The aim of this thesis is to evaluate and optimise current pharmacotherapeutic options in rhinosinusitis. There is often a marked variation in treatment response in those afflicted with chronic rhinosinusitis, both within and between patients, attributable in part to different disease phenotypes/endotypes, poor awareness of treatment optimization options, and trivialization of symptoms by patients and physicians. Characteristically, these factors contribute to a typical remitting and relapsing disease course. The objectives of this work are to improve the therapeutic index and reach of commonly used medications by boosting efficacy whilst reducing concomitant side effects. The third chapter explores the use of initial oral steroids in patients with chronic rhinosinusitis and nasal polyposis, focusing on the role of the ostiomeatal complex in the perpetuation of disease symptoms. Often a short course of oral steroids is used in patients with moderate to severe disease to achieve initial control before maintenance with intranasal steroids. This is termed as a ‘medical polypectomy’ and anecdotally is commonly used in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). However, the evidence for its efficacy is tenuous and there are no data to evaluate if it indeed re-establishes ostiomeatal sinus complex drainage which is a condicio sine qua non of ensuring long-term symptom resolution. Further, it is known that monotherapy with nasal steroids may result in loss of symptom control. We have therefore in a double-blind placebo controlled trial (Chapter 4) evaluated the effect of this initial induction with oral steroids on subsequent sequential intranasal therapy. Perhaps, however, more crucially we have for the first time comprehensively addressed the safety of both oral and topical steroids in patients with CRSwNP who have other concomitant steroid-dependent illnesses like asthma and COPD. A particularly refractory subset of those with CRSwNP also have aspirin intolerance and asthma. While recent guidelines have recommended more aspirin challenge testing in these patients, it is unclear what the significance of a positive test is in the absence of overt clinical symptoms or in patients with only moderate disease. This is addressed in Chapter 5, as this significant phenotype of aspirin intolerant rhinosinusitis need close monitoring, dose optimization, polytherapy, and in selected cases may be suitable for aspirin desensitization. Penultimately, we evaluate in a double-blind placebo controlled trial (Chapter 6) the tachyphylaxis and rebound congestion that blights the medium to long-term use of sympathomimetic nasal decongestant sprays like oxymetazoline and if this can be reversed by the concomitant use of nasal steroids. We also characterized nasal blood flow as an outcome to evaluate in these patients and its relation to other rhinological outcome measures (Chapter 7).

Air pollution is a well known public health problem that involves both long-term and acute effects. An outcome associated with traffic-related air pollution is respiratory illness. Many studies have described the relationship between asthmatic symptoms and traffic-related air pollution; however, few have investigated the potential of air pollution to cause asthma itself, especially among adults. The overall aim of this thesis was to study the relationship between vehicle exhaust levels at home and the prevalence of self-reported annoyance and asthmatic symptoms, and the incidence of asthma and rhinitis. These relationships were evaluated using different indicators of exposure with a high spatial resolution. Three different data sets were used for the four papers included in this thesis. The first paper (paper I) is based on a questionnaire that was sent to a random selection of the adult population within three Swedish cities (Gothenburg, Uppsala, and Umeå) as part of the Swedish Environmental Protection Agency’s health-related environmental monitoring. The aim was to study the degree of self-reported annoyance and the prevalence of asthmatic symptoms in relation to the levels of vehicle exhaust outside the home. The level of exposure was described using modeled levels of nitrogen dioxide (NO2) as the exposure indicator. The second paper (paper II) is based on new asthma cases identified within the Obstructive Lung disease In Northern Sweden (OLIN) study, each with a matched referent. The aim of this study was to analyze if new cases of asthma had higher levels of vehicle exhaust