OBJECTIVES: Smell impairment (SI) is a well-known symptom of chronic rhinosinusitis with nasal polyps (CRSwNP). The aim of study was to analyze olfactory and trigeminal event-related potentials (OERPs/TERPs) and psychophysical smell tests in subjects with CRSwNP, and its potential role in clinical practice. METHODS: Prospective study included 57 subjects. Two investigated groups with CRSwNP and one control group. Group I (n = 20) contained subjects without CRSwNP before septoplasty. Group II (n = 18) contained subjects with CRSwNP without therapy. Group III (n = 19) contained subjects with CRSwNP after intranasal corticosteroid therapy. Sniffin stick identification smell test and OERPs/TERPs were performed in all subjects. RESULTS: According to the psychophysical smell test, SI was detected in 65% of subjects with CRSwNP. In the control Group I (without CRSwNP), the absence of OERPs was 5.0%, whilethe mean absence rate in Groups II, III (with CRSwNP) was 8.1%. The highest percentage of absence of OERPs was registered in Group II (11.1%). Absence of TERPs was detected in an average of 21.6% of CRSwNP subjects. Group III showed the highest percentage of absence of TERPs (32%). In the control Group I, TERPs were absent in 0% of subjects. CONCLUSION: CRSwNP significantly impairs olfactory function compared to patients without CRSwNP, Absence of TERPs was detected in an average of 21.6% of CRSwNP subjects versus healthy controls (0%). Presence of TERPs appears to be a predictor of preservation of olfactory function.
- Klíčová slova
- Chronic rhinosinusitis, OERPs, Olfactory dysfunction, Smell test, Sniffin stick test, TERPs,
- MeSH
- chronická nemoc MeSH
- čich * fyziologie MeSH
- dospělí MeSH
- evokované potenciály * fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervus trigeminus * patofyziologie MeSH
- nosní polypy * patofyziologie komplikace MeSH
- poruchy čichu * patofyziologie MeSH
- prospektivní studie MeSH
- rinosinusitida MeSH
- rýma * patofyziologie komplikace MeSH
- sinusitida * patofyziologie komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Pivotal studies with dupilumab demonstrated clinically relevant improvements in nasal polyp score, symptom score, and quality-of-life score in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE: We evaluated the effectiveness of dupilumab in a large-scale CRSwNP cohort from 6 European tertiary-care centers. METHODOLOGY: Nasal polyp score, Sinonasal Outcome Test 22 score, visual analog scale for total sinus symptoms, loss of smell, and nasal blockage, and Asthma Control Test (ACT) score were collected from hospital records and assessed at baseline and again at 24 and 52 weeks' treatment with dupilumab in CRSwNP patients. Treatment effectiveness was evaluated in relation to demographic and lifestyle factors, sinus surgery history, presence of comorbidities, and blood eosinophil counts (BEC). Treatment response was evaluated according to European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) 2021 criteria. RESULTS: All patient outcomes improved at 24 and 52 weeks' treatment compared to baseline. Dupilumab showed effectiveness independent of age, sex, body mass index, smoking status, prior sinus surgery, presence of asthma, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergy, or baseline BEC. A total of 92.5% and 94.4% showed an improvement in at least 1 EUFOREA criterion at 24 and 52 weeks, respectively; 54.4% and 68.2% met all 4 of the more stringent EUFOREA criteria at 24 and 52 weeks, respectively. CONCLUSIONS: Real-world evaluation of dupilumab effectiveness demonstrates a robust and sustained response in at least two thirds of patients at 52 weeks' treatment. Favorable treatment response was independent of the number of sinus surgery procedures, major comorbidities, or baseline systemic levels of type 2 inflammation.
