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Lombardi C, Passalacqua G, Menzella F, Mauritz Canevari RF, Danesi G, Pusateri AM, Carone M, Vancheri C, Di Marco F, Micheletto C, Manzotti G, Di Gioacchino M, Bilò MB, Gelardi M, Senna G, Canonica GW. Chronic rhinosinusitis with nasal polyposis and biological agents: the ARIA-ITALY Survey. Eur Ann Allergy Clin Immunol 2024. [PMID: 38534135 DOI: 10.23822/eurannaci.1764-1489.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Summary Background. Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses. CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. Methods. As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immuno-allergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results. Two hundred and fifty-five experts and specialists participated in the survey. Conclusions. The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn. The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated. Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.
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Affiliation(s)
- C Lombardi
- Co-Chairman ARIA ITALY; Unit of Allergology, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - G Passalacqua
- Co-Chairman ARIA-Italy Allergy and Respiratory Diseases, IRCCS Policlinico S. Martino, University of Genoa, Genoa, Italy
| | - F Menzella
- UOC Pulmonary, "S. Valentino" Hospital, AULSS 2 Marca Trevigiana, Montebelluna, Treviso, Italy
| | - R F Mauritz Canevari
- Department of DISC, Otolaryngologist Clinic-IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - G Danesi
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A M Pusateri
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M Carone
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Telese Terme, Benevento, Italy
| | - C Vancheri
- UOC Respiratory System Diseases, Università degli Studi di Catania, Catania, Italy
| | - F Di Marco
- UOC Respiratory System Diseases, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C Micheletto
- UOC Pulmonary, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - G Manzotti
- Unit of Allergology, Casa di Cura B. Palazzolo, Bergamo, Italy
| | - M Di Gioacchino
- Società Italiana di Asma Allergologia e Immunologia Clinica, University of Chieti, Chieti, Italy
| | - M B Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Italy
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Gelardi
- ENT Clinic, University of Foggia, Foggia, Italy
| | - G Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
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Gelardi M, Fiore V, Giancaspro R, Di Canio FM, Fiorentino C, Patruno S, Ruzza A, Cassano M. General classification of rhinopaties: the need for standardization according to etiology and nasal cytology. Eur Arch Otorhinolaryngol 2023; 280:4751-4758. [PMID: 37462742 PMCID: PMC10562500 DOI: 10.1007/s00405-023-08117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Rhinitis is as an inflammation of the nasal mucosa, characterized by high prevalence, widespread morbidity, and a significant financial burden on health care systems. Nevertheless, it is often considered as no more than a mere annoyance. This point of view has progressively led to underestimate and trivialize the disease. Therefore, there are numerous, mostly overlapping classifications of rhinopaties, but clear and standardized guidelines for diagnosis and treatment are still lacking. In the context of Precision Medicine, the development of a classification system focused on the endotypes of rhinitis to be widely adopted appears of utmost importance, also by virtue of study of the nasal immunophlogosis that, thanks to nasal cytology (NC), has recently allowed to better define the different forms of rhinitis, giving a new nosological dignity to several rhinopaties. AIM We aimed to summarize the current knowledge regarding rhinitis and to propose a systematic classification of rhinitis, based on both etiology and cytological findings.
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Affiliation(s)
- M Gelardi
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - V Fiore
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - R Giancaspro
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy.
| | - F M Di Canio
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - C Fiorentino
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - S Patruno
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - A Ruzza
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - M Cassano
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
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Gelardi M, Giancaspro R, Cassano M. Charcot-Leyden crystals: An ancient but never so current discovery. Am J Otolaryngol 2023; 44:103844. [PMID: 36948077 DOI: 10.1016/j.amjoto.2023.103844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
From the first description of Charcot-Leyden crystals (CLCs) to the present, many steps have been taken to understand the mechanisms underlying their formation. In particular, to date not only eosinophils but also mast cells are known to be responsible for the production of CLCs, which represent the crystallized form of Galectin-10. Due to their characteristics, CLCs typically induce a crystallopathy and are responsible for an exacerbation of inflammation. Nasal cytology (NC) has allowed to better understand the correlation between the severity of several rhinopaties and the presence of CLCs in NC samples, which is strictly correlated with an eosinophiles and mast cells infiltration. As a matter of fact, rhinopaties with a mixed eosinophilic-mast cell inflammatory infiltrate, characterized by the presence of abundant CLCs, show a worse prognosis and a higher risk of relapse. This could have important therapeutic implications, since the treatments available today could be exploited to target both eosinophils and mast cells, to reduce the damage induced by CLCs.
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Affiliation(s)
- M Gelardi
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
| | - R Giancaspro
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
| | - M Cassano
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
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Husain S, Sage AT, Del Sorbo L, Cypel M, Martinu T, Juvet SC, Mariscal A, Wright J, Chao BT, Shamandy AA, Mousavi SH, Ma J, Wang B, Valero J, Liu M, Landes M, Balachandran S, Hudson K, Ngai M, Capuano M, Gelardi M, Lupia E, Marinowic DR, Friedrich FO, Schmitz CRR, Dos Santos LSM, Barbe-Tuana FM, Jones MH, Kain KC, Mazzulli T, Sabbah S, Keshavjee S. A biomarker assay to risk-stratify patients with symptoms of respiratory tract infection. Eur Respir J 2022; 60:2200459. [PMID: 36104292 PMCID: PMC9753477 DOI: 10.1183/13993003.00459-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients who present to an emergency department (ED) with respiratory symptoms are often conservatively triaged in favour of hospitalisation. We sought to determine if an inflammatory biomarker panel that identifies the host response better predicts hospitalisation in order to improve the precision of clinical decision making in the ED. METHODS From April 2020 to March 2021, plasma samples of 641 patients with symptoms of respiratory illness were collected from EDs in an international multicentre study: Canada (n=310), Italy (n=131) and Brazil (n=200). Patients were followed prospectively for 28 days. Subgroup analysis was conducted on confirmed coronavirus disease 2019 (COVID-19) patients (n=245). An inflammatory profile was determined using a rapid, 50-min, biomarker panel (RALI-Dx (Rapid Acute Lung Injury Diagnostic)), which measures interleukin (IL)-6, IL-8, IL-10, soluble tumour necrosis factor receptor 1 (sTNFR1) and soluble triggering receptor expressed on myeloid cells 1 (sTREM1). RESULTS RALI-Dx biomarkers were significantly elevated in patients who required hospitalisation across all three sites. A machine learning algorithm that was applied to predict hospitalisation using RALI-Dx biomarkers had a mean±sd area under the receiver operating characteristic curve of 76±6% (Canada), 84±4% (Italy) and 86±3% (Brazil). Model performance was 82±3% for COVID-19 patients and 87±7% for patients with a confirmed pneumonia diagnosis. CONCLUSIONS The rapid diagnostic biomarker panel accurately identified the need for inpatient care in patients presenting with respiratory symptoms, including COVID-19. The RALI-Dx test is broadly and easily applicable across many jurisdictions, and represents an important diagnostic adjunct to advance ED decision-making protocols.
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Affiliation(s)
- Shahid Husain
- Division of Infectious Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew T Sage
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Medical and Surgical Intensive Care Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tereza Martinu
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephen C Juvet
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea Mariscal
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Julie Wright
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Bonnie T Chao
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alaa A Shamandy
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - S Hossein Mousavi
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jin Ma
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Bo Wang
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Vector Institute, Toronto, ON, Canada
| | - Jerome Valero
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mingyao Liu
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Megan Landes
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharaniyaa Balachandran
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kimberley Hudson
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michelle Ngai
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Marialessia Capuano
- Division of Emergency Medicine and High Dependency Unit, Cittá della Salute e della Scienza di Torino Hospital-Molinette Site, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Gelardi
- Division of Emergency Medicine and High Dependency Unit, Cittá della Salute e della Scienza di Torino Hospital-Molinette Site, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, Cittá della Salute e della Scienza di Torino Hospital-Molinette Site, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Daniel R Marinowic
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Frederico O Friedrich
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carine R R Schmitz
- Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Leticya S M Dos Santos
- School of Health, Sciences and Life, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Florencia M Barbe-Tuana
- School of Health, Sciences and Life, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcus H Jones
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Kevin C Kain
- Tropical Disease Unit, Department of Medicine, University of Toronto, Sandra Rotman Centre for Global Health, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Tony Mazzulli
- Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Sam Sabbah
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Lupia E, Capuano M, Vizio B, Schiavello M, Bosco O, Gelardi M, Favale E, Pivetta E, Morello F, Husain S, Keshavjee S, Del Sorbo L, Montrucchio G. Thrombopoietin participates in platelet activation in COVID-19 patients. EBioMedicine 2022; 85:104305. [PMID: 36242922 PMCID: PMC9556163 DOI: 10.1016/j.ebiom.2022.104305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/24/2022] [Accepted: 09/28/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The pathogenesis of coronavirus disease 2019 (COVID-19) is characterized by enhanced platelet activation and diffuse hemostatic alterations, which may contribute to immunothrombosis/thromboinflammation and subsequent development of target-organ damage. Thrombopoietin (THPO), a growth factor essential to megakariocyte proliferation, is known to prime platelet activation and leukocyte-platelet interaction. In addition, THPO concentrations increase in several critical diseases, such as acute cardiac ischemia and sepsis, thus representing a potential diagnostic and prognostic biomarker. Furthermore, several data suggest that interleukin (IL)-6 is one of the most important inflammatory mediators involved in these phenomena, which led to explore the potential therapeutic role of IL-6 inhibitors. In this prospective cohort study, we aimed to study THPO and IL-6 concentrations in COVID-19 patients at the time of first clinical evaluation in the Emergency Department (ED), and to investigate their potential use as diagnostic and prognostic biomarkers. In addition, we sought to explore the role of THPO contained in plasma samples obtained from COVID-19 patients in priming in vitro platelet activation and leukocyte-platelet interaction. METHODS We enrolled 66 patients presenting to the ED with symptoms suggestive of COVID-19, including 47 with confirmed COVID-19 and 19 in whom COVID-19 was excluded (Non-COVID-19 patients). As controls, we also recruited 18 healthy subjects. In vitro, we reproduced the effects of increased circulating THPO on platelet function by adding plasma from COVID-19 patients or controls to platelet-rich plasma or whole blood obtained by healthy donors, and we indirectly studied the effect of THPO on platelet activation by blocking its biological activity. FINDINGS THPO levels were higher in COVID-19 patients than in both Non-COVID-19 patients and healthy subjects. Studying THPO as diagnostic marker for the diagnosis of COVID-19 by receiver-operating-characteristic (ROC) statistics, we found an area under the curve (AUC) of 0.73, with an optimal cut-off value of 42.60 pg/mL. IL-6 was higher in COVID-19 patients than in healthy subjects, but did not differ between COVID-19 and Non-COVID-19 patients. THPO concentrations measured at the time of diagnosis in the ED were also higher in COVID-19 patients subsequently developing a severe disease than in those with mild disease. Evaluating THPO as biomarker for severe COVID-19 using ROC analysis, we found an AUC of 0.71, with an optimal cut-off value of 57.11 pg/mL. IL-6 was also higher in severe than in mild COVID-19 patients, with an AUC for severe COVID-19 of 0.83 and an optimal cut-off value of 23 pg/ml. THPO concentrations correlated with those of IL-6 (r=0.2963; p=0.043), and decreased 24 h after the administration of tocilizumab, an IL-6 receptor blocking antibody, showing that the increase of THPO levels depends on IL-6-stimulated hepatic synthesis. In vitro, plasma obtained from COVID-19 patients, but not from healthy subjects, primed platelet aggregation and leukocyte-platelet binding, and these effects were reduced by inhibiting THPO activity. INTERPRETATION Increased THPO may be proposed as an early biomarker for the diagnosis of COVID-19 and for the identification of patients at risk of developing critical illness. Elevated THPO may contribute to enhance platelet activation and leukocyte-platelet interaction in COVID-19 patients, thus potentially participating in immunothrombosis/thromboinflammation. FUNDING This work was supported by Ministero dell'Università e della Ricerca Scientifica e Tecnologica (MURST) ex 60% to GM and EL.