outside the home compared to the population controls. Exposure was assessed using both measured levels of NO2 outside each home, and by summarizing the amount of traffic within a 200 metre buffer surrounding each participant’s home. Papers III and IV were based on the Respiratory Health in Northern Europe (RHINE) Cohort, a prospective cohort of adults included in 1990 and followed up with in 1999. The proportion of new cases of asthma (papers III and IV) and rhinitis (paper IV) were identified based on the answers from the initial and follow-up questionnaires. In paper III, exposure was assessed by using meteorological dispersion models to calculate the levels of NO2 outside each home as an indicator of the levels of vehicle exhaust. As an alternative indicator, the distance from each participant’s home to the nearest major road was calculated using geographical information system (GIS) tools. The exposure assessment in paper IV was also based on meteorological dispersion models, but expressed the levels of vehicle exhaust as particle mass concentration. The results show that the levels of vehicle exhaust outside the home are significantly correlated with the degree of self-reported annoyance and the prevalence of asthmatic symptoms, and also with the risk of developing asthma, but not rhinitis, among adults. The odds ratio (OR) for high annoyance to vehicle exhaust and reporting asthmatic symptoms was 1.14 (95% Confidence Interval, CI 1.11-1.18) and 1.04 (95% CI 1.01-1.07) per 1 µg/m3 increase in the NO2 level outside the home, respectively. Paper II showed there was a non-significant tendency for increased risk of developing asthma among those living with high levels of vehicle exhaust outside their home. This finding was then supported by papers III and IV, showing a significant relationship between the onset of asthma and the mean (winter) levels of NO2 outside the home (OR=1.46, 95% CI 1.07-1.99 per 10 µg/m3) and the levels of vehicle exhaust particles outside the home. In paper III, living close to a major road was significantly related to the risk of developing asthma. No significant results were shown between vehicle exhaust and rhinitis. In conclusion, vehicle exhaust outside the home is associated with the prevalence of annoyance and asthmatic symptoms, and with the risk of developing asthma, but not rhinitis, among adults.

In 2005 an equine rhinitis A virus (ERAV) isolate was recovered from a febrile horse during a respiratory outbreak in Ontario. This isolate (ERAV/ON/05) was propagated in cell culture and used to study its genomic characteristics and to investigate the clinical features in experimentally infected ponies. The fulllength genome of this isolate was sequenced and compared with other ERAV available in GenBank. The isolate genome is 7839 nucleotides (nts) in length with a variable 5’UTR and a more conserved 3’UTR. When the isolate was compared to other reported ERAV, an insertion of 13 nts in the 5’UTR was identified. Phylogenetic analysis demonstrated that ERAV/ON/05 was closely related to the ERAV/PERV isolate, which was recovered in 1962 in the United Kingdom. An experimental model was developed to study the clinical infection in naïve healthy ponies (ERAV/ON/05 n=4 and placebo n=4). ERAV/ON/05 induced clinical respiratory disease compared to placebo. The clinical signs consisted of pyrexia, nasal discharge, increased and abnormal lung sounds, increased size of submandibular lymph nodes and persistent mucopus in the trachea (up to 21 days post-infection). The virus was isolated from the lower and upper airways up to day 7 post-infection, corresponding with the detection of neutralizing ERAV antibodies. Assessment of the cytokine profile from bronchoalveolar lavage (BAL) cells demonstrated that this infection induced down-regulation of the mRNA expression of IL-4. One year later, four previously infected ponies with neutralizing antibodies to ERAV were assigned to a reinfection trial. None of the re-infected ponies developed clinical disease, and only one animal had a four-fold increase in antibody titres to ERAV. Attempts to recover the virus from the re-infected ponies using cell culture were negative; however, a down-regulation of the mRNA expression of IL-4 and IFN-β was identified in BAL cells. In conclusion, this study shows that the genome of ERAV has not significantly changed in the last 50 years and more importantly the virus induces clinical respiratory disease similar to other common equine respiratory viruses.

