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Background: Acute rhinosinusitis (ARS) is a common and well-defined disorder, primarily of viral aetiology, with rhinovirus and coronavirus accounting for more than 50% of viral ARS. The fight with COVID-19 pandemic resulted in an increased availability viral testing, which in turn allowed testing for presence of SARS-Cov-2 in all patients presenting common cold (or ARS) symptoms. The aim of this study was to assess the clinical characteristics of acute rhinosinusitis in patients diagnosed with COVID-19.Methodology/Principal: This study is a post-hoc analysis. Patients symptoms were evaluated using a structured questionnaire twice: directly after a positive SARS-Cov-2 result and 7-12 days following the first evaluation. Subjects were asked about presence of nasal and systemic symptoms as well as headache.Results: A total of 130 COVID-19 symptomatic patients were recruited into the study, 58 (45%) patients met EPOS2020 diagnostic criteria for ARS. Of all ARS patients, 72% presented with rhinorrhoea, 69% with pain perceived over paranasal sinuses, 62% with nasal congestion, 52% with cough, 45% with olfactory dysfunction, 38% with fever, 33% with facial pressure and in 22% pain was exacerbated by sinus palpation. Conclusions: Half of COVID-19 subjects has ARS. The course of SARS-Cov-2 ARS does not seem to differ significantly from ARS of other aetiologies. Since ARS in the course of COVID-19 seems to meet the definition of ARS proposed by EPOS 2020, we hypothesize that substances validated for ARS treatment, such as intranasal corticosteroids could be effective in SARS-Cov-2 ARS.

Tuberculous otitis media is not a common disease, especially in developed countries. Its low incidence and manifestation mimicking other diseases often results with delayed diagnosis and wrong treatment. A 29-year-old women presented to ENT department with history of bilateral acute otitis media not responding to regular treatment. Multiple tympanic membrane perforations noticed in the course of disease suggested tuberculosis. To confirm the diagnosis multiple examinations were performed: Quantiferon Test, traditional culture of Mycobacterium tuberculosis and genetic test. The patient responded well to anti-TBC treatment, however some of the damages done are irreversible and some requires adequate reconstructional treatment. This case emphasize that it is important to remain watchful, as tubercoulous otits media is often misdiagnosed. Proper early diagnosis may prevent further damage as chemotherapy is usually very effective and in most cases complete healing is achieved.

Aim: Development of an effective method of rinsing the nasal cavities and paranasal sinuses using the Zatoxin Rinse kit. Material and methods: In order to develop recommendations for rinsing the nasal cavities, a cadaver head specimen from Poznań Lab was used. The nasal cavities were rinsed with a methylene blue solution - 0.8 ml of 10% methylene blue in 240 ml of water. Rinsing was performed in the standard recommended position - the head tilted slightly forward (approx. 20–30 degrees) and to the side – approx. 45 degrees. After endoscopic examination, endoscopic surgery of the paranasal sinuses was performed and the staining of the mucosa of the paranasal sinuses was assessed. The nasal cavities were rinsed again with a solution of water and methylene blue in the head position as described above. Endoscopic examination was performed with the assessment of the staining of the nasal mucosa and paranasal sinuses, and the rinsing was repeated with the head tilted forward to 60 degrees and laterally to 45 degrees. The staining of the mucosa was recorded during the endoscopic examination. Results: The nasal rinsing performed allowed the fluid to flow along the turbinates into the nasopharyngeal region and then out. After opening the paranasal sinuses, it turned out that only a small amount of methylene blue had penetrated into the maxillary sinuses; There was also no staining of the mucosa within the ethmoid cells, the frontal sinus or the sphenoid sinus. Rinsing the nasal cavities again in the same position, but after the ethmoidectomy, showed poor penetration of methylene blue into the ethmoid region, the frontal sinus ostium and the sphenoid sinus ostium. The re-rinsing of the nasal cavities with the head tilted forward by at least 60 degrees and to the side by 45 degrees resulted in a stronger staining of the rush top and the staining of the entrance to the frontal sinus with methylene blue. Conclusions: The way the head is positioned when using Zatoxin Rinse should be adapted to the disease, and in the case of surgical treatment, to the type of surgery performed and to which sinuses are affected by the disease, so that the solution reaches the required regions.