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Affiliation(s)
- Enrico Lupia
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,Corresponding author at: Department of Medical Sciences, University of Turin, via Genova 3, 10126 Turin, Italy.
| | - Marialessia Capuano
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,School of Specialization in Emergency Medicine, University of Turin, Turin, Italy
| | - Barbara Vizio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Ornella Bosco
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Gelardi
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,School of Specialization in Emergency Medicine, University of Turin, Turin, Italy
| | - Edoardo Favale
- School of Specialization in Internal Medicine, University of Turin, Turin, Italy
| | - Emanuele Pivetta
- Department of Medical Sciences, University of Turin, Turin, Italy,School of Specialization in Internal Medicine, University of Turin, Turin, Italy
| | - Fulvio Morello
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy
| | - Shahid Husain
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Gelardi M, Giancaspro R, Iannuzzi L, Taliente S, Piccininni K, Quaranta N, Bulzis G, Sasso N, Carbonara R, Ciccone M, Cassano M. Nasal disorders and cardiovascular damage: flow-mediated dilation and intima-media thickness as risk parameters. Rhinology 2022; 60:479-480. [DOI: 10.4193/rhin22.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Gelardi M, Giancaspro R, Fiore V, Fortunato F, Cassano M. Corrigendum to "COVID-19: Effects of lockdown on adenotonsillar hypertrophy and related diseases in children" [International Journal of Pediatric Otorhinolaryngology (2020) 138/110284]. Int J Pediatr Otorhinolaryngol 2021; 146:110702. [PMID: 33941391 PMCID: PMC8086928 DOI: 10.1016/j.ijporl.2021.110702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - R. Giancaspro
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - V. Fiore
- Unit of Otolaryngology, University of Foggia, Foggia, Italy,Corresponding author
| | - F. Fortunato
- Section of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - M. Cassano
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
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8
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Pivetta E, Goffi A, Tizzani M, Locatelli SM, Porrino G, Losano I, Leone D, Calzolari G, Vesan M, Steri F, Ardito A, Capuano M, Gelardi M, Silvestri G, Dutto S, Avolio M, Cavallo R, Bartalucci A, Paglieri C, Morello F, Richiardi L, Maule MM, Lupia E. Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department. Ann Emerg Med 2021; 77:385-394. [PMID: 33461884 PMCID: PMC7552969 DOI: 10.1016/j.annemergmed.2020.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE Accurate diagnostic testing to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is critical. Although highly specific, SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) has been shown in clinical practice to be affected by a noninsignificant proportion of false-negative results. This study seeks to explore whether the integration of lung ultrasonography with clinical evaluation is associated with increased sensitivity for the diagnosis of coronavirus disease 2019 pneumonia, and therefore may facilitate the identification of false-negative SARS-CoV-2 RT-PCR results. METHODS This prospective cohort study enrolled consecutive adult patients with symptoms potentially related to SARS-CoV-2 infection who were admitted to the emergency department (ED) of an Italian academic hospital. Immediately after the initial assessment, a lung ultrasonographic evaluation was performed and the likelihood of SARS-CoV-2 infection, based on both clinical and lung ultrasonographic findings ("integrated" assessment), was recorded. RT-PCR SARS-CoV-2 detection was subsequently performed. RESULTS We enrolled 228 patients; 107 (46.9%) had SARS-CoV-2 infection. Sensitivity and negative predictive value of the clinical-lung ultrasonographic integrated assessment were higher than first RT-PCR result (94.4% [95% confidence interval {CI} 88.2% to 97.9%] versus 80.4% [95% CI 71.6% to 87.4%] and 95% [95% CI 89.5% to 98.2%] versus 85.2% [95% CI 78.3% to 90.6%], respectively). Among the 142 patients who initially had negative RT-PCR results, 21 tested positive at a subsequent molecular test performed within 72 hours. All these false-negative cases were correctly identified by the integrated assessment. CONCLUSION This study suggests that, in patients presenting to the ED with symptoms commonly associated with SARS-CoV-2 infection, the integration of lung ultrasonography with clinical evaluation has high sensitivity and specificity for coronavirus disease 2019 pneumonia and it may help to identify false-negative results occurring with RT-PCR.
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Affiliation(s)
- Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy.
| | - Alberto Goffi
- Li Ka Shing Knowledge Institute, Department of Critical Care Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Tizzani
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Stefania M Locatelli
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Giulio Porrino
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Isabel Losano
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Dario Leone
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Gilberto Calzolari
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Matteo Vesan
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Fabio Steri
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Arianna Ardito
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | | | - Maria Gelardi
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Giulia Silvestri
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Stefania Dutto
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Maria Avolio
- Clinical Microbiology, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Rossana Cavallo
- Clinical Microbiology, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alice Bartalucci
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Cristina Paglieri
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Milena M Maule
- Cancer Epidemiology Unit and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
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9
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Nazerian P, Morello F, Prota A, Betti L, Lupia E, Apruzzese L, Oddi M, Grosso F, Grifoni S, Pivetta E, Catini E, Gualtieri S, Casanova B, De Villa E, Cerini G, Lumini E, Gagliano M, Annovi A, Mucaj S, Albanesi M, Cavigli E, Moroni C, Miele V, Lagi F, Fanelli A, Rossolini GM, Turco L, Tomaiuolo M, Paolini D, Tonietti B, Tizzani M, Locatelli SM, Porrino G, Losano I, Leone D, Calzolari G, Versan M, Steri F, Ardito A, Capuano M, Gelardi M, Silvestri G, Tutto S, Avolio M, Cavallo R, Bartalucci A, Paglieri C, Baldassa F, Baron P, Bianchi G, Busso V, Conterno A, Del Rizzo P, Fascio Pecetto P, Giachino F, Iannacone A, Ferrera P, Riccardini F, Sacchi C, Sozzi M, Totaro S, Visconti P, Risi F, Basile F, Baricocchi D, Beaux A, Valentina B, Bima P, Cara I, Chichizola L, Dellavalle F, Labarile G, Ottimo M, Pia I, Scategni V, Surra A. Diagnostic accuracy of physician's gestalt in suspected COVID-19: Prospective bicentric study. Acad Emerg Med 2021; 28:404-411. [PMID: 33576155 PMCID: PMC8014604 DOI: 10.1111/acem.14232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
Objectives Physicians’ gestalt is central in the diagnostic pipeline of suspected COVID‐19, due to the absence of a single tool allowing conclusive rule in or rule out. The aim of this study was to estimate the diagnostic test characteristics of physician's gestalt for COVID‐19 in the emergency department (ED), based on clinical findings or on a combination of clinical findings and bedside imaging results. Methods From April 1 to April 30, 2020, patients with suspected COVID‐19 were prospectively enrolled in two EDs. Physicians prospectively dichotomized patients in COVID‐19 likely or unlikely twice: after medical evaluation of clinical features (clinical gestalt [CG]) and after evaluation of clinical features and results of lung ultrasound or chest x‐ray (clinical and bedside imaging–integrated gestalt [CBIIG]). The final diagnosis was adjudicated after independent review of 30‐day follow‐up data. Results Among 838 ED enrolled patients, 193 (23%) were finally diagnosed with COVID‐19. The area under the curve (AUC), sensitivity, and specificity of CG and CBIIG for COVID‐19 were 80.8% and 91.6% (p < 0.01), 82.9% and 91.4% (p = 0.01), and 78.6% and 91.8% (p < 0.01), respectively. CBIIG had similar AUC and sensitivity to reverse transcription–polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 on the first nasopharyngeal swab per se (93.5%, p = 0.24; and 87%, p = 0.17, respectively). CBIIG plus RT‐PCR had a sensitivity of 98.4% for COVID‐19 (p < 0.01 vs. RT‐PCR alone) compared to 95.9% for CG plus RT‐PCR (p = 0.05). Conclusions In suspected COVID‐19, CG and CBIIG have fair diagnostic accuracy, in line with physicians’ gestalt for other acute conditions. Negative RT‐PCR plus low probability based on CBIIG can rule out COVID‐19 with a relatively low number of false‐negative cases.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Fulvio Morello
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
- Department of Medical Sciences University of Turin Turin Italy
| | - Alessio Prota
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Laura Betti
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Enrico Lupia
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
- Department of Medical Sciences University of Turin Turin Italy
| | - Luc Apruzzese
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Matteo Oddi
- Residency Program in Emergency Medicine University of Torino Torino Italy
| | - Federico Grosso
- Residency Program in Emergency Medicine University of Torino Torino Italy
| | - Stefano Grifoni
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Emanuele Pivetta
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
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10
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Buonamico E, Dragonieri S, Sciancalepore PI, Carratù P, Carpagnano GE, Resta O, Gelardi M. Assessment of eosinophilic nasal inflammation in patients with severe asthma and nasal polyposis before and after six months of therapy with Benralizumab. J BIOL REG HOMEOS AG 2021; 34:2353-2357. [PMID: 33423452 DOI: 10.23812/20-323-l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E Buonamico
- Respiratory Diseases, University of Bari, Bari, Italy
| | - S Dragonieri
- Respiratory Diseases, University of Bari, Bari, Italy
| | | | - P Carratù
- Respiratory Diseases, University of Bari, Bari, Italy
| | | | - O Resta
- Respiratory Diseases, University of Bari, Bari, Italy
| | - M Gelardi
- Otolaringology, University of Foggia, Foggia, Italy
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11
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Maffezzoni E, Notargiacomo M, Agostini S, Gelardi M. Efficacy of a nasal spray containing N-acetylcysteine in hypertonic solution in the treatment of nonallergic chronic rhinitis with goblet cell metaplasia. J BIOL REG HOMEOS AG 2021; 34:2345-2352. [PMID: 33415969 DOI: 10.23812/20-411-l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E Maffezzoni
- Rhinocytoallergology Unit, Istituto Figlie di San Camillo, Cremona, Italy
| | | | - S Agostini
- Scientific Direction, Pharma Line, Milan, Italy
| | - M Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
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12
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La Mantia I, Gelardi M, Drago L, Aragona SE, Cupido G, Vicini C, Berardi C, Ciprandi G. Probiotics in the add-on treatment of pharyngotonsillitis: a clinical experience. J BIOL REG HOMEOS AG 2020; 34:11-18. [PMID: 33426861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pharyngotonsillitis is a common disease, mainly characterized by a sore throat. It may be classified as acute or chronic, based on duration. The diagnosis is usually performed on the clinical ground, and antibiotic therapy is frequently used in clinical practice. However, antibiotics frequently induce intestinal dysbiosis associated with some clinical problems. Therefore, probiotics are commonly prescribed in patients treated with antibiotics. The current clinical experience was conducted in patients with pharyngotonsillitis and treated with antibiotics. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million of living cells), and Lactobacillus delbrueckii subspecies delbrueckii LDD01 (200 million of living cells), was prescribed in the Group A, and was compared with no add-on treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3). Globally, 1118 outpatients were enrolled. Acute pharyngotonsillitis affected 795 subjects: 396 in Group A and 399 in Group B. Chronic pharyngotonsillitis affected 323 outpatients: 158 in Group A and 165 in Group B. All patients were usually treated with a 7-10-day course of antibiotic therapy. In patients with acute pharyngotonsillitis, the probiotic mixture significantly reduced the duration of all the symptoms (p<0.001 for all), except for the urinary tract infection, associated with antibiotic therapy which was already at the end of the antibiotic cycle (T1). The intergroup analysis showed that patients with chronic pharyngotonsillitis in Group A had significantly less tiredness, pain, and malaise (p<0.001 for all) than patients in Group B at T1. The probiotic course reduced the possible clinical relapse, and the use of additional medications at T2 and T3 in patients with both acute and chronic pharyngotonsillitis. In conclusion, the present clinical experience demonstrated that a probiotic mixture containing Lactobacillus plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, and Lactobacillus delbrueckii, was able to quickly reduce symptoms, possible relapse, and use of additional medications, associated with antibiotic therapy, in patients with both acute and chronic pharyngotonsillitis.