- Klíčová slova
- Chronic rhinosinusitis, asthma, biologic therapy, dupilumab, effectiveness, nasal polyps, real-world evidence, sinus surgery,
- MeSH
- chronická nemoc MeSH
- dospělí MeSH
- humanizované monoklonální protilátky * terapeutické užití MeSH
- kohortové studie MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- nosní polypy * farmakoterapie MeSH
- rinosinusitida MeSH
- rýma * farmakoterapie MeSH
- senioři MeSH
- sinusitida * farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- Názvy látek
- dupilumab MeSH Prohlížeč
- humanizované monoklonální protilátky * MeSH
OBJECTIVE: Endometrial polyp (EP) is a type of pathology that is quite common in clinical practice. Although its exact etiology is not fully known, there is evidence to support that it is sensitive to hormonal stimuli. We aimed to investigate the relationship between kisspeptin (KP) and EP by comparing the genetic (tissue-blood) and immunohistochemical (IHC) expression of KP in EP lesions in patients with normal endometrial findings. MATERIALS AND METHODS: A prospective case-control study of 50 patients with EP (N = 25) and normal endometrial findings (N = 25) on biopsy and/or excision material was performed. Blood and biopsy samples obtained from all patients were stored at -80 °C. KP gene expression levels were determined from paraffin blocks, and peripheral venous blood samples obtained from biopsy specimens and IHC-H-score analysis were performed from paraffin blocks. EP and matched controls were compared for KP. RESULTS: After IHC, the KP H-score of the control group was higher than the EP group, and this difference was statistically significant; H-score: control: 5 (++; 1-15); polyp: 1 (+; 0-12) (P < 0.05). Although KP expression in both tissue and blood was higher in the control group than in the EP group, this difference was not statistically significant (P > 0.05). No significant correlation was found between IHC H-score and KP expression levels in tissue and blood. According to the ROC analysis, the tissue and blood KP expression cut-off value and area under the curve (AUC) predicting the likelihood of developing EP were not significant (tissue KP: 1.04, AUC: 0.570, P = 0.388, sensitivity 56%, specificity 60%, Blood KP: 1.06, AUC: 0.569, P = 0.401, sensitivity 80%, specificity 40%). CONCLUSIONS: Decreased KP expression level in EP lesions may predict the diagnosis of EP, and in the future, KP may have therapeutic potential for benign gynecological pathologies such as polyps.
- Klíčová slova
- endometrial polyps, endometrium, immunohistochemistry, kisspeptin, reverse-transcription PCR (RT-PCR),
- MeSH
- dospělí MeSH
- endometrium metabolismus patologie MeSH
- imunohistochemie * MeSH
- kisspeptiny * genetika metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci dělohy genetika metabolismus patologie krev MeSH
- polypy * genetika metabolismus patologie MeSH
- prospektivní studie MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- kisspeptiny * MeSH
This article presents a comprehensive review of factors that increase the risk of malignancy in ultrasound findings of an endometrial polyp. We collected original studies, reviews, and meta-analyses that dealt with the topic of endometrial polyps and the risk of developing endometrial cancer. Each presumed risk factor was analysed individually. According to searched studies, abnormal uterine bleeding, old age, and body mass index are valid risk factors for developing endometrial cancer in endometrial polyps. Lynch syndrome patients are also in a high-risk group for endometrial cancer. On the other hand, the number of polyps, their size, diabetes mellitus, hypertension, and positive family history are factors with inconclusive results. There are either not enough data or different results among several studies.
- Klíčová slova
- Endometrial carcinoma, abnormal uterine bleeding, doppler ultrasound of uterine artery, endometrial cancer, endometrial polyp, polyp size, risk factors, tamoxifen,
- MeSH
- děložní krvácení etiologie MeSH
- endometrium patologie MeSH
- hysteroskopie MeSH
- lidé MeSH
- nádory dělohy * patologie MeSH
- nádory endometria * diagnostické zobrazování etiologie MeSH
- nemoci dělohy * komplikace MeSH
- polypy * diagnostické zobrazování patologie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications and considerations that are of importance to the patient, the physician and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP.