Master of Science / Department of Electrical and Computer Engineering / Punit Prakash / The primary objective of this research is to implement an experimentally validated computational model to guide device design and selection of energy delivery strategies for treating chronic rhinitis by radiofrequency ablation. Chronic rhinitis is one of the most common global health problems. It is not life-threatening but has a severe impact on quality of life. Direct cost by chronic rhinitis is enormous and places a burden on societies. Radiofrequency ablation is proposed to be as an efficient treatment providing symptom relief and avoiding side effects compared to traditional therapies. Three-dimensional finite element method (FEM) models were developed to investigate RFA devices and energy delivery strategies. FEM computational models could provide vital variable profiles that are technically challenging to determine through experiments. Also, computer simulation could reduce the number of experimental procedures during the device design process. First, single pair bipolar RF ablation experiments were performed to validate FEM simulations using the same geometry as in experiments. The data from experiments and simulations had a high correlation (R = 0.91). Second, the Neurent basket electrode was employed in experimental ablations in egg white, for comparison against FEM simulations. Smaller lesion sizes were observed in experiments compared to simulations, attributed to thermal convection that was not accounted for in simulation. Finally, FEM simulations were used to investigate the effects of basket electrode diameter, length, and applied power on ablation zone formation. A shorter but wider electrode with a maximum spacing distance between two pairs of electrodes is preferable to create discontiguous ablation zones. 50% duty cycle was recommended to create thermal ablation zones with gradually increasing temperature and sufficiently large thermal lesion volumes.

Orientador: Everardo Andrade da Costa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T21:33:45Z (GMT). No. of bitstreams: 1 Teixeira_RodrigoUbiratanFranco_M.pdf: 1228242 bytes, checksum: d6745d36e991daad043696bd5b074b70 (MD5) Previous issue date: 2011 / Resumo: Para a avaliação objetiva da patência nasal são utilizados a rinometria acústica, rinomanometria e o peak flow nasal inspiratório (PFNI). Estes exames, com exceção do PFNI, são dispendiosos e complexos. Para utilização na Medicina do Trabalho e mesmo na prática clínica diária, faz-se necessário um método de mensuração simples, rápido, de baixo custo e confiável. Atualmente, os estudos tendem a correlacionar métodos que reúnem estas características, com aqueles métodos já bem documentados. Objetivos: comparar os resultados do PFNI com achados da Escala Analógica Visual (EVA), antes e após o uso de vasoconstritor nasal em indivíduos assintomáticos. Em um segundo momento, avaliar o PFNI entre indivíduos saudáveis e com queixas nasais obstrutivas. Forma de estudo: Artigo 1: Estudo de coorte em que a variável em questão é a ralação entre o PFNI e a EVA para obstrução nasal antes e após vasoconstrição nasal em indivíduos saudáveis; Artigo 2: Estudo transversal, em que a variável estudada é o comportamento do PFNI em uma população de indivíduos sem e com queixas nasais obstrutivas. Métodos: Dissertação realizada em formato alternativo composta de dois artigos. No primeiro foi feito uma correlação entre o resultado do PFNI e EVA antes e após vasoconstrição nasal de uma amostra de 60 sujeitos saudáveis. No segundo artigo foram avaliados 78 sujeitos com e sem sintomas nasais obstrutivos. Ambos estudos tiveram alocação de sujeitos de forma não randomizada. Resultados: No teste de regressão linear simples, o PFNI mostrou resultados significantes para obstrução nasal, rinorréia, prurido, espirros e lacrimejamento (p<0,001) e não apresentou significância para desvio de septo nasal (p=0,561). Encontrou-se uma correlação positiva entre PFNI e a pesquisa através da EVA (p<0,001). Houve significância estatística entre os valores encontrados