The study investigates the process of creating evaluative homogeneity within a performance-based research funding system. It does so in reference to the experience of creating a national journal ranking in Poland in 2019. It refers to the cases of two disciplines: biology and history. The use of this case is justified by its unique character, that is creating the ranking through means of both bibliometric indicators and expert panels. We therefore asked: What guided the actors who participated in the process of creating the ranking through the use of bibliometric indicators when introducing changes to its initial form? To answer this question, a mixed-methods approach was used. First, we conducted a quantitative analysis of changes made to the ranking during the consecutive steps of its creation. Second, we conducted a qualitative analysis of semi-structured interviews regarding actors’ motivations. By reflecting on the qualitative analysis along with the results of the quantitative part, this study reveals the extent to which actors impacted the form evaluative homogeneity took within the system. It further argues that this is dictated by how actors position themselves in relation to two opposing forces: those favouring the homogenization of research and those maintaining its heterogeneity. As these forces remain imbalanced, the study concludes with a call for further exploration of the interplay between the forces of homogenization and heterogenization and how the tensions between them are mediated within a performance-based research funding system.

Aim: The aim of this study was to assess the effect of nasal irrigation with isotonic sodium chloride and sodium bicarbonate solution in the form of Zatoxin Rinse kit on the process of postopera-tive wound healing and resolution of inflammation in patients who undergo surgery of the nasal cavity or paranasal sinuses. Moreover, our study also compared the effectiveness of na-sal irrigation with Zatoxin Rinse kit to the use of saline spray, when applied for 4 weeks after nasal septum surgery. Material and methods: Multicenter observational studies were conducted with the use of a questionnaire which was filledout on two consecutive visits, scheduled with a 1-month interval. These questionnaires applied to patients who underwent endoscopic surgical intervention in the nasal cavity and paranasal sinuses and were therefore qualified for this study. The study group included 71 patients (mean age: 42.87 ± 13.22 years; 29 female and 42 male) suffering from the following disorders: chronic rhinosinusitis (CRS) with polyps, n = 25; CRS without polyps, n = 19; de-viated septum, n = 27. The control group included 7 patients with deviated septum (using saline nasal products/seawater spray). Based on the questionnaire results and ENT examina-tion, the severity of inflammation and effectiveness of wound healing were assessed with the use of: SNOT-22 (sino-nasal outcome score), Visual Analogue Scale (VAS) and endoscopic examination of nasal cavities. Results: The median value for results obtained from the SNOT-22 questionnaire was 38 points (IQR = 36) in CRS without polyps, 33 points (IQR = 24) in CRS with polyps and 26 points (IQR = 19) in deviated septum. The median values for all scores recorded in specific subgroups after 4 weeks of applying Zatoxin Rinse were as follows: patients with CRS with polyps: 7 points (IQR = 9.5), patients with CRS without polyps: 5 points (IQR = 13), patients with deviated septum: 6 points (IQR = 9). Postoperative nasal discharge was observed to be the most fre-quent in patients with CRS: among patients suffering from CRS with polyps, the median VAS scale result was 6 points (IQR = 4), while the median for patients diagnosed with CRS without polyps was 6 points (IQR = 5) and 3 points (IQR = 4) in the group with deviated septum. The feeling of impaired nasal patency in the postoperative period was reported to be the strongest in patients diagnosed with CRS without polyps: 8 points (IQR = 5), as com-pared to 5 points (IQR = 4.5) in patients with CRS with polyps and 5 points (IQR = 7) in the deviated septum group. Postoperative smell disorders were observed to be expressed as more severe among patients with CRS without polyps: 6 points (IQR = 4) and less severe in pa-tients with CRS with polyps: 4 points (IQR = 7). After 4 weeks of healing aided by irrigation of paranasal sinuses with the use of Zatoxin Rinse kit, patients from all subgroups experienced a statistically significant reduction in the severity of all parameters assessed by the VAS scale. In the endoscopic assessment of nasal cavities with the use of Lund-Kennedy scoring system, conducted prior to irrigating nasal cavities with the Zatoxin Rinse kit, the highest results were recorded in patients diagnosed with CRS with polyps: 10 points (IQR = 9.5), as compared to 8 points (IQR = 6) in patients with CRS without polyps and 6 points (IQR = 5) in patients with deviated septum. After 4 weeks, the median result in CRS with polyps group was 3 points (IQR = 3.5), while the CRS without polyps and deviated septum groups recorded the same median result of 3 points (IQR = 3). Conclusions: (1) Nasal irrigation with Zatoxin Rinse is characterized by good tolerability and is easy to per-form. No adverse effects of nasal irrigation were identified among 71 examined individuals and patients were satisfied with the application method provided by the Zatoxin Rinse kit; (2) Zatoxin Rinse promotes healing of postoperative wounds in patients who undergo surgical intervention in the paranasal sinuses or in the nasal septum, as compared to the use of saline spray.