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Affiliation(s)
- I La Mantia
- Unit of Otolaryngology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - M Gelardi
- Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - L Drago
- Microbiology Department, University of Milan, Milan, Italy
| | - S E Aragona
- Center of Regenerative Medicine, Humanitas Mater Domini, Castellanza (VA), Italy
| | - G Cupido
- ENT Department, University of Palermo, Palermo, Italy
| | - C Vicini
- ENT Department, Forlì-Faenza Hospital, Italy, University of Ferrara e Bologna
| | - C Berardi
- ENT Department, Istituto Clinico Città Studi di Milano, Milan, Italy
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
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13
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Gelardi M, La Mantia I, Drago L, Meroni G, Aragona SE, Cupido G, Vicini C, Berardi C, Ciprandi G. Probiotics in the add-on treatment of otitis media in clinical practice. J BIOL REG HOMEOS AG 2020; 34:19-26. [PMID: 33426862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Otitis media (OM) affects the middle ear and is typically characterized by earache. OM may be classified as acute (AOM) or chronic (COM), based on symptom duration. OM may be clinically suspected, but the diagnosis is usually confirmed by the otoscopy. Antibiotic therapy is frequently used in clinical practice. However, antibiotics often induce intestinal and respiratory dysbiosis associated with some clinical problems. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no addon treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3).
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Affiliation(s)
- M Gelardi
- Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - I La Mantia
- Unit of Otolaryngology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - L Drago
- Microbiology Department, University of Milan, Milan, Italy
| | - G Meroni
- Microbiology Department, University of Milan, Milan, Italy
| | - S E Aragona
- Center of Regenerative Medicine, Humanitas Mater Domini, Castellanza (VA), Italy
| | - G Cupido
- ENT Department, University of Palermo, Palermo, Italy
| | - C Vicini
- ENT Department, Forlì-Faenza Hospital, Italy, University of Ferrara e Bologna
| | - C Berardi
- ENT Department, Istituto Clinico Città Studi di Milano, Milan, Italy
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
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14
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La Mantia I, Gelardi M, Drago L, Aragona SE, Cupido G, Vicini C, Berardi C, Ciprandi G. Probiotics in the add-on treatment of rhinosinusitis: a clinical experience. J BIOL REG HOMEOS AG 2020; 34:27-34. [PMID: 33426863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Rhinosinusitis (RS) affects the nose and the paranasal sinus and is characterized by nasal and systemic symptoms. It may be classified as acute or chronic, based on duration. Rhinosinusitis may be clinically suspected, but the diagnosis is usually based on the endoscopy. Antibiotic therapy is frequently used for RS patients in clinical practice. However, antibiotics often induce intestinal dysbiosis associated with some clinical problems and respiratory microbiota impairment. The current clinical experience was conducted in patients with pharyngotonsillitis and treated with antibiotics. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no addon treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3).
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Affiliation(s)
- I La Mantia
- Unit of Otolaryngology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - M Gelardi
- Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - L Drago
- Microbiology Department, University of Milan, Milan, Italy
| | - S E Aragona
- Center of Regenerative Medicine, Humanitas Mater Domini, Castellanza (VA), Italy
| | - G Cupido
- ENT Department, University of Palermo, Palermo, Italy
| | - C Vicini
- ENT Department, Forlì-Faenza Hospital, Italy, University of Ferrara e Bologna
| | - C Berardi
- ENT Department, Istituto Clinico Città Studi di Milano, Milan, Italy
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
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15
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La Mantia I, Gelardi M, Drago L, Aragona SE, Cupido G, Vicini C, Berardi C, Ciprandi G. Probiotics in the add-on treatment of laryngotracheitis: a clinical experience. J BIOL REG HOMEOS AG 2020; 34:35-40. [PMID: 33426864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Laryngotracheitis is a common disease, mainly characterized by dysphonia, cough, and sore throat. The diagnosis is usually based on the clinical ground, and antibiotic therapy is frequently used in clinical practice. However, antibiotics frequently induce intestinal dysbiosis associated with some clinical problems. The current clinical experience was conducted in patients with pharyngotonsillitis and treated with antibiotics. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no add-on treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3). Globally, 833 outpatients with laryngotracheitis were enrolled: 425 in Group A and 408 in Group B. All of them were treated with a 7-10-day course of antibiotic therapy. The probiotic mixture reduced the duration of symptoms associated with antibiotic therapy already at the end of the antibiotic cycle. The intergroup comparison showed that probiotic group patients experienced less fever, tiredness, headache, pain, malaise, diarrhea, and nausea (p<0.001 for all) than control patients at T1. The probiotic course reduced the possible clinical relapse, and the use of additional medications at T2 and T3. In conclusion, the present clinical experience demonstrated that a probiotic mixture containing Lactobacillus plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, and Lactobacillus delbrueckii subspecies delbrueckii, was able to rapidly reduce symptoms associated with antibiotic therapy in patients with laryngotracheitis.
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Affiliation(s)
- I La Mantia
- Unit of Otolaryngology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - M Gelardi
- Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - L Drago
- Microbiology Department, University of Milan, Milan, Italy
| | - S E Aragona
- Center of Regenerative Medicine, Humanitas Mater Domini, Castellanza (VA), Italy
| | - G Cupido
- ENT Department, University of Palermo, Palermo, Italy
| | - C Vicini
- ENT Department, Forlì-Faenza Hospital, Italy, University of Ferrara e Bologna
| | - C Berardi
- ENT Department, Istituto Clinico Città Studi di Milano, Milan, Italy
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
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16
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Gelardi M, Giancaspro R, Fiore V, Fortunato F, Cassano M. COVID-19: Effects of lockdown on adenotonsillar hypertrophy and related diseases in children. Int J Pediatr Otorhinolaryngol 2020; 138:110284. [PMID: 32861977 PMCID: PMC7415340 DOI: 10.1016/j.ijporl.2020.110284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND In response to the coronavirus pandemic 2019 (COVID-19), Italy established the national school closings from March 5, 2020. It has been shown that during school closures, there are significant decreases in the diagnoses of the respiratory infections. This has brought as well to a reduction in all those symptoms related to adenotonsillar hypertrophy. METHODS The study included 162 children, aged between 3 and 13 years, waiting for adenoidectomy and/or tonsillectomy, eventually combined with tympanocentesis or tube insertion. Parents have been called to answer a telephone interview aimed at detecting how the symptoms related to adenotonsillar hypertrophy were changing during lockdown. RESULTS There was an improvement in the overall symptomatology of children during the lockdown period. The value attributed by parents to the children's general assessment during the lockdown period decreased significatively during the quarantine (p = 0,0000). CONCLUSIONS The present study demonstrates that lockdown can have a positive impact on those specific diseases derived from precocious socialization and that it results to be particularly effective for the most vulnerable children. Indeed, lockdown has resulted to be so efficient that it has caused a modification in a medical and surgical therapeutic indication.
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Affiliation(s)
- M. Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - R. Giancaspro
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - V. Fiore
- Unit of Otolaryngology, University of Foggia, Foggia, Italy,Corresponding author. Unit of Otolaryngology, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - F. Fortunato
- Section of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - M. Cassano
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
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17
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Gelardi M, La Mantia I, Drago L, Meroni G, Aragona SE, Cupido G, Vicini C, Berardi C, Ciprandi G. A probiotic mixture in patients with upper respiratory diseases: the point of view of the otorhinolaringologist. J BIOL REG HOMEOS AG 2020; 34:5-10. [PMID: 33426860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Upper respiratory infections are widespread in clinical practice. Antibiotics are frequently used in the management of patients with airways infection. However, antibiotics can induce intestinal and respiratory dysbiosis that, in turn, worsens respiratory symptoms. Moreover, respiratory infections per se can cause dysbiosis. Consequently, probiotics may counterbalance the disturbed microbiota. The current clinical experience evaluated the efficacy and safety of an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii subspecies delbrueckii LDD01 (200 million living cells), in 2928 outpatients with an upper respiratory infection and treated with antibiotics. Patients took one stick/daily for four weeks. Simultaneously, 2877 patients with an upper respiratory infection and treated with antibiotics were recruited as control. This probiotic mixture significantly diminished the presence and the severity of respiratory symptoms at the end of the probiotic course and, more evidently, after a 3-month follow-up. In conclusion, the current clinical experience suggested that this probiotic mixture may be considered an effective and safe therapeutic option in managing patients with an upper respiratory infection and treated with antibiotics.