no PFNI com rinite alérgica e idade (p=0,005 e p=0,023 respectivamente). O valor médio encontrado para EVA pré vasoconstrição foi de 4,1 e 2 após a vasoconstrição (variação de 44%). Em relação ao PFNI, a média encontrada foi de 151l/mim e de 178l/mim antes e após a vasoconstrição (variação de 20%). Conclusão: O PFNI mostrou ser um método confiável para detecção das alterações da patência nasal, tanto por causas obstrutivas quanto inflamatórias, com um nível de significância estatística aceitável. Apresentou forte correlação com a EVA, que é um método subjetivo muito utilizado para mensuração da obstrução nasal. É simples, fácil de manusear, pouco dispendioso e reprodutível. Por estas características descritas, pode ser usado como exame de triagem em Medicina do Trabalho. Entretanto, estudos com amostras maiores serão necessários para a normatização e sua utilização em massa / Abstract: For the objective assessment of nasal patency are used to acoustic rhinometry, rhinomanometry and nasal inspiratory peak flow (PFNI). These tests, except PFNI, are expensive and impractical. For use in occupational medicine and even in daily clinical practice, it is necessary a method for measuring simple, fast, inexpensive and reliable. Currently, studies tend to correlate methods that meet these characteristics, with other methods already well documented. Objectives: compare the results with findings PFNI EVA before and after using a nasal vasoconstrictor. In a second step, to evaluate the PFNI between healthy and obstructive nasal symptoms for allergic rhinitis. Study design: Article 1: A cohort study in which the variable is to determine the relationship between EVA Visual Analogue Scale) and PFNI for nasal obstruction before and after using a nasal vasoconstrictor. Article 2: A cross-sectional study in which the variable is the behavior of PFNI in a population of individuals. Methods: Essay held in alternate format consists of two articles. In the first article, was made a correlation between the result of PFNI and VAS before and after nasal vasoconstriction of a sample of 60 subjects. In the second article, was involve 78 subjects with and without symptoms of rhinitis. Both studies had allocation of subjects in a non-randomized. Results: In simple linear regression, the PFNI showed significant results for nasal obstruction, rhinorrhea, itching, sneezing and watery eyes (p<0.001). There was also a correlation between the presence of nasal septal deviation and PFNI (p=0.561). We found a positive correlation, the Spearman test between PFNI and research through the VAS (p<0.001). There was no statistical significance between the values found in PFNI with allergic rhinitis and age (p=0.005 and p=0.023 respectively). The mean value for VAS pre vasoconstriction was 4.1 and 2 after vasoconstriction. This represented a 44% variation between measurements. Regarding the values of PFNI, the average found in the pre measure vasoconstriction was 151l/min and 178l/min after vasoconstriction, an increase of 20%. At the moment pre vasoconstrictor, the change of a point on the average VAS represents a decrease of 3.8% in the average PFNI. In the post, each one point increase in the average value of EVA, corresponds to a decrease of 4.5% on average PFNI. Conclusion: The PFNI proved to be a reliable method for detecting larger studies are needed for a proper understanding of the method and its widespread use. changes in nasal patency by both inflammatory and obstructive causes, with an acceptable level of statistical significance, simple, easy to handle, inexpensive and reproducible. Showed strong correlation with the EVA, which is a very subjective method used to measure the nasal obstruction. Due to its characteristics described, can be used as a screening test in occupational medicine. However, larger studies are needed for a proper understanding of the method and its widespread use / Mestrado / Epidemiologia / Mestre em Saude Coletiva

