This thesis embodies research investigating the role that bacterial biofilms play in the pathogenesis of chronic rhinosinusitis (CRS). It focuses on their detection on the sinus mucosa of CRS patients and the implications of their presence. Finally, it addresses deficiencies in the innate immune system that may predispose to their development in this condition. Bacterial biofilms are structural assemblages of microbial cells that encase themselves in a protective self-produced matrix and irreversibly attach to a surface. Their extreme resistance to both the immune system as well as medical therapies has implicated them as playing a potential role in the pathogenesis of many chronic diseases. Although their role in many diseases is now well established, their objective presence and importance in CRS remains largely unknown. Chapter 1 of this thesis reviews the current literature pertaining to CRS and biofilms and critically evaluates the small body of research relating to this topic. Chapter 2 describes the development of a sheep model to study the role of bacterial biofilms in rhinosinusitis. It compares the use of traditional electron microscopy (EM) and more recent confocal scanning laser microscopy (CSLM) in the detection of biofilms on the surface of sinus mucosa. The results of this study inferred a causal relationship between biofilms and the macroscopic changes that accompany rhinosinusitis. Furthermore it illustrated the superiority that CSLM has over EM in the imaging of biofilms on sinus mucosa Chapter 3 and 4 outline the results of human studies utilizing the more objective CSLM to evaluate the prevalence of bacterial biofilms on the sinus mucosa of CRS patients and their effect on post-operative mucosal healing. The results of these studies demonstrated a biofilm prevalence of approximately 50% in the CRS population studied and suggested, that biofilm presence may predispose to adverse post-operative outcomes following sinus surgery. Chapter 5 and 6 describe experiments examining the level of the innate immune system’s anti-biofilm peptide lactoferrin, in patients with CRS. Lactoferrin was found to be downregulated at both an mRNA and protein level in the majority of CRS patients, with biofilm positive patients demonstrating the most significant reduction. In summary, this thesis provides further evidence that bacterial biofilms play a major role in the pathogenesis and disease persistence in a subset of CRS patients. Deficiencies in components of the innate immune system, such as lactoferrin, may play an important role in the predisposition of certain individuals to the initial development of bacterial biofilms. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346621 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine 2008

Con el objetivo de evaluar las alteraciones anatómicas en pacientes con diagnóstico anatomopatológico de sinusitis crónica llevamos a cabo un estudio de casos entre los meses de Enero a Diciembre del 2003 en el Hospital Nacional Edgardo Rebagliati Martins - ESSALUD Resultados: En este lapso de tiempo, 93 pacientes fueron evaluados. La edad promedio fue de 51.05 años (DS 15.3). El grupo mayoritario se encontró entre 40 y 60 años (46.23%). Cincuentaisiete pacientes fueron varones (61.29%). 40 (80%) habían sido sometidos a cirugía otorrinolaringológica previamente. Respecto a los hallazgos tomográficos se encontró tabique nasal desviado (TND) en el 58.06%, hipertrofia turbinal (HTT) en el 51.61% y concha media bullosa (CMB) en el 8.60%. El compromiso de senos fue mayor en el maxilar (93.5%), etmoidal (60.21%), seguidos del frontal (33.3%) y esfenoidal (30.10%). Asimismo se encontró poliposis nasal relacionada estadísticamente con sinusopatía esfenoidal, maxilar y etmoidal. Conclusiones: 5 de cada 10 pacientes tuvieron TND e HTT, mientras que sólo 8 de cada 100 tuvieron CMB. Los senos mayoritariamente afectados fueron el maxilar y etmoidal, seguidos del frontal y el esfenoidal. Sugerimos realizar un estudio en población sana, comparando sus resultados con nuestros hallazgos en población con sinusopatía.