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Affiliation(s)
- M Gelardi
- Department of Otolaryngology, University of Foggia, Foggia, Italy
| | - I La Mantia
- Unit of Otolaryngology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - L Drago
- Microbiology Department, University of Milan, Milan, Italy
| | - G Meroni
- Microbiology Department, University of Milan, Milan, Italy
| | - S E Aragona
- Center of Regenerative Medicine, Humanitas Mater Domini, Castellanza (VA), Italy
| | - G Cupido
- ENT Department, University of Palermo, Palermo, Italy
| | - C Vicini
- ENT Department, Forlì-Faenza Hospital, Italy, University of Ferrara e Bologna
| | - C Berardi
- ENT Department, Istituto Clinico Città Studi di Milano, Milan, Italy
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
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Moffa A, Casale M, Fiore V, Rinaldi V, Giancaspro R, Lopez MA, Baptista P, Gelardi M, Cassano M. Impact of intranasal nebulized ectoine on morbidity and short-term quality of life after pediatric adenoidectomy. J BIOL REG HOMEOS AG 2020; 34:1213-1218. [PMID: 32666776 DOI: 10.23812/20-160-l-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Moffa
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - M Casale
- Integrated Sleep Surgery Team UCBM - Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - V Fiore
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - V Rinaldi
- Integrated Sleep Surgery Team UCBM - Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - R Giancaspro
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - M A Lopez
- Integrated Sleep Surgery Team UCBM - Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - P Baptista
- Unit of Otolaryngology, Clinica Universitaria de Navarra, Pamplona, Spain
| | - M Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - M Cassano
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
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19
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Gelardi M, Piccininni K, Quaranta N, Quaranta V, Silvestri M, Ciprandi G. Olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps is associated with clinical-cytological grading severity. ACTA ACUST UNITED AC 2020; 39:329-335. [PMID: 31708579 PMCID: PMC6843581 DOI: 10.14639/0392-100x-2426] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/12/2019] [Indexed: 01/04/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder, affecting about 4% of the worldwide population and strongly impacting the quality of life. CRSwNP is still a challenge for ENT specialists in terms of its unknown pathogenesis, difficulty in management and frequent relapse. Olfactory impairment frequently affects CRSwNP patients. We tested the hypothesis that clinical-cytological grading (CCG) could be associated with olfactory dysfunction. The study was cross-sectional, enrolling 62 patients (37 males, 25 females, mean age 49 years, range 18-83) suffering from newly diagnosed CRSwNP. Olfactory dysfunction was very frequent (about 90%) and did not depend on nasal obstruction as assessed by both polyp size and nasal airflow limitation. A CCG > 4 was the best cut-off value to suspect olfactory dysfunction [area under the ROC curve of 0.831 (0.715 to 0.914)]; in addition, the statistical risk of having dysosmia was over 7-fold higher in subjects with CCG > 4 compared with subjects reporting a CCG < 4 (adjOR 7.46). The present study underlines that olfactory dysfunction is common in CRSwNP patients and demonstrates an association between olfactory dysfunction and inflammation, suggesting that CCG could be useful in the work-up of CRSwNP patients and in suspecting olfactory impairment.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - K Piccininni
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - V Quaranta
- Pulmonology Unit, Ospedale Di Venere, Bari, Italy
| | - M Silvestri
- Pediatric Pulmonology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
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20
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Cupido GF, Gelardi M, La Mantia I, Aragona SE, Ciprandi G. Broser® (bromelain, escin and selenium), oral nutraceutical, monotherapy in patients with inflammatory otorhinolaryngological disorders. J BIOL REG HOMEOS AG 2019; 33:609-615. [PMID: 30891997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Inflammation is a common pathogenic mechanism involved in many otorhinolaryngological (ORL) disorders. Broser® is an oral nutraceutical currently containing bromelain 100 mg, escin 30 mg, and selenium 42.5 mcg. It could exert a safe and effective anti-inflammatory activity by virtue of these components. Therefore, the aim of the current survey, conducted in clinical practice of 84 Italian ORL centers, was to evaluate its safety and efficacy in the treatment of patients.
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Affiliation(s)
- G F Cupido
- ENT Department, University of Palermo, Palermo, Italy
| | - M Gelardi
- Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - I La Mantia
- ENT Department, University of Catania, Catania, Italy
| | - S E Aragona
- Center of Regenerative Medicine, Humanitas Mater Domini, Castellanza (VA), Italy
| | - G Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy
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21
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Farid A, Gelardi M, Angelini C, Franck AR, Costanzo F, Kaminsky L, Ercole E, Baroni TJ, White AL, Garey JR, Smith ME, Vizzini A. Phylloporus and Phylloboletellus are no longer alone: Phylloporopsis gen. nov. ( Boletaceae), a new smooth-spored lamellate genus to accommodate the American species Phylloporus boletinoides. Fungal Syst Evol 2018; 2:341-359. [PMID: 32467893 PMCID: PMC7225682 DOI: 10.3114/fuse.2018.02.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The monotypic genus Phylloporopsis is described as new to science based on Phylloporus boletinoides. This species occurs widely in eastern North America and Central America. It is reported for the first time from a neotropical montane pine woodland in the Dominican Republic. The confirmation of this newly recognised monophyletic genus is supported and molecularly confirmed by phylogenetic inference based on multiple loci (ITS, 28S, TEF1-α, and RPB1). A detailed morphological description of P. boletinoides from the Dominican Republic and Florida (USA) is provided along with colour images of fresh basidiomata in habitat, line drawings of the main anatomical features, transmitted light microscopic images of anatomical features and scanning electron microscope images of basidiospores. The taxonomic placement, ecological requirements and distribution patterns of P. boletinoides are reviewed and the relationships with phylogenetically related or morphologically similar lamellate and boletoid taxa such as Phylloporus, Phylloboletellus, Phyllobolites and Bothia are discussed.
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Affiliation(s)
- A Farid
- Herbarium, Department of Cell Biology, Micriobiology and Molecular Biology, University of South Florida, Tampa, Florida 33620, USA
| | - M Gelardi
- Via Angelo Custode 4A, I-00061 Anguillara Sabazia, RM, Italy
| | - C Angelini
- Via Cappuccini 78/8, I-33170 Pordenone, Italy.,National Botanical Garden of Santo Domingo, Santo Domingo, Dominican Republic
| | - A R Franck
- Wertheim Conservatory, Department of Biological Sciences, Florida International University, Miami, Florida, 33199, USA
| | - F Costanzo
- Via Angelo Custode 4A, I-00061 Anguillara Sabazia, RM, Italy
| | - L Kaminsky
- Department of Plant pathology, University of Florida, Gainesville, Florida 32611, USA
| | - E Ercole
- Department of Life Sciences and Systems Biology, University of Turin, Viale P.A. Mattioli 25, I-10125 Torino, Italy
| | - T J Baroni
- Department of Biological Sciences, State University of New York - College at Cortland, Cortland, NY 1304, USA
| | - A L White
- Herbarium, Department of Cell Biology, Micriobiology and Molecular Biology, University of South Florida, Tampa, Florida 33620, USA
| | - J R Garey
- Herbarium, Department of Cell Biology, Micriobiology and Molecular Biology, University of South Florida, Tampa, Florida 33620, USA
| | - M E Smith
- Department of Plant pathology, University of Florida, Gainesville, Florida 32611, USA
| | - A Vizzini
- Department of Life Sciences and Systems Biology, University of Turin, Viale P.A. Mattioli 25, I-10125 Torino, Italy
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22
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Gelardi M, Porro G, Sterlicchio B, Quaranta N, Ciprandi G. Internal nasal dilatator (Nas-Air®) in patients who snore. J BIOL REG HOMEOS AG 2018; 32:1267-1273. [PMID: 30334424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Snoring is a very common human habit, and for this reason it is considered more a social nuisance that a disease symptom. The nasal valve area has the minimal cross-sectional area of the upper airways. A problem at this level may easily induce impaired breathing and consequently snoring, therefore nasal dilation might significantly improve this complaint. Nas-Air® is a new internal nasal dilator which was tested on 41 outpatients who snore. Snoring duration, assessed by smartphone, visual analogue scale for the perception of sleep quality were measured before and during Nas-Air® use. A significant reduction of snoring time and an improvement of sleep quality were achieved during Nas-Air® wearing. In conclusion, the present study demonstrates that Nas-Air® is an internal nasal dilator able to reduce snoring time and improve sleep quality.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - G Porro
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - B Sterlicchio
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - G Ciprandi
- Ospedale Policlinico San Martino, Genoa, Italy
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23
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Gelardi M, Barbara F, Covelli I, Damiani MA, Plantone F, Notarnicola A, Moretti B, Quaranta N, Ciprandi G. Long-Term Therapy with Corticosteroids in Nasal Polyposis: A Bone Metabolism Assessment. Indian J Otolaryngol Head Neck Surg 2018; 71:2050-2056. [PMID: 31763293 DOI: 10.1007/s12070-018-1466-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/30/2018] [Indexed: 01/29/2023] Open
Abstract
Chronic rhinosinusitis associated with nasal polyposis (RSCwNP) affects 4% of the general population. As chronic condition, it requires chronic pharmacological treatment, whereas the surgical approach becomes necessary in obstructive and/or complicated cases. Intranasal and systemic corticosteroids (CS) represent the "Gold Standard" treatment for RSCwNP. The present study aimed to evaluate the side effects of prednisone in a group of patients with RSCwNP treated with long-term CS. In particular, attention was focused on bone disorders (osteopenia and osteoporosis) and prospective fracture risk increase. Forty patients (26 females, mean age 55.70 ± 14.03 years) affected by RSCwNP have been enrolled. Control group included 40 healthy subjects (17 females, mean age 56.37 ± 13.03 years). Nasal endoscopy, skin prick tests, nasal cytology, and bone densitometry were evaluated in all subjects. The likelihood of impaired bone metabolism (osteopenia or osteoporosis) was superimposable in both groups. Within RSCwNP group, no parameter was statistically significant in predicting a metabolism alteration.
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Affiliation(s)
- M Gelardi
- 1Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - F Barbara
- 1Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - I Covelli
- 2Orthopaedic, Trauma and Spine Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Bari, Italy
| | - M A Damiani
- 1Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - F Plantone
- 1Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - A Notarnicola
- 2Orthopaedic, Trauma and Spine Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Bari, Italy
| | - B Moretti
- 2Orthopaedic, Trauma and Spine Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Bari, Italy
| | - N Quaranta
- 1Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - G Ciprandi
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132 Genoa, Italy
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24
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Heffler E, Landi M, Caruso C, Fichera S, Gani F, Guida G, Liuzzo MT, Pistorio MP, Pizzimenti S, Riccio AM, Seccia V, Ferrando M, Malvezzi L, Passalacqua G, Gelardi M. Nasal cytology: Methodology with application to clinical practice and research. Clin Exp Allergy 2018; 48:1092-1106. [PMID: 29904978 DOI: 10.1111/cea.13207] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nasal cytology is an easy, cheap, non-invasive and point-of-care method to assess nasal inflammation and disease-specific cellular features. By means of nasal cytology, it is possible to distinguish between different inflammatory patterns that are typically associated with specific diseases (ie, allergic and non-allergic rhinitis). Its use is particularly relevant when other clinical information, such as signs, symptoms, time-course and allergic sensitizations, is not enough to recognize which of the different rhinitis phenotypes is involved; for example, it is only by means of nasal cytology that it is possible to distinguish, among the non-allergic rhinitis, those characterized by eosinophilic (NARES), mast cellular (NARMA), mixed eosinophilic-mast cellular (NARESMA) or neutrophilic (NARNE) inflammation. Despite its clinical usefulness, cheapness, non-invasiveness and easiness, nasal cytology is still underused and this is at least partially due to the fact that, as far as now, there is not a consensus or an official recommendation on its methodological issues. We here review the scientific literature about nasal cytology, giving recommendations on how to perform and interpret nasal cytology.