Introduction: Surgical orbital decompression involves removal of one or more orbital bony walls in order to gain space for overgrown muscles and adipose tissue, which results in a reduction in pressure on the eye. This observational study aims to perform an endocrinological assessment of the surgical treatment outcomes of thyroid eye disease (TED) patients before and after orbital decompression. Material &Methods: This retrospective study included 51 TED patients (84 orbits) who underwent endoscopic orbital decompression (EOD) or balanced orbital decompression.The effect of surgical treatment was evaluated via the clinical activity score (CAS), modified NOSPECS and EUGOGO classification. Results: Before orbital decompression, the average CAS index was 3.83+/–1.86 points, whereas the modified NOSPECS score was 3.31+/–0.97 points. After surgical intervention, the values were as follows: 2.07+/–1.84 points for CAS and 2.5+/–0.97 points for modified NOSPECS. The EUGOGO classification before surgery showed that Graves’ orbitopathy (GO) was mild, moderate to severe and sight-threatening in 1%, 25% and 74% of the orbits, respectively. After surgery, GO was determined to be mild, moderate to severe and sight-threatening in 24%, 57% and 19% of the orbits. Statistical analysis was performed using the R 3.6.2 statistical environment. Inference about the statistical reliability of the parameter was made by calculating the mean and the 95% credibility interval (CI). Conclusions: The severity of TED decreased after orbital decompression. The CAS, modified NOSPECS and EUGOGO classification showed a statistically reliable postoperative reduction. The drop in activity of the disease after orbital surgery requires careful follow-up.

Many current Marxist debates point to a crisis of imagination as a challenge to emancipatory thoughts and actions. The naturalisation of the capitalist mode of production within the production of subjectivity is among the chief reasons behind this state of affairs. This article contributes to the debate by focusing on the notion of imagination, marked by a deep ambivalence capable of both naturalising and denaturalising social relations constitutive of the established order. Such an understanding of imagination is constructed from within the framework of historical materialism, and it draws on Spinoza and Marx, taking advantage of the similarities between the two with respect to the constitution of the subject. From this stems an investigation into the imagination as a material force that partakes both in subjection and liberation. This is further demonstrated in regard to juridical forms of subjectivation and the possibility of subverting these forms through imagination.

In this paper, we place the issue of university activism in the context of constituent and constituted power. By this we mean the ever-present danger that activists’ demands will be co-opted and concurrently deactivated. To mitigate this risk, we develop a set of conceptual tools that enables thinking about the activist university in terms of instituent praxis; that is, an open process of co-becoming of an institution and its actors through the continuous co-production of rules that drive their actions. Contrary to the view of the university as something instituted, the activist university that we propose emphasises the possibility of sustaining the process of acting and its underlying rules, rather than the result of the act. The activist university is understood here as a crack that leaves the instituted university open every time the self-production of its subject emerges by the self-transformation of the actors in the very course of their activities. We observe a chance for grounding instituent praxis in the ontological shift in thinking the activist university from being to co-becoming, as this will allow for reclaiming the future for the university and its broader ecology.