- Klíčová slova
- CRSwNP, aspirin intolerance, biologics, corticosteroids, sinus surgery,
- MeSH
- chronická nemoc MeSH
- lidé MeSH
- management nemoci MeSH
- nosní polypy * terapie diagnóza MeSH
- rinosinusitida * diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
OBJECTIVES: The development of fundic gland polyps (FGPs) is the most common side effect of long-term proton pump inhibitor (PPI) use; however, the effect of drug use characteristics and their impact on the risk of other gastric polyp development remain unclear. We aimed to identify the influence of PPI administration, as well as its duration and dose, in the development of gastric polyps. METHODS: A prospective cohort study was conducted on consecutive patients who underwent gastroscopy between September 2017 and August 2019. Detailed characteristics of gastric polyps, Helicobacter pylori infection, and PPI use were analyzed. RESULTS: Among the 2723 patients included, gastric polyps (75% FGPs, 22% hyperplastic) were detected in 16.4%, and 60% were prescribed PPI. The risk of FGPs and hyperplastic polyps according to the duration of PPI use were as follows: 2-5 years [odds ratio (95% confidence interval); 2.86 (2.00-4.11) and 2.82 (1.69-4.78)]; 6-9 years [7.42 (5.03-11.01) and 2.32 (1.05-4.78)]; ≥10 years [14.94 (10.36-21.80) and 3.52 (1.67-7.03)]. Multivariate analysis confirmed that the risk of FGPs was 17.16 (11.35-26.23) for ≥10 years of PPI use. Portal hypertension-related conditions were associated with hyperplastic polyps [4.99 (2.71-9.20)]. CONCLUSION: Duration of and indications for PPI use are the most predictive factors for the development of gastric polyps. Prolonged PPI use increases the risk of polyp development and the number of patients with polyps, which may burden endoscopic practice. Highly selected patients may require particular care despite minimal risk of dysplasia and bleeding generally.
- MeSH
- adenomové polypy MeSH
- gastroskopie MeSH
- Helicobacter pylori * MeSH
- infekce vyvolané Helicobacter pylori * komplikace farmakoterapie MeSH
- inhibitory protonové pumpy škodlivé účinky MeSH
- lidé MeSH
- nádory žaludku * chemicky indukované epidemiologie komplikace MeSH
- polypy * chemicky indukované epidemiologie komplikace MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- inhibitory protonové pumpy MeSH
Asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) or without (CRSsNP) are chronic respiratory diseases. These two disorders often co-exist based on common anatomical, immunological, histopathological, and pathophysiological basis. Usually, asthma with comorbid CRSwNP is driven by type 2 (T2) inflammation which predisposes to more severe, often intractable, disease. In the past two decades, innovative technologies and detection techniques in combination with newly introduced targeted therapies helped shape our understanding of the immunological pathways underlying inflammatory airway diseases and to further identify several distinct clinical and inflammatory subsets to enhance the development of more effective personalized treatments. Presently, a number of targeted biologics has shown clinical efficacy in patients with refractory T2 airway inflammation, including anti-IgE (omalizumab), anti-IL-5 (mepolizumab, reslizumab)/anti-IL5R (benralizumab), anti-IL-4R-α (anti-IL-4/IL-13, dupilumab), and anti-TSLP (tezepelumab). In non-type-2 endotypes, no targeted biologics have consistently shown clinical efficacy so far. Presently, multiple therapeutical targets are being explored including cytokines, membrane molecules and intracellular signalling pathways to further expand current treatment options for severe asthma with and without comorbid CRSwNP. In this review, we discuss existing biologics, those under development and share some views on new horizons.
