Saad Alsaleh

The safety and efficacy of short-term budesonide delivered via mucosal atomization device for chronic rhinosinusitis without nasal polyposis

Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chronic rhinosinusitis (CRS). The standard for prescribing budesonide is via impregnated nasal saline irrigation (INSI), although recently the mucosal atomization device (MAD) has emerged as a theoretically superior method of distributing medication into the sinuses. The MAD atomizes medication into small droplets and this is thought to enhance absorption and improve bioavailability. However, no studies have shown whether enhanced absorption and improved bioavailability of budesonide via MAD causes adrenal suppression. The objective of this study is to determine whether budesonide via MAD affects the hypothalamic‐pituitary‐adrenal (HPA) axis.

Lead concentration in breast milk of nursing mothers living in Riyadh.

Lead poisoning has proven to be one of the most difficult environmental health problems. Part of this difficulty is based on the lack of distinctive manifestations at an early phase in the process. Breast milk feeding with high lead concentration is one of the first sources of lead exposure in neonates. This study reported that lead in breast milk samples from 81% of nursing mothers varied from a low concentration of 0.318 microg/dL to a high of 2.5 microg/dL with an average of 0.768 +/- 0.42 microg/dL. The high lead concentration of 2.5 microg/dL recorded in this study is similar to the average lead concentration reported by others. Lead concentration was found to be low in young mothers and higher in mothers age 36 years or more with an average of 0.515 +/- 0.14 and 1.344 +/- 0.65 microg/dL respectively. There were no significant differences between lead concentration in samples obtained from right or left breasts and similarly, there were no significant differences in lead concentrations in milk samples in relation to the length of period of lactation (P>/=0.1). Breast milk samples obtained from mothers residing near industrial areas or highways, using copper casserole coated with white (rich in lead) inner coat and eating food material preserved for long periods in metal containers showed higher lead concentration than from those living in remote areas with reduced exposure. The diagnosis of lead poisoning required a constant awareness of its prevalence.

Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial.

The endoscopically magnified operative field in functional endoscopic sinus surgery (FESS) makes even a small amount of bleeding a potentially significant hindrance. It is thought that irrigation with hot saline during surgery may improve surgical field of view by producing a hemostatic effect. Our objective was to assess the effectiveness of hot saline irrigation (HSI) compared to room temperature saline irrigation (RTSI) in the control of intraoperative bleeding during FESS.

The Sino-Nasal Outcome Test–22 as a tool to identify chronic rhinosinusitis in adults with cystic fibrosis

Chronic rhinosinusitis (CRS) is becoming increasingly prevalent in adults with cystic fibrosis (CF), as the median age of survival rises for these individuals. Delayed identification of CRS may contribute to worsening health‐related quality of life and increased treatment burden. Our objective was to investigate the utility of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) as a tool to identify CRS in adults with CF.

The Effect of Crude and Purified Cerastes Vipera Venom Protein Fractions on Respiratory Chain Function in Cultured Human Fibroblasts

This study was conducted to investigate the effect of crude and venom protein fractions of Cerastes vipera on the major enzymatic components of the respiratory chain in cultured human fibroblasts. Cerastes vipera crude venom was fractionated into seven protein fractions by using 8% preparative native polyacrylamide gel electro-phoresis. The effect of crude venom and purified venom fractions (F1-F7) on respiratory chain function in cultured human fibroblasts was investigated. Confluent fibroblast cultures were incubated with crude venom and venom protein fractions for a fixed period of three hours at 37°C. Crude venom and venom protein fractions 2, 4, 5 and 6 significantly increased the production of lactate as compared to control fibroblasts. The production of pyruvate was markedly decreased in all these cell lines. The ratio of lactate/pyruvate was increased in the cells and in the culture medium by crude venom and venom protein fractions 2, 4, 5 and 6. On the other hand fractions 1,3 and 7 exhibited no effect in relation to lactate and pyruvate production. Similarly the crude venom protein and venom protein fractions 2, 4, 5 and 6 significantly lowered the activity of the major enzymatic component of the respiratory chain in fibroblast mitochondria. In conclusion it is apparent that the crude and venom protein fractions 2, 4, 5 and 6 resulted in a significant lowering of the mitochondrial respiratory chain activity in cultured human fibroblasts.

Steroids in aminoglycoside-containing ear drops: Do they reduce cochlear toxicity?

To determine whether betamethasone (BM) reduces the cochlear toxicity of otic gentamicin (GM) if given together.