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Affiliation(s)
- E Heffler
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, Humanitas University, Milano, Italy
| | - M Landi
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Paediatric National Healthcare System, Torino, Italy
| | - C Caruso
- Allergy Unit, Fondazione Policlinico Gemelli, Presidio Columbus, Rome, Italy
| | - S Fichera
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - F Gani
- Respiratory Allergy, A.O.U. San Luigi, Orbassano, Torino, Italy
| | - G Guida
- Allergy and Lung Physiology, AO Santa Croce e Carle, Cuneo, Italy
| | - M T Liuzzo
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - M P Pistorio
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - S Pizzimenti
- Respiratory Medicine Unit, National Health System, ASL Città di Torino, Torino, Italy
| | - A M Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - V Seccia
- 1st Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - M Ferrando
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - L Malvezzi
- Department of Otolaryngology, Humanitas Clinical and Research Center, Milano, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
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25
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Gelardi M, Iannuzzi L, De Giosa M, Taliente S, De Candia N, Quaranta N, De Corso E, Seccia V, Ciprandi G. Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach. Acta Otorhinolaryngol Ital 2018; 37:38-45. [PMID: 28374869 PMCID: PMC5384308 DOI: 10.14639/0392-100x-1417] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/16/2016] [Indexed: 01/04/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder that strongly impacts patients' quality of life. CRSwNP is still a challenge for ENT specialists due to its unknown pathogenesis, difficult control and frequent relapse. We tested the hypothesis that a new standardised therapeutic approach based on individual clinical-cytological grading (CCG), may improve control of the disease and prevent the needing for surgery. We analysed 204 patients suffering from bilateral CRSwNP, 145 patients of whom regularly assumed therapy, respecting the planned check-up, and were considered cases; 59 patients were not assuming therapy as indicated and were considered as controls. After five years of standardised treatment, 15 of 145 (10.5%) improved endoscopic staging, 61 of 145 (42%) did not change their endoscopic staging, and 69 of 145 (47.5%) were worse. In the control group, 49 of 59 (83%) were worse by at least two stages (p < 0.05). Patients and controls were stratified basing on clinical and cytological grading as mild, moderate and severe. After patient stratification, in the mild group (n = 27) 92% patients had a constant trend, with no worsening and no need for surgery over a 5-year period, whereas in the mild CCG control group 1 of 59 (1.6%) required surgery (p < 0.05). In moderate GCC (n = 83), 44% of patients did not modify or improve endoscopic staging and 3.6% needed surgery, compared to 13.6% of controls with moderate GCC (p < 0.05). In severe CCG (n = 35), even though no patients achieved significant amelioration of endoscopic grading, 40% of patients were considered as "clinically controlled" and 5.7% of patients underwent surgery, but the percentage was significantly higher (49%) in the control group significant (p = 0.0000). Finally, statistical analyses revealed a clear trend that polyp size increased at a faster rate in the control group than in the treatment group and for each subgroup (low, moderate and severe). The present study suggests a new approach in the management of CRS according to clinical cytological grading that allows defining the grade of CRSwNP severity and to adapt the intensity of treatment. This approach limited the use of systemic corticosteroids to only moderate-severe CRSwNP with a low corticosteroid dosage in comparison with those previously suggested. Our protocol seems to improve the adherence by patients, control of disease and the need for surgery in the long-term.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - L Iannuzzi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - M De Giosa
- Department of Mathematics, University of Bari "Aldo Moro", Bari, Italy
| | - S Taliente
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - N De Candia
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy
| | - E De Corso
- Otorhinolaryngology, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - V Seccia
- 1st Otorhinolaryngology Unit; Department of Neuroscience, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G Ciprandi
- Department of Medicine, IRCCS-AOU San Martino-IST, Genoa, Italy
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26
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Gelardi M, Silvestri M, Ciprandi G. Relieving laryngopharingeral reflux (RELIEF) survey in otolaryngology - II the viewpoint of the patient. J BIOL REG HOMEOS AG 2018; 32:21-28. [PMID: 29436211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As LPR diagnostic work-up is complex in the absence of a definitive gold standard diagnostic test, patient symptoms have become a primary method to identify those with LPR. In this regard, Reflux Symptom Index (RSI) is a reliable self-administered questionnaire useful also to monitor changes after treatment. An Italian survey on patients with LPR evaluated the effect of treatments for LPR that were prescribed in a real-world setting, such as Otolaryngological clinics. In this part of the survey, 1,680 subjects [45.2% males, 54.8% females, 50.4 (14.7) years] were visited in the 86 Italian ORL centers. About 70% of patients were treated with Marial® alone, 27% with PPI plus add-on. RSI change assessment was the primary outcome. Both therapeutic options significantly (p<0.0001) reduced RSI score interestingly since the second week. The inter-group comparison demonstrated the Marial® monotherapy induced a greater reduction of RSI than PPI plus add-on since the second week. In conclusion, the present survey reported that a new medical device (Marial®) may be considered a valid option for the treatment of LPR.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | | | - G Ciprandi
- Ospedale Policlinico San Martino, Genoa, Italy
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27
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Gelardi M, Silvestri M, Ciprandi G. Correlation between the reflux finding score and the reflux symptom index in patients with laryngopharyngeal reflux. J BIOL REG HOMEOS AG 2018; 32:29-31. [PMID: 29436212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
LaryngoPharyngeal Reflux (LPR) is characterized by symptoms, signs, and/or tissue damage resulting from the aggression of the gastrointestinal contents in the upper airways. The Reflux Finding Score (RFS) assesses the laryngeal signs through laryngoscopy. The Reflux Symptom Index (RSI) scores the LPR symptoms. The objective of this real-world study was to compare RFS with RSI in a cohort of Italian LPR patients. Globally, 3932 patients with LPR were evaluated and RFS and RSI were assessed in all subjects. A moderate correlation was found between RSI and RFS (r=0.484, p<0.0001). In conclusion, the RSI and RFS can easily be included in the LPR work-up as objective and consistent parameters, with low cost and high practicality. Based on these clinical outcomes, the specialist can easily use these tests in clinical practice.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory
Organs, University of Bari, Italy
| | | | - G Ciprandi
- Ospedale Policlinico San Martino, Genoa, Italy
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28
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Ciprandi G, Gelardi M. Gastric reflux: comparison between the gastroenterologist and the otorhinolaryngologist’s approach. Pragmatic conclusive remarks. J BIOL REG HOMEOS AG 2018; 32:33-38. [PMID: 29436213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gastroesophageal reflux (GER) is a normal physiological process that usually happens after eating in healthy infants, children, young people and adults. In contrast, gastroesophageal reflux disease (GERD) occurs when the effect of GER leads to symptoms severe enough to merit medical treatment. In clinical practice, it is difficult to differentiate between GER and GERD, and health professionals and families use the terms interchangeably alike. There is no simple, reliable and accurate diagnostic test to confirm whether the condition is GER or GERD, and this in turn affects research and clinical decisions (1-6). Furthermore, the term GERD covers a number of specific conditions that have different effects and present in different ways. This makes it difficult to identify the person who genuinely has GERD, and to estimate the real prevalence and burden of the problem.