This thesis embodies research investigating the role that bacterial biofilms play in the pathogenesis of chronic rhinosinusitis (CRS). It focuses on their detection on the sinus mucosa of CRS patients and the implications of their presence. Finally, it addresses deficiencies in the innate immune system that may predispose to their development in this condition. Bacterial biofilms are structural assemblages of microbial cells that encase themselves in a protective self-produced matrix and irreversibly attach to a surface. Their extreme resistance to both the immune system as well as medical therapies has implicated them as playing a potential role in the pathogenesis of many chronic diseases. Although their role in many diseases is now well established, their objective presence and importance in CRS remains largely unknown. Chapter 1 of this thesis reviews the current literature pertaining to CRS and biofilms and critically evaluates the small body of research relating to this topic. Chapter 2 describes the development of a sheep model to study the role of bacterial biofilms in rhinosinusitis. It compares the use of traditional electron microscopy (EM) and more recent confocal scanning laser microscopy (CSLM) in the detection of biofilms on the surface of sinus mucosa. The results of this study inferred a causal relationship between biofilms and the macroscopic changes that accompany rhinosinusitis. Furthermore it illustrated the superiority that CSLM has over EM in the imaging of biofilms on sinus mucosa Chapter 3 and 4 outline the results of human studies utilizing the more objective CSLM to evaluate the prevalence of bacterial biofilms on the sinus mucosa of CRS patients and their effect on post-operative mucosal healing. The results of these studies demonstrated a biofilm prevalence of approximately 50% in the CRS population studied and suggested, that biofilm presence may predispose to adverse post-operative outcomes following sinus surgery. Chapter 5 and 6 describe experiments examining the level of the innate immune system’s anti-biofilm peptide lactoferrin, in patients with CRS. Lactoferrin was found to be downregulated at both an mRNA and protein level in the majority of CRS patients, with biofilm positive patients demonstrating the most significant reduction. In summary, this thesis provides further evidence that bacterial biofilms play a major role in the pathogenesis and disease persistence in a subset of CRS patients. Deficiencies in components of the innate immune system, such as lactoferrin, may play an important role in the predisposition of certain individuals to the initial development of bacterial biofilms. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346621 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine 2008

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, at Technikon Natal, 1999. / The purpose of this investigation was to compare the relative effect of spinal manipulation as opposed to acupuncture treatment in order to determine a more effective approach in the treatment of chronic sinusitis. It was hypothesized that chiropractic treatment and acupuncture treatment would both be effective in the treatment of chronic sinusitis. However, it was proposed that the chiropractic treatment would be more effective than acupuncture treatment / M

Con el objetivo de evaluar las alteraciones anatómicas en pacientes con diagnóstico anatomopatológico de sinusitis crónica llevamos a cabo un estudio de casos entre los meses de Enero a Diciembre del 2003 en el Hospital Nacional Edgardo Rebagliati Martins - ESSALUD Resultados: En este lapso de tiempo, 93 pacientes fueron evaluados. La edad promedio fue de 51.05 años (DS 15.3). El grupo mayoritario se encontró entre 40 y 60 años (46.23%). Cincuentaisiete pacientes fueron varones (61.29%). 40 (80%) habían sido sometidos a cirugía otorrinolaringológica previamente. Respecto a los hallazgos tomográficos se encontró tabique nasal desviado (TND) en el 58.06%, hipertrofia turbinal (HTT) en el 51.61% y concha media bullosa (CMB) en el 8.60%. El compromiso de senos fue mayor en el maxilar (93.5%), etmoidal (60.21%), seguidos del frontal (33.3%) y esfenoidal (30.10%). Asimismo se encontró poliposis nasal relacionada estadísticamente con sinusopatía esfenoidal, maxilar y etmoidal. Conclusiones: 5 de cada 10 pacientes tuvieron TND e HTT, mientras que sólo 8 de cada 100 tuvieron CMB. Los senos mayoritariamente afectados fueron el maxilar y etmoidal, seguidos del frontal y el esfenoidal. Sugerimos realizar un estudio en población sana, comparando sus resultados con nuestros hallazgos en población con sinusopatía. / Tesis de segunda especialidad

