal septum and maxillary fungal ball sinusitis. A literature review of the previous case reports was carried out to elucidate the immune status of patients of this disease. In order to reach a rapid establishment of a fungal abscess of the anterior nasal septum, clinicians should keep this disease in mind and remain vigilant. An immuno-compromised status is more commonly found in patients with fungal abscess of the anterior nasal septum and is another important characteristic of this disease. Prompt diagnosis and effective treatment are equally important in patients with lower immune status of this kind, and the latter is based on the former. Full article

Background: Sinusitis, whether acute or chronic, is likely due at least in part to disruptions in the microbiota of the paranasal sinuses. Sinus cultures are often employed to guide medical treatment. Objective: To quantify the contemporary microbiology of the paranasal sinuses and better understand the utility of paranasal sinus cultures. Methods: We identified patients from 2018 to 2019 with sinus cultures taken by an otolaryngologist in the outpatient setting in our healthcare system with a concurrent diagnosis of acute or chronic rhinosinusitis. These cultures were analyzed based on their culture type and result. The most commonly isolated bacteria were further analyzed by species; Staphylococcus resistance patterns were analyzed as well. Results: A total of 2302 culture samples were collected: 2012 (87%) bacterial, 287 (13%) fungal, and 3 (0.1%) mycobacterial cultures. The results of more than half (1142, 57%) of these bacterial cultures were positive for a named genus, while those of 592 (29%) were positive for normal sinus flora and 16 (0.8%) for normal oral flora, and those of 183 (9%) showed no growth. The results of another 79 (4%) bacterial cultures were positive for unnamed bacteria, which were not further classified (e.g., Gram-negative rods). Of the positive bacterial cultures with named genera, the most common genera identified was Staphylococcus (383, 34%). Of these, the most common species of Staphylococcus was S. aureus (311, 81%), 42 of which (14%) showed methicillin resistance (MRSA). Of the fungal cultures, 265 (92%) resulted in no growth, and all three mycobacterial cultures showed no growth. Conclusions: In contrast to fungal cultures, the majority (57%) of sinus bacterial cultures showed positive results, with the identification of a named genus, highlighting the potential utility of this assay in guiding medical therapy. Full article

Xylitol is considered a naturally occurring antibacterial agent. It is generally believed to enhance the body’s own innate bactericidal mechanisms. It also provides anti-adhesive effects against both Streptococcus pneumoniae and Haemophilus influenza. This study was performed to evaluate the efficacy and safety of xylitol nasal irrigation in the postoperative care of functional endoscopic sinus surgery (FESS). Patients with chronic rhinosinusitis who received FESS were recruited and randomly assigned to two groups at one month post-surgery. Thirty-five patients in the xylitol group received 400 mL of 5% xylitol nasal irrigation daily for 2 months, while another 35 in the normal saline (NS) group received 400 mL of NS nasal irrigation daily for 2 months. Prior to FESS, as well as before and after nasal irrigation, sinonasal symptoms were assessed through the 22-item Sino-Nasal Outcome Test Questionnaire. The patients also underwent an endoscopic examination while undergoing nasal function tests, and a cytokine measurement of the nasal lavage and a bacterial culture from the middle meatus were performed. The safety of the nasal irrigation was assessed through any self-reported adverse events, the Eustachian Tube Dysfunction Patient Questionnaire and the eustachian tube function test. The endoscopic scores and olfactory threshold significantly decreased after xylitol irrigation when compared with those before irrigation. The prevalence of Staphylococcus aureus in the nasal secretions also decreased significantly after xylitol irrigation. The amounts of Interleukin-5 and Interleukin-17A were significantly increased in the nasal lavage after xylitol irrigation. No side effects, including those related to eustachian tube function, were seen after nasal irrigation in both groups. Our results showed that xylitol nasal irrigation was both beneficial and safe during the postoperative care of FESS. Full article