Background MORF-057 is an orally administered small molecule designed to inhibit the α 4β 7 receptor, addressing an unmet medical need in inflammatory bowel disease (IBD) patients, and avoiding the need for periodic therapeutic infusions and the risk for infusion-related reactions. This study evaluated single (SAD) and multiple ascending doses (MAD) of MORF-057 in healthy volunteers. Methods This was a randomized, double-blind, placebo-controlled, single and multiple doses, phase 1 study of the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of MORF-057 conducted in a Phase I Unit in the USA. Subjects were randomized 3:1 to MORF-057 or placebo capsules once daily in the SAD cohorts: 25, 50, 100, 150, and 400 mg; or twice daily (BID) in the MAD cohorts: 100 and 200 mg total daily doses (dosed as 50 and 100 mg BID, respectively). In the MAD cohorts, trough PK samples were obtained premorning or pre-evening dose following administration of 50 or 100 mg BID, respectively. Blood samples to assess receptor occupancy (RO) of α 4β 7 and α 4β 1 integrins were obtained prior to the first dose and 12 hours after treatment. Results To date, 51 healthy subjects were dosed; 1 subject withdrew consent on Day 2 for personal reasons. Eleven non-serious adverse events (AEs) were reported; AEs were mild and did not result in discontinuation. Two reversible mild AEs in the 200 mg MAD cohort were possibly related to MORF-057 (macular / maculopapular rash). No safety signals were identified to date. Following dosing, MORF-057 was rapidly absorbed and systemic exposure increased approximately dose-proportionally (Fig.1). Mean α 4β 7 RO was found to be greater than 95% after each of the three highest single doses (Fig.2). In multiple dosing, mean α 4β 7 RO was greater than 90% at the lower dose, while the highest dose tested resulted in α 4β 7 RO saturation at steady state. α 4β 1 RO was below the limit of quantitation with mean trough values estimated to be Conclusion Current results demonstrated that single and multiple ascending doses of MORF-057 were well tolerated, with only mild, non-serious AEs reported that did not result in study drug discontinuation. MORF-057 demonstrated a favorable PK profile where target engagement was confirmed and resulted in α4β7 receptor saturation in many subjects receiving higher doses. These results support further investigation of MORF-057 and provide a basis for dose selection phase 2 studies in patients with IBD. (NCT04580745)

This article opens a space for dialogue between Marxism and the field of higher education research. First, it demonstrates to what extent Marx is present in the theoretical and methodological discussions within the field and it examines the reasons behind his absence, i.e., the development of two perspectives regarding capitalist transformations, namely academic capitalism and exceptionalism. Second, it introduces Marx’s method of critique, conceived as the integrity of three different analytical moments and it further explicates how those moments can be translated into the general research program. It does so in reference to a) ontological assumptions; b) sector’s political economy; c) students and academic protests; d) ideas about the alternative. Finally, it uses those four areas to reflect on the key differences between Marx’s critique and the two perspectives discussed. By doing so it opens up paths for further dialogue between Marxism and higher education research.

The aim of this study was to evaluate oral cavity morphology in children at risk of sleep disordered breathing (SDB).The study included children 3-17 years of age. The risk of SDB was evaluated using the paediatric sleep questionnaire (PSQ); afterwards, children at risk of SDB were enrolled in the study group. A control group was randomly established from patients with negative PSQ results. The oral cavity morphology evaluation included assessment of the oropharynx using Mallampati classification (MC), palatine tonsil size using the Pirquet scale, occlusion and the presence of a high-arched palate and lingual frenulum.A total of 131 children were evaluated, 65 in the study and 66 in the control group. The mean ages were 9.5 ± 3.0 and 9.4 ± 3.1 years, respectively. The presence of higher scores on the MC, higher scores in the Pirquet scale, a crossbite, a high-arched palate and a short frenulum were significantly more frequent in the study group than the control group.The evaluation of oral morphology is an important part of paediatric examination. Enlarged palatine tonsils; higher scores on the MC; and the presence of a crossbite, short lingual frenulum and high-arched palate may suggest abnormal breathing during sleep in children.