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Affiliation(s)
- G Ciprandi
- Ospedale Policlinico San Martino, Genoa, Italy
| | - M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
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29
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Gelardi M, Cavaliere C, Jannuzzi L. Nasal cytology. J BIOL REG HOMEOS AG 2018; 32:37-40. [PMID: 29552872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Nasal cytology represents a useful, inexpensive and easy-to-apply diagnostic method to better detail the phenotypic characteristics of rhinitis. In fact, it allows to detect and quantify the cell population within the nasal mucosa at a given time. The technique involves sampling, processing and microscope reading. Sampling requires the collection of cells from the surface of nasal mucosa that is usually done by a sterile disposable curette. Samples should be collected from the middle portion of the inferior turbinate where the ratio ciliate/mucinous cells is expected to be well balanced. This totally painless procedure is performed under anterior rhinoscopy, with an appropriate light source. The sample staining is executed using the common May-Grünwald-Giemsa (MGG). The stained sample is read at optical microscopy with a 1000x objective and with oil detecting the presence of inflammatory elements (eosinophils, mast cells, neutrophils and lymphocytes) in nasal mucosa, as in the case of allergic and non-allergic rhinitis. Nasal cytology is easy to perform, non-invasive, inexpensive and repeatable in the same subject, also at short time intervals. For these reasons it represents an affordable diagnostic technique that can be applied in all age ranges, to better differentiate pathological conditions and also to evaluate the effects of various stimuli (allergens, infectious, irritants) or the effect of treatments.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, University Department of Basic Medical Science, Neuroscience and Sensory Organs, Bari, Italy
| | - C Cavaliere
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - L Jannuzzi
- Section of Otolaryngology, University Department of Basic Medical Science, Neuroscience and Sensory Organs, Bari, Italy
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30
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Gelardi M, Ciprandi G. Focus on gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR): new pragmatic insights in clinical practice. J BIOL REG HOMEOS AG 2018; 32:41-47. [PMID: 29436209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gastroesophageal reflux (GER) is a common disease usually limited to the oesophagus. Laryngopharyngeal reflux (LPR) is an inflammatory reaction of the mucosa of pharynx, larynx, and other associated upper respiratory organs, caused by a reflux of stomach contents outside the oesophagus. LPR is considered to be a relatively new clinical entity with a vast number of clinical manifestations which are treated sometimes empirically and without a correct diagnosis. However, there is disagreement between specialists about its definition and management: gastroenterologists consider LPR to be a substantially rare manifestation of gastroesophageal reflux disease (GERD), whereas otolaryngologists believe that LPR is an independent, but common in their practice, disorder. Patients suffering from LPR firstly consult their general practitioners, but a multidisciplinary approach may be fruitful to define a unified strategy based on specific medications and behavioural changes. The present Supplement would review the topic, considering LPR and GER characteristics, pathophysiology, diagnostic work-up, and new therapeutic strategies also comparing different specialist points of view and patient populations. In particular, new insights derive from an interesting gel compound, containing magnesium alginate and E-Gastryal® (hyaluronic acid, hydrolysed keratin, Tara gum, and Xantana gum). In particular, two very large Italian surveys were conducted in real-world setting, such as outpatient clinics. The most relevant outcomes are presented and discussed in the current Issue. Actually, laryngopharyngeal reflux (LPR) is considered an extraesophageal manifestation of the gastroesophageal reflux disease (GERD). Both GERD and its extraesophageal manifestation are very common in clinical practice. Both disorders have a relevant burden for the society: about this topic most of pharmaco-economic studies were conducted in the United States. In population-based studies, 19.8% of North Americans complain of typical symptoms of GERD (heartburn and regurgitation) at least weekly (1). Also in the late 1990s, GERD accounted for $9.3 to $12.1 billion in direct annual healthcare costs in the United States, higher than any other digestive disease. As a result, acid-suppressive agents were the leading pharmaceutical expenditure in the United States. The prevalence of GERD in the primary care setting becomes even more evident when one considers that, in the United States, 4.6 million office encounters annually are primarily for GERD, whereas 9.1 million encounters include GERD in the top 3 diagnoses for the encounter. GERD is also the most frequently first-listed gastrointestinal diagnosis in ambulatory care visits (2, 3) Extraesophageal manifestations of reflux, including LPR, asthma, and chronic cough, have been estimated to cost $5438 per patient in direct medical expenses in the first year after presentation and $13,700 for 5 years.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | - G Ciprandi
- Ospedale Policlinico San Martino, Genoa, Italy
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Gelardi M, Silvestri M, Ciprandi G. Relieving laryngopharingeral reflux (RELIEF) survey in otolaryngology - the viewpoint of the otorhinolaryngologist. J BIOL REG HOMEOS AG 2018; 32:9-19. [PMID: 29436210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Laryngopharyngeal Reflux (LPR) should be considered as part of extraesophageal reflux (EER). This reflux involves respiratory structures other than, or in addition to, the oesophagus. A new medical device for the treatment of gastric reflux, including LPR, has been launched in Italy: Marial®. Therefore, the aim of the present survey was to analyse the prescriptive behaviour both considering the past or current treatments and clinical features during a specialist routine visit. The current survey was conducted in 86 Otorhinolaryngological centers, distributed in all of Italy. Globally, 4.418 subjects [47% males and 53% females, 50.1 (14.5) years-of-age] were visited. The visits included laryngoscopy, Reflux Finding Score (RFS) and Reflux Symptom Index (RSI) questionnaires. The total RSI median score was 15 (12-19) and the total median RFS value was 10 (8-12). Interestingly, a significant change in the new drug prescription was observed (p<0.0001): over two-third of patients (67%) received Marial® as monotherapy, whereas PPI plus add-on were prescribed to almost one-third of the patients. PPI alone was prescribed in less than 1%. In conclusion, LPR is a common disorder characterized by typical signs and symptoms; LPR patients may be correctly identified and scored by evidence-based criteria. In addition, the present survey reported that LPR treatment has been considerably changed by the introduction of a new medical device.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | | | - G Ciprandi
- Ospedale Policlinico San Martino, Genoa, Italy
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Abstract
Nasal cytology is a simple and safe diagnostic procedure that allows to assess the normal and pathological aspects of the nasal mucosa, by identifying and counting the cell types and their morphology. It can be easily performed by a nasal scraping followed by May-Grunwald-Giemsa staining and optical microscopy reading. This procedure allows to identify the normal cells (ciliated and mucinous), the inflammatory cells (lymphocytes, neutrophils, eosinophils, mast cells), bacteria, or fungal hyphae/spores. Apart from the normal cell population, some specific cytological patterns can be of help in discriminating among various diseases. Viral infections, allergic rhinitis, vasomotor rhinitis and overlapping forms can be easily identified. According to the predominant cell type, various entities can be defined (named as NARES, NARESMA, NARMA). This implies a more detailed knowledge and assessment of the disease that can integrate the standard diagnostic procedures. Nasal cytology also represents a useful research tool for diagnosis and therapy.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - L Iannuzzi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - N Quaranta
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - M Landi
- National Pediatric Healthcare System, Turin, Italy.,Unit Research of Pediatric Pulmonology and Allergy, Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council, Palermo, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Genoa, Italy
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Affiliation(s)
- M. Gelardi
- Italian Academy of Rhinology; Varese Italy
- Italian Academy of Nasal Cytology; Bari Italy
| | - M. Landi
- Italian Academy of Nasal Cytology; Bari Italy
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Pipolo C, Bianchini S, Barberi S, Landi M, D'Auria E, Fuccillo E, Gaffuri M, Marchisio P, Rosazza C, Saibene AM, Gelardi M, Torretta S. Nasal cytology in children: scraping or swabbing? Rhinology 2017; 55:242-250. [PMID: 28492610 DOI: 10.4193/rhin16.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nasal cytology has become a valuable tool in the assessment of a multitude of nasal pathologies in children. Collection methods differ significantly and even though the use of the nasal curette is regarded as the most reliable in adults, most practitioners use the nasal swab in children. However, no studies have validated the reliability and supposed better tolerability of the latter. We have compared these two sampling methods regarding their tolerability and analysed the diagnostic accuracy of the cotton nasal swab (NSW) to identify nasal cytotypes and rhinitis phenotypes, using nasal scraping (NSC) for comparison. In a multicentric prospective study we recruited 208 children and performed nasal cytology by means of NSW and NSC. Microscopic evaluating of the nasal cytotypes was performed and tolerability of NSW and NSC was tested. Our data revealed a significantly inferior diagnostic accuracy of NSW compared to NSC regarding reliability and cell counts. Our study is the first to shed light on the role of the sampling tools for pediatric nasal cytology. We documented a poor diagnostic accuracy of NSW, thus suggesting using only the nasal curette in clinical practice. Furthermore, tolerability did not differ between the two, refuting the common thesis that swabs are to be preferred when doing nasal cytology in children.
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Affiliation(s)
- C Pipolo
- Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - S Bianchini
- Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy
| | - S Barberi
- Department of Pediatrics, ASST Fatebenefratelli, Sacco, Milan, Italy
| | - M Landi
- Gruppo pediatrico di cure primarie Asl To1, Turin, Italy
| | - E D'Auria
- Department of Pediatrics, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - E Fuccillo
- Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - M Gaffuri
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan
| | - P Marchisio
- Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy
| | - C Rosazza
- Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy
| | - A M Saibene
- Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - M Gelardi
- Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - S Torretta
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan
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Ciofalo A, Zambetti G, Altissimi G, Fusconi M, Soldo P, Gelardi M, Iannella G, Pasquariello B, Magliulo G. Pathological and cytological changes of the nasal mucosa in acute rhinosinusitis: the role of hyaluronic acid as supportive therapy. Eur Rev Med Pharmacol Sci 2017; 21:4411-4418. [PMID: 29077152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the reparative role of hyaluronic acid in acute rhinosinusitis (ARS). PATIENTS AND METHODS 48 patients affected by ARS were submitted to nasal endoscopy, nasal cytology, mucociliary transport evaluation (MCTt) and visual analogue scale questionnaire (VAS) at T0, after 14-18 days (T1) and after 30-35 days (T2). The patients were randomized into two groups, A and B, and received Levofloxacin and Prednisone. Moreover, using a nebulizer ampoule for nasal douche, Group A received high molecular weight Sodium Hyaluronate (3%) plus saline solution (NaCl 0.9%) twice a day for 30 days; Group B received saline solution twice a day for 30 days. RESULTS At T0 only the VAS score showed differences regarding nasal discharge and post-nasal drip. At T1, in Group A MCTt and the number of bacteria were significantly lower than in Group B. The VAS score showed improvement in Group A. At T2 in Group A, MCTt and number of neutrophils were significantly lower than in Group B. The VAS score showed statistically significant differences between the two groups regarding nasal discharge. CONCLUSIONS In ARS patients sodium hyaluronate plus saline solution significantly improved symptoms, MCT time and reduced neutrophil count on nasal cytology.
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Affiliation(s)
- A Ciofalo
- Organi di Senso Department, "Sapienza" University of Rome, Rome, Italy.