M.Tech. (Homoeopathy) / Allergic Rhinitis (AR) is the inflammation of the nasal and often conjunctival mucous membrane. It manifests due to the exposure of inhaled allergic agents and results in an immunoglobulin E (lgE) mediated reaction (DiPiro et al., 2002; Shargel et al., 2001). Allergic rhinitis is characterised by four principle symptoms, watery rhinorrhoea, nasal obstruction, nasal itching and sneezing (Min, 2010). In addition to the cardinal symptoms experienced during AR other common symptoms include postnasal drip, pruritic eyes; ears; nose and palate (Kemp, 2009). Although allergic rhinitis is not life threatening, the adverse impact on quality of life is significant. Those affected by allergic rhinitis are restricted in their ability to carry out their normal daily activities (Nelson, 2007; Wilson et al., 2002). Sleep, social interaction, emotional well being as well as cognitive and psychomotor function are affected by allergic rhinitis, and can lead to impaired learning ability. Serious disorders such as eczema, asthma, sinusitis, otitis media, nasal polyposis, respiratory infections and orthodontic malocclusions are. frequently linked with allergic rhinitis (DiPiro et al., 2002; Kemp, 2009)., The therapeutic goal for patients suffering with allergic rhinitis is to prevent or minimise symptoms, using treatment with minimal or no side effects and of reasonable expense, so that patients may maintain a normal lifestyle (DiPiro et aI., 2002). One of the most frequent indications for which homoeopathic treatment is sought after is for respiratory allergies (Ramchandani, 2009). Thus it has been proposed that the remedies contained within Otirin Nasal Spray"; namely Allium cepa, Euphrasia officinalis, Luffa operculata and Sabadilla officinarummay be effective as a treatment for allergic rhinitis (Vermeulen, 2000). Otirin Nasal Spray" is a homoeopathic complex preparation indicated for allergic rhinitis. No specific research has been conducted on this product to determine its efficacy in this condition (Medford, 2008). The aim of this research study was to determine the efficacy of Otirin Nasal Spray" in the treatment of allergic rhinitis with regard to the severity Of symptoms; specifically on the symptoms relating to the nose, eyes, throat, mouth and ears. Diary cards and questionnaires were completed, making use of the severity of symptoms scores to grade the symptoms. This research study was a quantitative" double-blind, placebo-controlled study and included thirty participants suffering from AR. Participants volunteered to participate in the study, were over the age of eighteen and consented to the procedures of the research study. Participants involved in the study were randomly divided into a treatment (experimental) group and a control (placebo) group. The treatment group received the Otirin Nasal Spray'" as opposed to the control group who received the placebo nasal spray (saline nasal spray). The research study was conducted over a period of four weeks at the UJ Health Centre. Participants were instructed to complete an individual "Treatment Diary Card" (Appendix E) during each hayfever attack by scoring the severity of each symptom they suffered from. During the final consultation the "Response to Treatment Questionnaire" (Appendix F) was completed under the researcher's supervision. This questionnaire required participants to score an amelioration, aggravation, no change or not applicable for each symptom, as well as other associated symptoms. Results acquired from the research study were statistically analysed by Statkon at the University of Johannesburg by means of descriptive statistics, parametric and non-parametric tests. The parametric test included the Independent Samples TTest. Non-parametric tests included the Friedman Test, Wilcoxon Signed Rank, and Mann-Whitney U Test. This research study determined that the homoeopathically prepared Otirin Nasal Spray" did have a statistically significant effect in the treatment of allergic rhinitis symptoms. A trend towards a decrease in the severity of the participant's symptoms was observed, in particular for rhinorrhoea, sneezing, nasal blockage/congestion, pruritic/itchy eyes and postnasal drip.