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Le but de notre travail a été d’évaluer l’effet de la réduction de la dose d’irradiation en TDM multibarrette quant à la performance diagnostique, la confiance de l’observateur dans le diagnostic proposé, la capacité à suggérer un diagnostic alternatif dans quelques pathologies courantes et/ou caractérisées par des situations de faibles contrastes entre les structures anatomiques normales ou pathologiques. Nous avons donc comparé ces paramètres entre des TDM à doses réduites et à doses standard telles que couramment rapportées dans la littérature dans les circonstances suivantes : • La suspicion clinique de colique néphrétique: le contraste naturel élevé du calcium avec les structures voisines suggère de pouvoir réduire fortement la dose, dans une pathologie potentiellement récidivante et qui intéresse des patients jeunes dont le pronostic est excellent. Notre étude a montré qu’une dose 10 fois inférieure à celle générée par des examens TDM courants permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique de sinusite chronique: le contraste naturel élevé entre l’air des cavités sinusales, la muqueuse nasale et les os de la face permet de réduire fortement la dose, dans cette pathologie potentiellement récidivante et qui intéresse des patients jeunes dont le pronostic est excellent. Notre étude a montré qu’une dose 10 à 25 fois inférieure à celle générée par des examens TDM courants, et dès lors inférieure à celle générée par quatre incidences radiographiques, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique d’appendicite aiguë: L’appendice est situé dans une atmosphère anatomique caractérisée par un faible contraste entre les structures. Néanmoins, comme l’appendicite est une pathologie qui concerne l’adolescent et l’adulte jeune, nous avons tenté de réduire la dose des TDM dans ce contexte. Notre étude a montré qu’une dose 3 à 10 fois inférieure à celle générée par des examens TDM courants, et dès lors inférieure à celle générée par trois incidences radiographiques, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique de diverticulite aiguë du colon: la diverticulite aiguë du colon est également caractérisée par une atmosphère anatomique de faible contraste entre les structures. Néanmoins, comme cette pathologie peut concerner l’adulte jeune et récidiver, nous avons tenté de réduire la dose des TDM dans ce contexte. Notre étude a montré qu’une dose 3 à 10 fois inférieure à celle générée par des examens TDM courants, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • Le diagnostic d’embolie pulmonaire aiguë: la TDM spiralée occupe une position centrale dans le diagnostic d’embolie pulmonaire aiguë mais impose l’injection intraveineuse de produit de contraste iodé. La comparaison d’images obtenues à des doses variables d’irradiation a nécessité leur traitement à posteriori pour simuler la réduction de dose. Notre étude a montré qu’une dose 9 fois inférieure à celle générée par des examens TDM conventionnels permet des performances diagnostiques semblables. Ces investigations ont été complétées par l’investigation de l’influence du genre, de l’indice de masse corporelle et de l’âge sur la modulation automatique du courant au tube radiogène (6). Cette investigation a montré que la modulation automatique ne réduit la dose d’irradiation que d’au plus 20% avec peu ou pas de différence en fonction du genre, de l’âge ou de l’indice de masse corporel des patients ; indiquant ainsi qu’elle ne pouvait pas remplacer la réduction de la charge volontaire de l’opérateur.

Orientador: José Vicente Tagliarini / Resumo: CAMPOS, C. S. M. 2018. Avaliação da incidência e evolução das manifestações das doenças nasais em pacientes portadores de fibrose cística. 2018. Dissertação (Mestrado) – Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, 2018. Introdução: A fibrose cística é uma doença originada da mutação do gene responsável pela codificação da proteína CFTR. A ausência ou defeito dessa proteína leva a um transporte irregular de sal e água em células mucosas respiratórias e de glândulas exócrinas podendo resultar em diversas manifestações clínicas. As alterações otorrinolaringológicas frequentes são rinossinusite crônica e polipose nasal. Objetivo: Avaliar a incidência e a evolução de doenças nasais em pacientes portadores de fibrose cística com exame videonasolaringoscópico documentado em prontuário do período de agosto de 2015 a agosto de 2017. Casuística e Métodos: Realizou-se a coleta de dados de 65 pacientes acompanhados no ambulatório de fibrose cística do Hospital das Clínicas de Botucatu. Foram incluídos os pacientes que possuíam exames videonasolaringoscópicos realizados durante o período de acompanhamento e que concordaram em participar do estudo. Realizou-se um estudo de coorte com avaliação dos dados epidemiológicos, presença de comorbidades, achados nos exames videonasolaringoscópicos, positivação de cultura de orofaringe e resposta ao tratamento clínico. Resultados: Foram analisados 51 pacientes. A mutação delta F508 esteve pr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: CAMPOS, C.S.M. 2018. Evaluation of the incidence and evolution of the manifestations of nasal diseases in patients with cystic fibrosis. 2018. Thesis (Master) – Botucatu Medical School, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, 2018. Introduction: Cystic fibrosis is a disease originated from the mutation of the gene responsible for the coding of the CFTR protein. The absence or defect of this protein leads to an irregular transport of salt and water in respiratory mucous cells and exocrine glands, resulting in several clinical manifestations. Frequent otorhinolaryngological changes are chronic rhinosinusitis and nasal polyps. Objective: To evaluate the incidence and evolution of nasal diseases in patients with cystic fibrosis with a videonasolaryngoscopic exam documented in medical records from August 2015 to August 2017. Casuistry and Methods: Data were collected from 65 patients followed in the cystic fibrosis outpatient clinic Botucatu Medical School. Patients who had videonasolaryngoscopic examinations performed during the follow-up period and who agreed to participate in the study were included. A cohort study was conducted with epidemiological data, presence of comorbidities, findings in videonasolaryngoscopic examinations, oropharyngeal culture positivity and response to clinical treatment. Results: Fifty-one patients were analyzed. The delta F508 mutation was present in 20 patients. The comorbidities evaluated were: bronchiectasis (n = 39), p... (Complete abstract click electronic access below) / Mestre