This article introduces a general framework for the critique of the university in crisis that originates in the Marxist tradition. After indicating the limitations of current proposals regarding th...

Study objectives The purpose of this work is to present available questionnaires enabling diagnostic screening when obstructive sleep disordered breathing (SDB) in a child is suspected or its effects are observed and polysomnography is unavailable. These questionnaires are designed to facilitate further diagnostic process or even therapeutic decisions, aid in selecting the optimal one for the specified conditions of clinical practice, with the caveat that none of these represents a diagnostic equivalent to PSG. Methods The questionnaires subjected to analysis: Pediatric Sleep Questionnaire (PSQ), Sleep Clinical Record (SCR), OSA-18 score (OSA-18), Brouilette score (BS), “I'm Sleepy” questionnaire (I'M SLEEPY), and “Sleeping Sleepless Sleepy Disturbed Rest” questionnaire (SSSDR). The comparative analysis of questionnaires included the following parameters: simplicity and time of administer; necessity to engage a physician or other trained individual; taking into account examination of the patient; type and scope of considered symptoms and consequences of obstructive SDB, sensitivity, specificity, recommendations of the guidelines. Results Seven questionnaires were subjected to analysis with presentation of their similarities and differences. Six out of seven were evaluated as simple in administration. Time required to fulfill the questionnaires ranged between 1 and 60 min. Three of them involved a physician or a trained personnel. Physical examination was necessary in two out of seven questionnaires. Sensitivity was estimated in 5 of them and ranged between 59 and 96%. Specificity ranged between 46 and 72%. Conclusions Several questionnaires enabling quick, simple, and inexpensive screening for OSAS have been created. Four (of the seven analyzed) questionnaires may be useful in diagnosis of obstructive SDB in children – two follow current (2015) recommendations. However, there is a need for further work on optimizing such tools, particularly on improving their specificity.

INTRODUCTION Granulomatosis with polyangiitis (GPA) is an autoimmune disease leading to necrotizing lesions in the affected tissues. Computed tomography (CT) of paranasal sinuses reveals multiple lesions in patients with GPA, for example, sinus opacification, bone / cartilage destruction, and neoosteogenesis. OBJECTIVES We aimed to describe and compare CT lesions found in patients with GPA and those with chronic rhinosinusitis (CRS) and to propose a new radiological marker of GPA-nasal strands. PATIENTS AND METHODS This retrospective study (2014-2019) included 53 patients with GPA (22 men, 31 women) at a median (interquartile range) age of 45 (34-60) years. Computed tomography findings of mucosal lesions in paranasal sinuses, neoosteogenesis, bony and cartilaginous lesions, and nasal strands were analyzed. Nasal strands were described as intermucosal adhesions resembling bands. A total of 71 patients with CRS (reference group) were assessed for the presence of the same parameters. RESULTS Computed tomography scans showed mucosal lesions in the sinuses of 35 patients (66%) with GPA. Nasal septum perforation was observed in 19 patients (35.8%), neoosteogenesis in 17 (32.1%), and bone damage in 14 (26.4%). External nose deformity was present in 16 patients (30.2%). Nasal strands on CT were found in 36 patients with GPA (68%) and 32 patients with CRS (45%). The presence of 5 or more strands was more characteristic of GPA than CRS (P

Background Recent studies have shown that a short lingual frenulum is a potential risk factor for obstructive sleep apnea syndrome (OSAS) in children. A short frenulum leads to abnormal orofacial development and may consequently contribute to sleep-disordered breathing by narrowing the upper airways and increasing the risk of upper-airway collapsibility. The aim of this study was to assess the impact of a short lingual frenulum on the risk of OSAS in children. Methods Children from pre-, primary, secondary, and high school, aged 3–17 years, were included in the study. Parents/guardians were asked to fill in the Pediatric Sleep Questionnaire (PSQ), and then, children at risk of OSAS were enrolled in the study group. A control group was established randomly from patients with negative PSQ results. A physical examination, including measurements of head-forward posture (HFP) and length of the free tongue, inter-incisor distance and subjective high-arched palate evaluation was performed in children from both groups. Results A total of 1,500 PSQ questionnaires were distributed, and less than half (713) were returned correctly filled in. In the second part of the study, 135 children were evaluated: 67 in the study group and 68 in the control group. The mean ages were 9.4 ± 3.0 and 9.5 ± 3.1 years, respectively. Children in the study group had significantly shorter lingual frenula, higher HFP measures, and had a higher prevalence of a high-arched palate. Based on statistical analysis, a short lingual frenulum (OR 5.02 [1.58–15.94]). Conclusions The study identified a relationship between a short lingual frenulum and the risk of OSAS in children. Detecting and addressing ankyloglossia in children is necessary before it leads to orofacial changes, malocclusion, and consequently, sleep apnea. Furthermore, OSAS was associated with higher HFP, but no relationship was found between the two parameters.