Submitted in partial compliance with requirements for Master`s Degree in Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2017. / Allergic rhinitis (AR) is a symptomatic disorder of the nose characterized by inflammation of the nasal mucosa. It consists of a group of disorders that are all typified by the presence of one or more of the following: nasal itching, congestion, sneezing and rhinorrhoea (Wallace et. al., 2008). Allergic rhinitis can result in decreased quality of life, decreased sleep quantity, obstructive sleep apnoea and impaired performance at work and school (Blaiss, 2010: 375-380). According to Small and Kim (2011) allergic rhinitis (AR) is the most common allergic condition and one of the most common of all minor afflictions. It affects between 10- 20% of all people in the United States, and the prevalence of the disorder is increasing. This may result in significant impairment to quality of life, sleep and work performance (Small and Kim 2011). A therapeutic goal for patients suffering from allergic rhinitis is to prevent or minimise symptoms, using treatment with minimal effects or no side effects and of reasonable expenses, so that patients may maintain a normal life style (DiPiroet al.2002). Homoeopathy is a complete system of medicine developed by German physician and chemist, Dr Samuel Hahnemann (1755-1843). It is based on the following theories, first the doctrine of signature that disease is curable by those drugs which produce effect on the body similar to the symptoms of the disease “similia similibus currantur”; second that the effects of the drug are increased by giving it in a minute dose, which is obtained by dilution or trituration to an extreme limit and thirdly the notion that chronic disease are only manifestation of suppressed itch or psora (Ernst 2016). Similasan Nasal Allergy Relief Spray® is commercially available as a homoeopathic nasal spray. It is based on the principle of "let likes cure likes" or the Law of Similars. According to the company, this product is 100% natural, and contains active ingredients with non-drowsy effects which relieves allergic congestion, itching and runny nose, and it is preservative free (Similasan Corporation 1999-2015). Similasan Nasal Allergy ReliefSpray® mist gently stimulates the body's natural ability to relieve allergic congestion, itchy, runny nose and rhinitis caused by pollen, pet dander, dust and mould spores. Furthermore, the Similasan Nasal Allergy ReliefSpray® mists is non-habit forming and will not cause reliance or a rebound effect. The ingredients are: Cardiospermum 6X, Galphimiaglauca 6X, Luffa operculata 6X, Sabadilla 6X (SimilasanCoorporation 1999-2015). The aim of this double-blind randomised controlled study is to determine the efficacy of the homoeopathic Similasan Nasal Allergy Relief Spray® in the management of allergic rhinitis. Outcomes were monitored using questionnaires and a daily log book. This was a quantitative study which included thirty participants suffering from allergic rhinitis. Participants volunteered to participate in the study, were over the age of eighteen and consented to the procedure of the study. Participants involved in the research study were randomly divided into treatment group and placebo group. The treatment group received Similasan Nasal Allergy Relief Spray® and the placebo group received a saline nasal spray. The research study was conducted over a period of four weeks at the Durban University of Technology Homoeopathic Day Clinic. Participants were instructed to rate their symptoms before, during and after taking treatment (Appendix, C and D). The parametric test used in this study was Independent Samples T- Test. Non-parametric tests included ANOVA and Pearson chi-square. Rhinorrhoea, sneezing, itching of the eyes and nasal congestion showed a statistically significant results but some of the participant’s symptoms deteriorated after a period of improvement. This research determined that Similisan Nasal Allergy Relief Spray ® didn’t have a significant effect in treating allergic rhinitis in terms of the CARAT questionnaire. / M

A dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Homoeopathy at Technikon Natal, 1994. / The purpose of this study was to evaluate the efficacy of simillimum and allergen treatment to patients allergic to mixed grass pollens in terms of patients' responses to RAST and patients' percept ion of the effectiveness of treatment in order to identify key issues calling for the selection of the most effective method of treatment. / M

M.Tech. / Allergic rhinitis, otherwise referred to as hay fever, is a common allergic reaction affecting the nose, throat, eyes, and respiratory system, of persons of all ages and both sexes. This study attempted to demonstrate the effect of the homoeopathically prepared remedy Sabadilla officinarum 30CH and Sabadilla officinarum 200CH in the treatment of allergic rhinitis. Thirty participants were selected for this one hour, double-blind, placebo-controlled study. The participants were randomly placed into one of three groups of ten, consisting of the control group, and the two experimental groups. The control group received the placebo medication. The first experimental group received Sabadilla officinarum 30CH, and the second experimental group received Sabadilla officinarum 200CH. The patients were all supplied with: a stat dose of medication to use at the time of an allergic rhinitis attack, a diary card on which to score the severity of their symptoms at the time of such an attack, and a response to treatment questionnaire to fill in after the completion of their treatment. The results were statistically analysed using the Wilcoxon Signed Ranks Test, the Kruskal Wallis Test, and descriptive statistics. The results show that treatment with Sabadilla officinarum 30CH and 200CH had a significant effect in improving the symptoms of allergic rhinitis.

No description available.