Introduction Bacterial biofilms have been implicated in the pathogenesis of Chronic Rhinosinusitis (CRS). This thesis consists of a number of separate studies. The results of each study were designed to help provide an evolution of knowledge that could be applied to our subsequent investigations on the topic of bacterial biofilms and chronic rhinosinusitis. In vitro studies were utilized to document the capacity of CRS bacteria to form biofilms as well as to investigate the efficacy of various antimicrobials at high concentrations. Additionally, an in vivo sheep model was developed to examine different biofilm detection techniques. Finally, a study of CRS patients was conducted to investigate the incidence of biofilm related sinus disease. Methods Our in vitro studies used 96 well crystal violet microtiter plate assays to determine the biofilm growth characteristics of S.aureus isolated from patients with CRS. Established biofilms were then subjected various antimicrobial agents, and the degree of biofilm reduction calculated to examine their potential for sinus biofilm treatment. A sheep sinusitis model involved performing endoscopic sinus surgery, occlusion of frontal sinus ostia and the introduction of bacteria. Mucosal specimens were subsequently examined for the presence of bacterial biofilms using transmission electron microscopy (TEM), scanning electron microscopy (SEM) and confocal scanning laser microscopy (CSLM). CSLM was also used in a prospective study to document the presence bacterial biofilms on the mucosa of patients with CRS compared to controls. Results The findings of in vitro experiments revealed that not all isolates were capable of forming biofilms. Of the antibiotics tested, only Mupirocin was capable of reducing biofilm mass by 90% in all isolates. The animal model showed considerable variation in biofilm detection rates. The CSLM biofilm detection rate was 100% in obstructed sinuses with bacteria introduced, whereas TEM detected only 66%. Both these objective measures failed to identify biofilms in control groups. SEM found biofilms in all experimental groups including controls. CSLM analysis of CRS patients found Bacterial biofilms in 44% and no biofilms in controls. Conclusion The demonstration of biofilms in the sheep model for sinusitis and biofilms on the mucosal specimens of patients with CRS, and the ability of bacteria in CRS to form biofilms in vitro, further supports the hypothesis that biofilms play a role in the pathogenesis of CRS. CSLM is the modality of choice in documenting the presence of bacterial biofilms on sinus mucosal surfaces due to the inherent flaws of sampling error and subjectivity of TEM and SEM. Finally, CRS is a multi-factorial disease, topical Mupirocin via nasal irrigation may be a therapeutic option in patients with likely S.aureus biofilms. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1367183 / Thesis (M.S.) - University of Adelaide, School of Medicine, 2009

Thesis (M.Tech.: Homoeopathy)-Dept of. Homoeopathy, Durban Institute of Technology,2004 xiv, 74 leaves : ill. ; 30 cm / The purpose of this double blind placebo-controlled study was to determine the efficacy of Natura Homoeopathic Laboratory’s Nasosinus (Hepar sulphuris calcareum D3, Nux vomica D3 and Pulsatilla pratensis D3) in the treatment of acute sinusitis, in terms of patients’ perception of response to treatment.