Niniejszy tekst przedstawia trzy dominujące narracje na temat uniwersytetu w kryzysie, jak również możliwe scenariusze dla przyszłego uniwersytetu, które się z nich wyłaniają. Nacisk położony zostaje na trzy różne ontologie, które podtrzymują wspominane dyskursy: indywidualną, publiczną i tego, co wspólne. W celu odsłonięcia ukrytych przesłanek, które oddziałują na wspominane dyskusje, wprowadzona zostaje metoda ontologii politycznej. Krytyczna analiza ontologicznych założeń, wspierających wizję przyszłego uniwersytetu, pokazuje, że dwa pierwsze hegemoniczne modele, choć przedstawiane jako alternatywy, w istocie wiąże założenie statyczności sektora. Dlatego też niniejszy artykuł przedstawia ontologię relacji opierającą się na tym, co wspólne, jako sposób wyrwania się z klinczu wywołanego hegemonią dyskursów o prywatnym i publicznym charakterze uniwersytetu.

The aim of the study was to investigate the prevalence of upper respiratory tract infections (URI) - as indicated by rhinosinusitis (RS), ear infections (EI), and antibiotic consumption - in a general pediatric population and evaluate the relationship between these conditions and habitual snoring and mouth breathing during sleep.A population-based cross-sectional study was performed in three medium-sized Polish cities from 2011 to 2015.4837/6963 questionnaires (69.5%) were completed, returned and analyzed. Mean age of studied group was 7.07 ± 0.72 and 7.14 ± 0.73 in girls and boys, respectively. Habitual mouth breathing during sleep (MB) was reported in 907 (18.7%) children and habitual snoring (HS) in 290 (6.0%). 230/290 (79.3%) of children with HS were also MB. Both HS and MB were more prevalent in boys than in girls (p = 0.027 and p 0.0001, respectively) and neither was associated with BMI (p = 0.11 and p = 0.07, respectively). Habitual snoring and habitual mouth breathing were highly associated with more frequent bouts of rhinosinusitis, ear infections, and antibiotic use (p 0.0001 for each parameter).Higher rates of rhinosinusitis, ear infections, and antibiotic consumption were similarly associated with HS and MB. MB is over three times more prevalent in the pediatric population relative to HS, therefore it might be considered as a risk factor for URI and may be included in history of URI.

Introduction: In the general population, nasal obstruction is a common complaint. However, an objective evaluation of nasal obstruction is difficult. Nose examination, computed tomography (CT), acoustic rhinometry, and anterior rhinomanometry do not accurately reflect the discomfort reported by patients with nasal obstruction. In patients with nasal obstruction, this study evaluated nasal breathing with a unique device for continuous nasal-oral spirometry – a nasal-oral flow analyzer (NOFA); moreover, quality of life was compared between patients with normal nasal breathing on NOFA and of those with impaired nasal breathing on NOFA. Methods: Of 181 adult patients admitted to an ENT department due to nasal obstruction that were enrolled in the study, 97 (53.6%) completed all per-protocol assessments, including the SF-36 questionnaire and 3-hour, continuous nasal-oral spirometry with NOFA. Based on the presence of normal nasal breathing defined as ≥95% of nasal flow, the 97 patients were divided into those with normal nasal breathing (n=31) and impaired nasal breathing (n=66). Results: Patients with normal nasal breathing differed from those with impaired nasal breathing with respect to all SF-36 subscales (physical functioning, p=0.004; role-physical, p=0.009; bodily pain, p

Resenha: IZAK, Micha?; KOSTERA, Monika; ZAWADZKI, Micha?. (Orgs.). The future of university education. Basingstoke: Palgrave Macmillan, 2017.Review: IZAK, Micha?; KOSTERA, Monika; ZAWADZKI, Micha?. (Orgs.). The future of university education. Basingstoke: Palgrave Macmillan, 2017.