Sinonasal Outcomes Test-22 as a Tool to Identify Chronic Rhinosinusitis among Adults with Cystic Fibrosis

Objectives: (1) Investigate the ability of a sinus-specific health-related quality of life questionnaire (HRQoL) to distinguish clinically significant chronic rhinosinusitis (CRS) among adults with cystic fibrosis (CF). (2) Determine an appropriate cutoff score on the Sinonasal Outcomes Test-22 (SNOT-22) with sufficient test sensitivity and specificity, to assist caregivers in identifying adults with CF who may warrant specialist referral and treatment. Methods: Participants were enrolled at an adult-specific CF clinic in a tertiary academic hospital in Vancouver, Canada. Subjects completed the SNOT-22 followed by endoscopic assessment by otolaryngologists. The Canadian Clinical Practice Guidelines for Chronic Rhinosinusitis were used to confirm diagnosis of CRS. Results: To date, 52 of 80 individuals with a confirmed diagnosis of CF have participated in this study. Thirty-nine (75.0%) individuals were identified with CRS, 12 (30.8%) of whom presented with nasal polyposis. Aggregate SNOT-22 scores were significantly higher among individuals with CRS compared to non-CRS counterparts (39.4 ± 20.0 vs 22.7 ± 8.7, P = .007, 95% confidence interval [CI] for mean difference: 4.7, 28.7). A SNOT-22 score >26 was found to have a test sensitivity of 74.4% and specificity of 66.7% for diagnosis of CRS (AUC = 0.77, P < .01). Using SNOT-22 scores related to rhinological symptoms increased the likelihood ratio of a positive test when compared to aggregate scores (8.3 vs 2.2, respectively). Conclusions: The SNOT-22 significantly discriminates between CF adults with and CF adults without CRS. Using rhinological symptom scores increases the likelihood of detecting true CRS cases. The use of this questionnaire may assist specialists in identifying individuals who have clinically significant CRS, warranting specialist referral and treatment.

Non-axial proptosis secondary to pneumosinus dilatans of the maxillary sinus

Pneumosinus Dilatans (PD) is a rare condition characterized by abnormal enlargement of one or more paranasal sinuses that can lead to different functional and cosmetic presentations. Here we report right non-axial proptosis in a 47-year-old female secondary to pneumosinus dilatans of the maxillary sinus with superior bowing of the orbital floor.

Potential risk factors associated with the development of synechiae following functional endoscopic sinus surgery

PurposeSynechiae formation in the middle meatus is the most common complication of functional endoscopic sinus surgery (FESS). Our objectives were to determine the incidence of synechiae occurring in a cohort of patients that have undergone FESS and identify characteristics associated with the development of synechiae postoperatively.MethodsA retrospective chart review was conducted of CRS patients, with or without nasal polyposis, that had undergone bilateral FESS in the past. All patients had received non-absorbable spacers intraoperatively that were left in situ for 6 days. Demographic and preoperative variables were analyzed to identify synechiae risk factors. A multivariable logistic regression model was constructed to estimate the probability of developing synechiae, given demographic and preoperative variables.ResultsTwo hundred cases of bilateral FESS were retrospectively reviewed. Thirty-eight (19.0%, 95% CI 13.6–24.4%) patients developed synechiae. Individuals receiving primary FESS and nasal septal reconstruction (NSR) were strongly associated with the development of synechiae (OR 3.5, 95% CI 1.5–8.5; OR 3.0, 95% CI 1.3–6.9). A multivariable logistic regression model adjusting for NSR, recurrent FESS, concha bullosa, requirement of anterior and posterior ethmoidectomy, Lund-Mackay CT score and gender, identified the likelihood of developing synechiae with a sensitivity of 68%, specificity of 73%, positive predictive value of 38% and likelihood ratio of 2.5.ConclusionPatients undergoing primary FESS and NSR are at greatest odds of developing postoperative synechiae. Methods of assessing risk factors and preventing synechiae formation in this population should be evaluated in future prospective investigations.

Safety of intranasal corticosteroid sprays during pregnancy: an updated review

IntroductionRhinitis and rhinosinusitis are commonly encountered in pregnant women. Intranasal corticosteroid (INCS) sprays are generally safe and effective in the treatment of these conditions in the general population. However, the use of some of these INCS sprays during pregnancy is still controversial.ObjectiveTo review the current literature about the safety of intranasal corticosteroid sprays during pregnancy.MethodologyUsing different search engines, each type of INCS was reviewed separately (triamcinolone, beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, mometasone, and ciclesonide). A total of 51 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, a total of three articles were reviewed.ResultsNo significant association with congenital organ malformations has been linked to intranasal use of beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, or mometasone. Intranasal triamcinolone, however, has been found to have a significant association with respiratory tract defects. Data about the safety of intranasal ciclesonide during pregnancy are not available.ConclusionLacking sufficient clinical trials on the use of intranasal corticosteroid sprays in pregnancy, we suggest that the intranasal use of fluticasone furoate, mometasone, and budesonide is safe if they are used at the recommended therapeutic dose after a proper medical evaluation. Intranasal fluticasone propionate might be a safe option in the absence of other INCS options due to its questionable efficacy during pregnancy. Risk-benefit ratio should always be considered before prescribing any intranasal corticosteroid sprays during pregnancy.