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Gelardi M, De Candia N, Quaranta N, Russo C, Pecoraro P, Mancini M, Luperto P, Lombardo G, Macchi A, Bocciolini C, Ciofalo A, De Corso E, Ciprandi G. The relevance of counseling in patients with nasal polyps. Acta Otorhinolaryngol Ital 2017; 36:326-327. [PMID: 27734987 PMCID: PMC5066470 DOI: 10.14639/0392-100x-1315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022]
Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | - N De Candia
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | - N Quaranta
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy
| | - C Russo
- U.O.C. of Otolaryngology, Ospedale Di Venere, Carbonara di Bari (BA), Italy
| | | | - M Mancini
- Section of Otolaryngology, Azienda Area Vasta Romagna-Riccione, Italy
| | - P Luperto
- Section of Otolaryngology, ASL BR1 Brindisi, Italy
| | - G Lombardo
- Section of Otolaryngology, ASP of Agrigento, Italy
| | - A Macchi
- ORL Clinic University of Insubriae, Varese, Italy
| | - C Bocciolini
- U.O.C. of Otolaryngology Hospital Maggiore of Bologna, Italy
| | - A Ciofalo
- Department of Sensory Organs, Sapienza University of Roma, Italy
| | - E De Corso
- Otorhinolaryngology, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ciprandi
- Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
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Gelardi M, Guarino R, Taliente S, Quaranta N, Carpentieri A, Passalacqua G. Allergic and nonallergic rhinitis and skin sensitization to metals: is there a link? Eur Ann Allergy Clin Immunol 2017; 49:106-109. [PMID: 28497672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background. Chromium, Cobalt and Nickel are responsible for contact dermatitis, that is largely prevalent in the general population. They can act also as irritants in the upper and lower respiratory airways. Also rhinitis (allergic and nonallergic) is a high prevalence disorder. Both diseases could share some common inflammatory mechanisms, but the clinical association between skin sensitization to metals and rhinitis was never studied. Objective. We assessed the presence of skin sensitization to metals in subjects with rhinitis. Methods. Patients suffering from rhinitis underwent a standard diagnostic procedure, including skin testing, nasal endoscopy and nasal cytology. Control healthy subjects were also included. None of the patients had skin diseases. All subjects underwent patch test with Chromium, Cobalt and Nickel. Results. None of the 26 controls had positive skin prick test or nasal cytology. The 82 rhinitis patients were subdivided into allergic (group A = 27), nonallergic (group B = 31) and overlapping (group C = 24). The prevalence of positive patch test to metals was 26% in group A, 45% in group B, 42% in group C and 31% in controls. The percentage of patch-positive subjects was significantly different between Group A and B (p = 0.0045; OR: 0.43), Group A and C (p = 0.0186; OR: 0.49), and Group B and controls (p = 0.0360; OR: 1.85). There was a significant difference between groups A + controls and B + C. Conclusion. Even in the absence of skin diseases, the prevalence of sensitization to metals (patch test) is greater in nonallergic and overlapping rhinitis, as compared to allergic rhinitis and controls.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - R Guarino
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - S Taliente
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - N Quaranta
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - A Carpentieri
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-Ist-University of Genoa, Genoa, Italy. Phone: +39 010 353 8904 E-mail:
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Gelardi M, De Luca C, Taliente S, Fiorella ML, Quaranta N, Russo C, Ciofalo A, Macchi A, Mancini M, Rosso P, Seccia V, Guagnini F, Ciprandi G. Adjuvant treatment with a symbiotic in patients with inflammatory non-allergic rhinitis. J BIOL REG HOMEOS AG 2017; 31:201-206. [PMID: 28337893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Inflammatory non-allergic rhinitis (INAR) is characterized by the presence of an inflammatory infiltrate and a non-IgE-mediated pathogenesis. This retrospective, controlled, multicentre study investigated whether a symbiotic, containing Lactobacillus acidophilus NCFM, Bifidobacterium lactis, and fructo-oligosaccharides (Pollagen®, Allergy Therapeutics, Italy), prescribed as adjunctive therapy to a standard pharmacological treatment, was able to reduce symptom severity, endoscopic features, and nasal cytology in 93 patients (49 males and 44 females, mean age 36.3±7.1 years) with INAR. The patients were treated with nasal corticosteroid, oral antihistamine, and isotonic saline. At randomization, 52 patients were treated also with symbiotic as adjunctive therapy, whereas the remaining 41 patients served as controls. Treatment lasted for 4 weeks. Patients were visited at baseline, after treatment, and after 4-week follow-up. Adjunctive symbiotic treatment significantly reduced the percentages of patients with symptoms and endoscopic signs, and diminished inflammatory cells. In conclusion, the present study demonstrates that a symbiotic was able, as adjuvant treatment, to significantly improve symptoms, endoscopic feature, and cytology in patients with INAR, and its effect may be long lasting.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - C De Luca
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - S Taliente
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - M L Fiorella
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - C Russo
- U.O.C. of Otolaryngology Ospedale Di Venere Carbonara di Bari, Italy
| | - A Ciofalo
- Otolaryngology, Department of Sensory Organs, University Sapienza, Roma, Italy
| | - A Macchi
- ORL Clinic University of Insubriae, Varese, Italy
| | - M Mancini
- Section of Otolaryngology, Azienda Area Vasta Romagna-Riccione, Italy
| | - P Rosso
- Section of Otolaryngology, Ospedale Civico di Chivasso (TO), Italy
| | - V Seccia
- Otorhinolaryngology Unit, Department of Neuroscience, AOU Pisana, Pisa, Italy
| | - F Guagnini
- Medical and Scientific Department Allergy Therapeutics Italia, Milan, Italy
| | - G Ciprandi
- Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) - Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy
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Gelardi M, Taliente S, Piccininni K, Silvestre G, Quaranta N, Ciprandi G. Nasal irrigation with Nasir® in children: a preliminary experience on nasal cytology. J BIOL REG HOMEOS AG 2016; 30:1125-1130. [PMID: 28078863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Allergic rhinitis (AR) and upper airway respiratory infections are frequent in children, and both have a relevant impact on some social aspects, including school attendance and performance, sleep, quality of life (also of the parents), and costs. Saline nasal irrigation is widely employed to reduce nasal congestion and mucopurulent secretion, to stimulate cleansing of the nasal and paranasal cavities, and to induce restoration of mucociliary clearance. The present study evaluated the effects of nasal irrigation on nasal cytology, using the new device Nasir® in 66 children (40 males, 26 females, mean age 7.31±1.7 years, age range 4-17 years) with allergic rhinitis. The patients were treated with nasal irrigation with warm (36°C) Nasir® (250 mL sacs of premixed solution): one sac twice daily for 12 days. Nasal irrigation significantly reduced the neutrophilic infiltrate (baseline median value 2.8±0.7; post treatment value 2±0.5; p less than 0.05). In addition, there was a reduction of eosinophil infiltrate (T0= 3.2±1.1; T1= 2.6±1.2; p= less than 0.05). There was no significant change with regard to bacteria (T0= 2.7±0.9; T1= 2.3±1.02; p= 0.17). In conclusion, this pilot study reports that nasal irrigation with Nasir® might be useful to attenuate upper airway inflammation.
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Affiliation(s)
- M Gelardi
- Department of Otolaryngology, University of Bari, Bari, Italy
| | - S Taliente
- Department of Otolaryngology, University of Bari, Bari, Italy
| | - K Piccininni
- Department of Otolaryngology, University of Bari, Bari, Italy
| | | | - N Quaranta
- Department of Otolaryngology, University of Bari, Bari, Italy
| | - G Ciprandi
- Department of Medicine, IRCCS-AOU San Martino, Genoa, Italy
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Gelardi M, Abbattista G, Quaranta VN, Quaranta N, Seccia V, Buttafava S, Frati F, Ciprandi G. Standardization procedure for the nasal nitric oxide measurement method using Niox MINO® and the tidal-breathing technique with velum-closure. J BIOL REG HOMEOS AG 2016; 30:853-858. [PMID: 27655510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nitric oxide (NO) is a molecule that performs many functions in the human body. The entire respiratory tract can produce NO, but the highest production occurs in the upper respiratory tract, in the paranasal sinuses in particular. The aim of the present study was to assess a new nasal NO (nNO) measurement method using the Niox MINO Nasal® device (Aerocrine AB, Solna, Sweden) and a special procedure, in order to compare the nNO values obtained in 32 healthy subjects with the values found in the international literature. The measured normal nNO values were equal to 426.76±143.27 ppb, with a 95% confidence interval [160.22-733.30]. Males had an average nNO value equal to 446.76±133.63 [178.64 714.02], whereas in females the average value was 403.80±154.90 [94.00-713.60]. This study allows us to confirm that we have been able to establish the normal range of nitric oxide quantity produced in the nasal/sinus cavities of healthy individuals using the Niox MINO Nasal® device and tidal-breathing with velum-closure manoeuvre.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - G Abbattista
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - V N Quaranta
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - N Quaranta
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - V Seccia
- Otorhinolaryngology Unit, Department of Neuroscienze, A.O.U. Pisana, Pisa, Italy
| | - S Buttafava
- Medical and Scientific Department, Stallergenes, Milan, Italy
| | - F Frati
- Medical and Scientific Department, Stallergenes, Milan, Italy
| | - G Ciprandi
- Department of Internal Medicine, IRCCS A.O.U. San Martino, Genoa, Italy
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Gelardi M, Taliente S, Fiorella ML, Quaranta N, Ciancio G, Russo C, Mola P, Ciofalo A, Zambetti G, Caruso Armone A, Cantone E, Ciprandi G. Ancillary therapy of intranasal T-LysYal® for patients with allergic, non-allergic, and mixed rhinitis. J BIOL REG HOMEOS AG 2016; 30:255-262. [PMID: 27049100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Allergic rhinitis (AR) is caused by an IgE-mediated inflammatory reaction. Non-allergic rhinitis (NAR) is characterized by a non-IgE-mediated pathogenesis. Frequently, patients have the two disorders associated: such as mixed rhinitis (MR). Hyaluronic acid (HA) is a fundamental component of the human connective tissue. HA may exert anti-inflammatory and immune-modulating activities. Recently, an intranasal HA formulation was proposed: a supramolecular system containing lysine hyaluronate, thymine and sodium chloride (T-LysYal®). This randomized study investigated whether intranasal T-LysYal® (rinoLysYal®, Farmigea, Italy) was able to reduce symptom severity, endoscopic features, and nasal cytology in 89 patients (48 males and 41 females, mean age 36.3±7.1 years) with AR, NAR, and MR. Patients were treated with intranasal T-LysYal® or isotonic saline solution as adjunctive therapy to nasal corticosteroid and oral antihistamine for 4 weeks. Patients were visited at baseline, after treatment and after 4-week follow-up. Intranasal T-LysYal® treatment significantly reduced the quote of patients with symptoms, endoscopic features, and inflammatory cells. In conclusion, the present study demonstrates that intranasal T-LysYal® is able, as ancillary therapy, to significantly improve patients with AR, NAR, and MR, and its effect is long lasting.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - S Taliente
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - M L Fiorella
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - G Ciancio
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - C Russo
- U.O.C. di Otorinolaringoiatria - Ospedale Di Venere, Carbonara Di Bari (BA), Italy
| | - P Mola
- Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo, Italy
| | - A Ciofalo
- Rhinology and Immuno-Allergy Unit, Sense Organs Department, Otolaryngology Section, Umberto I General Hospital, La Sapienza University, Rome, Italy
| | - G Zambetti
- Rhinology and Immuno-Allergy Unit, Sense Organs Department, Otolaryngology Section, Umberto I General Hospital, La Sapienza University, Rome, Italy
| | | | - E Cantone
- Department of Neuroscience, Reproductive and Dentistry Science, ENT Unit; Federico II University, Naples, Italy
| | - G Ciprandi
- Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) - Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
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Gelardi M, Taliente S, Fiorella ML, Quaranta N, De Candia N, Russo C, Mola P, Ciofalo A, Zambetti G, Cantone E, Arnone F, Macchi A, Rosso P, Ciprandi G. Intranasal T-LysYal® as adjunctive therapy for patients after functional endoscopic sinus surgery. J BIOL REG HOMEOS AG 2016; 30:277-284. [PMID: 27049103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Functional Endoscopic Sinus Surgery (FESS) is a common day surgery technique for upper airway disorders. Hyaluronic acid (HA) is a fundamental component of the human connective tissue. HA may exert reparative, anti-inflammatory and immune-modulating activities. Recently, a new intranasal HA formulation has been proposed: a supramolecular system containing lysine hyaluronate, thymine and sodium chloride (T-LysYal®). This randomized study investigated whether intranasal T-LysYal® (RinoLysYal®, Farmigea, Italy) was able to reduce symptom severity, endoscopic features, and nasal cytology in 83 patients (49 males and 34 females mean age 45.4±6.2 years) treated with FESS. All patients were treated with isotonic saline solution for 4 weeks, and a sub-group (active group) was also treated with intranasal T-LysYal®. Patients were visited at baseline, after treatment, and after 4-week follow-up. Intranasal T-LysYal® treatment significantly reduced the quote of patients with symptoms, endoscopic features, and inflammatory cells in comparison to isotonic solution. In conclusion, the present study demonstrates that intranasal T-LysYal® is able to significantly improve patients after FESS and its effect is long lasting.