- Klíčová slova
- airway remodelling, asthma, biologics, chronic rhinosinusitis, precision medicine, type 2 inflammation,
- MeSH
- biologické přípravky * terapeutické užití MeSH
- bronchiální astma * komplikace farmakoterapie epidemiologie MeSH
- chronická nemoc MeSH
- komorbidita MeSH
- lidé MeSH
- nosní polypy * komplikace farmakoterapie MeSH
- rýma * komplikace farmakoterapie MeSH
- sinusitida * komplikace farmakoterapie MeSH
- zánět farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- biologické přípravky * MeSH
BACKGROUND: Real-world evidence (RWE) is a valuable instrument to better understand the patient journey and effectiveness of therapies. RWE on the prevalence of uncontrolled chronic rhinosinusitis (CRS) and CRS natural course of disease across Europe is scarce. In addition, there is limited RWE that enables comparison of the effectiveness of marketed therapies including topical or systemic corticosteroids, sinus surgery, or biologics. OBJECTIVE: To establish an international CHRonic rhINOSinusitis Outcome Registry (CHRINOSOR) based on real-world data collection enabled by mobile health technology. METHODOLOGY: A digital platform, Galenus Health, supporting patients and physicians in the management of chronic respiratory diseases, is used to collect data on patient profile, disease history, patient outcomes, and a set of relevant clinical outcomes. Adult patients with a diagnosis of CRS are eligible for inclusion. RESULTS: A collaborative scientific network of 17 university ear-nose-throat (ENT) clinics from 10 European countries has been established with the aim to collect real-world data in a longitudinal and standardized manner. The Galenus Health digital platform is currently being implemented in these ENT clinics taking into account legal, privacy, and data security aspects. Up to 300 patients have already been included. CONCLUSIONS: CHRINOSOR is a collaborative effort that aims at improving our understanding of CRS, its comorbidities, and the effectiveness of its treatments. Ultimately, these insights will guide us as scientific community to develop future care pathways informed by RWE.
- Klíčová slova
- Biologic therapy, Chronic rhinosinusitis, Mobile health technology, Nasal polyps, Real-world evidence,
- MeSH
- chronická nemoc MeSH
- dospělí MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- lidé MeSH
- nosní polypy * farmakoterapie MeSH
- rýma * terapie farmakoterapie MeSH
- sinusitida * terapie farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- hormony kůry nadledvin MeSH
- MeSH
- časná detekce nádoru MeSH
- kolonoskopie MeSH
- kolorektální nádory * diagnóza MeSH
- lidé MeSH
- polypy tlustého střeva * diagnóza MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Recently, a new CT scan classification of the extent of previous endoscopic sinus surgery called The Amsterdam Classification of Completness of Endoscopic Sinus Surgery (ACCESS) was published. The aim of this study was to investigate possible associations between traditionally used Lund-Mackay CT score and ACCESS score and their possible relationship to pre- and postoperative quality of life in a narrowly defined group of patients with recurrent CRSwNP. METHODS: Forty-nine patients who underwent a revision ESS for CRSwNP were enrolled in a retrospective study. CT imaging scans were evaluated, LM and ACCESS scores determined. All patients completed the validated Czech version of the SNOT-22 questionnaire before and 6 months after surgery. The correlation between the two CT scores and the QoL questionnaire was tested using Pearson's correlation tests. RESULTS: No correlation was demonstrated between LM scores and patient-based SNOT-22 scores neither preopratively nor postoperatively (r = - 0.0580; p = 0.918 and r = 0.0252; p = 0.8634, respectively. Similarly, no correlation was found between the ACCESS score and SNOT-22 before and after surgery (r = - 0.1988; p = 0.1708 and r = - 0.943; p = 0.5193, respectively). No linear relationship was demonstrated between the LM score and the ACCESS score (r = 0.075; p = 0.6053). CONCLUSIONS: The results show that even the CT score evaluating the completeness of previous procedures has no linear relationship to the quality of life preoperatively and cannot serve as a predictor for the outcomes of surgical treatment. This study also confirms that ACCESS evaluates a different aspect of the radiological finding than the traditionally used LM score.
- Klíčová slova
- ACCESS score, CT scan, Chronic rhinosinusitis, Correlation, Endoscopic sinus surgery, Lund–Mackay score, Nasal polyps, Patient-reported outcome measure, Quality of life, SNOT-22,
- MeSH
- chronická nemoc MeSH
- endoskopie metody MeSH
- kvalita života MeSH
- lidé MeSH
- nosní polypy * chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- průzkumy a dotazníky MeSH
- retrospektivní studie MeSH
- rýma * chirurgie MeSH
- sinusitida * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