Background: Aspergillus can cause fungal rhinosinusitis (FRS). We aimed to identify risk factors for sinonasal Aspergillus disease. Methods: Patients with a positive sinonasal mycological culture for Aspergillus species diagnosed in our hospital located in a continental climate were included in the 9-year retrospective study. Results: Of the 86 patients, 3 had invasive FRS (IFRS), 51 had fungal ball (FB) disease, and 32 had chronic rhinosinusitis with fungus (CFRS). In the IFRS group, all patients had a malignancy and were immunocompromised. Allergies, allergic rhinitis, asthma, nasal polyps, and the use of inhaled and nasal steroids were more common in the CFRS group, and IgE levels were greater than those in the FB and IRFS groups (p < 0.05). Conclusion: FB disease is a relatively symptom-free single-sinus disease among elderly individuals, and IFRS is dominant among immunocompromised patients. We discovered a third patient group, predominantly with nasal polyps, atopy, asthma, and elevated blood IgE and eosinophils, that did not fulfill the allergic FRS (AFRS) criteria. It is possible that a less fulminant category of underdiagnosed AFRS exists in cold climates. Treatment with local debridement is usually sufficient for FRS, apart from IFRS, and relapses are not common in cold climates. Full article

Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms. Full article

A rise in fungal infections has been observed worldwide among patients with extended hospital stays because of the severe infection caused by the new coronavirus pandemic. A 62-year-old female patient was admitted with a severe form of Coronavirus disease 2019 (COVID-19) and spent four weeks in the intensive care unit (ICU) requiring mechanical ventilation support before being moved to a tertiary hospital for further testing. Aspergillus fumigatus filamentous fungus, Candida spp., and positive bacteriology for multidrug-resistant Klebsiella pneumoniae and Proteus mirabilis were identified by bronchial aspirate cultures. The patient’s progress was gradually encouraging while receiving oral antifungal and broad-spectrum antibiotic therapy along with respiratory physical therapy; but ultimately, thoracic surgery was necessary. Long-lasting tissue damage and severe, persistent inflammatory syndrome were the two main pathophysiological mechanisms that led to significant outcomes regarding lung lesions that were rapidly colonized by fungi and resistant flora, cardiac damage with sinus tachycardia at the slightest effort, and chronic inflammatory syndrome, which was characterized by marked asthenia, myalgias, and exercise intolerance. Full article

Sinonasal teratocarcinosarcoma (TCS) is a rare tumor that displays a variable histology with admixtures of epithelial, mesenchymal, neuroendocrine and germ cell elements. Facing a very poor prognosis, patients with TCS are in need of new options for treatment. Recently identified recurrent mutations in SMARCA4 may serve as target for modern therapies with EZH1/2 and CDK4/6 inhibitors. Here, we present the first in vitro cell line TCS627, established from a previously untreated primary TCS originating in the ethmoid sinus with invasion into the brain. The cultured cells expressed immunohistochemical markers, indicating differentiation of epithelial, neuroepithelial, sarcomatous and teratomatous components. Whole-exome sequencing revealed 99 somatic mutations including SMARCA4, ARID2, TET2, CDKN2A, WNT7A, NOTCH3 and STAG2, all present both in the primary tumor and in the cell line. Focusing on mutated SMARCA4 as the therapeutic target, growth inhibition assays showed a strong response to the CDK4/6 inhibitor palbociclib, but much less to the EZH1/2 inhibitor valemetostat. In conclusion, cell line TCS627 carries both histologic and genetic features characteristic of TCS and is a valuable model for both basic research and preclinical testing of new therapeutic options for treatment of TCS patients. Full article

Background: Incidence of fungal rhinosinusitis has increased in recent few years. We investigated the differences in microbiological findings between patients with fungal and non-fungal rhinosinusitis by growing microbiological cultures from samples obtained from sinus surgery. Methods: Using the Chang Gung Research Database, we enrolled all chronic rhinosinusitis (CRS) patients who had ever undergone sinus surgery from 2001 to 2019 and had microbiological culture during sinus surgery. Enrolled patients were divided into fungal and non-fungal groups, based on fungal culture and surgical pathology. Results: A total of 898 patients were diagnosed with fungal rhinosinusitis and 2884 with non-fungal rhinosinusitis. The fungal group had a higher age distribution (56.9 ± 13.1 vs. 47.0 ± 14.9), a larger proportion of females (62.4% vs. 37.0%), more unilateral lesions (80.4% vs. 41.6%), a lower incidence of the need for revision surgery (3.6% vs. 6.0%, p = 0.004), and a higher proportion of Pseudomonas aeruginosa in the culture (14.3% vs. 4.6%, p < 0.001). Conclusions: This large-scale study showed that Pseudomonas aeruginosa are more commonly found in patients with fungal rhinosinusitis and in patients who needed revision surgery, suggesting that efforts aimed at eliminating Pseudomonas are needed in order to improve the disease outcomes of patients with fungal rhinosinusitis. Full article