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Affiliation(s)
- M Gelardi
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - S Taliente
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - M L Fiorella
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - N Quaranta
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - N De Candia
- Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - C Russo
- U.O.C. di Otorinolaringoiatria, Ospedale Di Venere, Carbonara Di Bari (BA), Italy
| | - P Mola
- Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo (TO), Italy
| | - A Ciofalo
- Rhinology and Immuno-Allergy Unit, Sense Organs Department, Otolaryngology Section, Umberto I General Hospital, La Sapienza University, Rome, Italy
| | - G Zambetti
- Rhinology and Immuno-Allergy Unit, Sense Organs Department, Otolaryngology Section, Umberto I General Hospital, La Sapienza University, Rome, Italy
| | - E Cantone
- Department of Neuroscience, Reproductive and Dentistry Science, ENT Unit, Federico II University, Naples, Italy
| | - F Arnone
- Clinica Otorinolaringoiatrica, Ospedale San Paolo, Milan, Italy
| | - A Macchi
- ORL Clinic University of Insubriae, Varese, Italy
| | - P Rosso
- S.C. Otorinolaringoiatra, Ospedale Civico di Chivasso (To), Italy
| | - G Ciprandi
- Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) - Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
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Gelardi M, Simonini G, Ercole E, Davoli P, Vizzini A. Cupreoboletus (Boletaceae, Boletineae), a new monotypic genus segregated from Boletus sect. Luridi to reassign the Mediterranean species B. poikilochromus. Mycologia 2015; 107:1254-69. [DOI: 10.3852/15-070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022]
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Gelardi M. "Overlapped" rhinitis: a real trap for rhinoallergologists. Eur Ann Allergy Clin Immunol 2014; 46:234-236. [PMID: 25398169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Under the broad heading of "vasomotor" rhinitis two big groups can be distinguished: allergic rhinitis (IgE-mediated), and nonallergic rhinitis. Since they are two separate nosological entities, they can co-exist in the same patient, classifying themselves in the group of "overlapped" rhinitis (OR). Although not absolutely rare (indeed it is estimated a 15-20% incidence among all vasomotor rhinopathies), this condition is not investigated and diagnosed, with significant implications in the clinical-diagnostic and therapeutic field.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology Department of Basic Medical Science, Neuroscience and Sensory Organs University of Bari, Italy E-mail:
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Gelardi M, Siciliano RA, Papa F, Mazzeo MF, De Nitto E, Quaranta N, Lippolis R. Proteomic analysis of human nasal mucosa: different expression profile in rhino-pathologic states. Eur Ann Allergy Clin Immunol 2014; 46:164-171. [PMID: 25224946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Rhinitis comprises several diseases with varying causes and different clinical manifestations and pathological features, but treated as a single clinical disorder. As heterogeneous disease, proper differential diagnosis is useful to delineate appropriate therapeutic intervention. Comparative proteomic investigation was aimed to provide information for specific differentially expressed proteins in rhino pathologic state, that could be used for diagnostic purpose and therapeutic monitoring. METHODS Proteins extracted from nasal mucosa cells of patients with different features of rhinitis and from control subjects, were separated by 2-DE. Proteins differentially expressed were identified by mass spectrometry (MS). RESULTS Comparative proteomic analyses led to the identification of eighteen proteins differentially expressed in patients with rhinitis, mainly related to cell defense and innate and acquired immunity. From that, at least one protein can be a possible candidate as biomarker of disease.
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Affiliation(s)
- M Gelardi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - R A Siciliano
- Institute of Food Sciences, Italian National Research Council (CNR), Avellino, Italy
| | - F Papa
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - M F Mazzeo
- Institute of Food Sciences, Italian National Research Council (CNR), Avellino, Italy
| | - E De Nitto
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - N Quaranta
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - R Lippolis
- Institute of Biomembranes and Bioenergetics (IBBE) National Research Council (CNR) c/o Department of Basic Medical Sciences Neurosciences and Sense Organs P.zza Giulio Cesare 11, 70124 Bari, Italy. E-mail:
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Gelardi M, Ciprandi G, Buttafava S, Quaranta N, Squeo V, Incorvaia C, Frati F. Nasal inflammation in Parietaria-allergic patients is associated with pollen exposure. J Investig Allergol Clin Immunol 2014; 24:352-353. [PMID: 25345306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Ventura MT, Murgia N, Montuschi P, Gelardi M, Ciabattoni G, Buquicchio R, Resta O, Passalacqua G. Exhaled breath condensate, nasal eosinophil cationic protein level and nasal cytology during immunotherapy for cypress allergy. J BIOL REG HOMEOS AG 2013; 27:1083-1089. [PMID: 24382191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Interest in cypress allergy is widely rising: an increasing number of studies have pointed out the efficacy of immunotherapy to reduce cypress-related symptoms and drug use. Cypress immunotherapy is well tolerated, but there are few studies dealing with its sub-clinical effects on the airways. The aim of this investigation is to assess the effects of immunotherapy on airways by the analysis of exhaled breath condensate (EBC), nasal lavage fluid (NAL) and nasal cytology. Fifteen mono-sensitized to cypress pollen patients have been observed, among them 9 have been treated with sub-cutaneous immunotherapy (SCIT), 3 with sub-lingual immunotherapy (SLIT) and 3 which were not treated underwent EBC, NAL and nasal cytology out of the pollen season. 8-isoprostane in EBC, Eosinophil cationic protein (ECP) and inflammatory cells in nasal cytology were also evaluated. The median value of 8-isoprostane in EBC was 18.58 pg/ml in patients who did not undergo immunotherapy, 49.38 pg/ml in SCIT patients and 13.41 pg/ml in SLIT subjects. The median value of ECP in nasal lavage was higher in non- treated subjects (27.3 mg/l) than in those treated with SCIT (1 mg/l)(p less than 0,05) or SLIT (2.6 mg/l). All nasal cytology specimens did not show any sign of inflammation. In conclusion SLIT seems to be well tolerated and to reduce significantly the levels of ECP in nasal lavage. In addition the levels of 8-isoprostane in EBC among SCIT patients were unexpectedly high and need to be further evaluated.
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Affiliation(s)
- M T Ventura
- Interdisciplinary Department of Medicine (DIM), University of Bari Medical School, Policlinico, Bari, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Occupational and Environmental Toxicology, University of Perugia, Italy
| | - P Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University Sacro Cuore, Rome, Italy
| | - M Gelardi
- University Department of Otolaryngology, Bari, Italy
| | - G Ciabattoni
- Department of Drug Sciences, School of Pharmacy, University of Chieti G. d'Annunzio, Chieti, Italy
| | - R Buquicchio
- Department of Dermatology, University of Bari, Medical School, Policlinico, Bari, Italy
| | - O Resta
- Department of Respiratory Diseases, University of Bari Medical School, Bari, Italy
| | - G Passalacqua
- Allergy and Respiratory Disease, DIMI, University of Genoa, Genoa, Italy
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Gelardi M, Guglielmi AVN, De Candia N, Maffezzoni E, Berardi P, Quaranta N. Effect of sodium hyaluronate on mucociliary clearance after functional endoscopic sinus surgery. Eur Ann Allergy Clin Immunol 2013; 45:103-108. [PMID: 23862400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND To determine the effect of intranasal sodium hyaluronate on mucociliary clearance time following functional endoscopic sinus surgery in patients with nasal polyposis. STUDY DESIGN Randomized, controlled, blinded study. METHODS Thirty-six patients with grade II nasal polyposis undergoing functional endoscopic sinus surgery received intranasal sodium hyaluronate 9 mg twice daily or saline for 30 days commencing on the second day after surgery. Ciliary mucous transport time was assessed using charcoal powder and saccharin administered during rhinoscopy. Other outcomes included changes in symptoms, endoscopic appearance of the nasal mucosa, and tolerability. RESULTS Patients receiving sodium hyaluronate had a significantly faster mucociliary clearance time at 1 month compared with controls (14.3 +/- 2.5 vs. 23.6 +/- 3.3 minutes; p = 0.000). Furthermore, sodium hyaluronate recipients experienced a lower incidence of rhinorrhea, less nasal obstruction and a lower incidence of exudate on endoscopy than control subjects at 1 month (all p < 0.05). Sodium hyaluronate was well tolerated in patients following functional endoscopic sinus surgery. CONCLUSION The use of intranasal sodium hyaluronate in patients undergoing functional endoscopic sinus surgery for nasal polyposis augmented the improvement in mucociliary clearance observed following this procedure and improved several clinical and endoscopic parameters. These data provide encouraging evidence of the beneficial effects of sodium hyaluronate in the care of patients undergoing functional endoscopic sinus surgery with which to continue the development of the product for this indication.
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Affiliation(s)
- M Gelardi
- Section of Otolaryngology, Department Basic Medical Science of Neuroscience and Sensory Organs, University of Bari, Bari, Italy.
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Gelardi M, Passalacqua G, Fiorella ML, Quaranta N. Assessment of biofilm by nasal cytology in different forms of rhinitis and its functional correlations. Eur Ann Allergy Clin Immunol 2013; 45:25-29. [PMID: 23678556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Recently, it has been reported that nasal cytology in light microscopy can identify biofilms, which appear as cyan-stained "Infectious Spots". We assessed by the same method and in the same population, the presence of biofilms in different nasal disorders, and estimated if a correlation with the functional grade of obstruction existed. METHODS Subjects suffering from different nasal disorders, after a detailed clinical history and ENT examination, underwent nasal fibroendoscopy, skin prick test, rhinomanometry and nasal cytology. The presence of biofilm was linked to the type ofdisease and to the grade of obstruction. RESULTS Among 1,410 subjects previously studied, the infectious spot was found in 107 patients (7.6%), and this percentage reached 55.4% in subjects with cytologic signs of infectious rhinitis (presence of bacteria/fungi). Biofilms were largely more frequent in patients with adenoid hypertrophy (57.4%), followed by nasal polyposis (24%), chronic rhinosinusitis (9.5%) and non-allergic rhinitis (7.6%). Nasal cytology was normal in the remaining patients, where no infectious spot was detectable. Statistical analysis showed that nasal resistances were significantly higher in presence of biofilms in patients with adenoid hypertrophy (p = 0.003), nasal polyposis (p < 0.001), chronic rhinosinusitis (p = 0.018) and septal deviation (p = 0.001). CONCLUSION The results demonstrate that biofilm is present not only in infectious rhinitis, but also in inflammatory and/or immune-mediated diseases. The presence of biofilms significantly correlates with the degree of nasal obstruction as assessed by rhinomanometry.
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MESH Headings
- Adolescent
- Adult
- Aged
- Bacteria/growth & development
- Bacteria/isolation & purification
- Biofilms/growth & development
- Case-Control Studies
- Child
- Child, Preschool
- Cytodiagnosis
- Endoscopy
- Female
- Fiber Optic Technology
- Humans
- Male
- Middle Aged
- Nasal Cavity/microbiology
- Nasal Cavity/pathology
- Nasal Obstruction/diagnosis
- Nasal Obstruction/microbiology
- Nasal Obstruction/pathology
- Nasal Polyps/diagnosis
- Nasal Polyps/microbiology
- Nasal Polyps/pathology
- Rhinitis/diagnosis
- Rhinitis/microbiology
- Rhinitis/pathology
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/microbiology
- Rhinitis, Allergic, Perennial/pathology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/microbiology
- Rhinitis, Allergic, Seasonal/pathology
- Rhinomanometry
- Severity of Illness Index
- Sinusitis/diagnosis
- Sinusitis/microbiology
- Sinusitis/pathology
- Skin Tests
- Young Adult
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Affiliation(s)
- M Gelardi
- Department of Otolaryngology, University of Bari, Italy
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