Kaszel jest najczęstszym objawem chorób układu oddechowego. Stosowane dotychczas metody leczenia przewlekłego kaszlu u dorosłych nie są w pełni skuteczne. Przewlekły kaszel o niejasnej przyczynie lub niepoddający się leczeniu może spowodować znaczne upośledzenie jakości życia. Wyniki badań dowodzą, że jedną z metod leczenia przewlekłego, uporczywego kaszlu jest terapia mowy. W pracy zaprezentowano przypadek chorej z przewlekłym kaszlem w przebiegu przewlekłego niealergicznego nieżytu nosa i choroby refluksowej przełyku, przez 18 lat leczonej nieskutecznie, u której terapia mowy istotnie zmniejszyła kaszel i poprawiła jakość życia.

Cough is the most common symptom of respiratory diseases. The results of management of chronic cough in adults are still unsatisfactory. Unexplained and difficult-to-treat chronic cough causes significant impairment in patients‘ quality of life. The results of recent studies suggest that speech therapy (speech language intervention) is one of the few methods which are usefull in management of persistent chronic cough. We present a case of a patient with chronic cough due to chronic nonallergic rhinitis and gastroesophageal reflux disease, who had been unsuccessfully treated for 18 years. In the patient speech therapy resulted in a significant decrease of cough severity and improvement of quality of life.

Epilepsy is often associated with altered expression or function of ion channels. One example of such a channelopathy is the reduction of A-type potassium currents in the hippocampal CA1 region. The underlying mechanisms of reduced A-type channel function in epilepsy are unclear. Here, we show that inhibiting a single microRNA, miR-324-5p, which targets the pore-forming A-type potassium channel subunit Kv4.2, selectively increased A-type potassium currents in hippocampal CA1 pyramidal neurons in mice. Resting membrane potential, input resistance and other potassium currents were not altered. In a mouse model of acquired chronic epilepsy, inhibition of miR-324-5p reduced the frequency of spontaneous seizures and interictal epileptiform spikes supporting the physiological relevance of miR-324-5p-mediated control of A-type currents in regulating neuronal excitability. Mechanistic analyses demonstrated that microRNA-induced silencing of Kv4.2 mRNA is increased in epileptic mice leading to reduced Kv4.2 protein levels, which is mitigated by miR-324-5p inhibition. By contrast, other targets of miR-324-5p were unchanged. These results suggest a selective miR-324-5p-dependent mechanism in epilepsy regulating potassium channel function, hyperexcitability and seizures.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the pediatric population. In 35% of cases, RMS develops in the head and neck (H&N) region, and only combined therapy is recognized as a curative treatment. However, recent advances in skull base and reconstructive surgery, along with microsurgery and endoscopic surgery, have strengthened the role of surgery as an important part of RMS treatment. In the present study, 36 pediatric RMS cases (24 males and 12 females) were analyzed after surgical treatment. The average age at diagnosis was 7 years. In total, 67% of tumors were localized in the parameningeal region. Alveolar RMS was the most common histopathological type. A total of 16 patients were treated due to disease recurrence or a previous non-radical surgical procedure, while 19 cases had inductive chemotherapy and/or radiotherapy preceding surgical treatment due to locally advanced disease. In 1 case, only diagnostic biopsy was performed. It is recommended that the management of H&N RMS is interdisciplinary from the beginning. Extensive surgical dissection in the H&N region for RMS may result in severe cosmetic defects and functional impairment; thus, these risks should be considered during treatment planning, and the surgical approach should be based on the individual characteristics of each patient.

In the diversity of the flavor world only five basic tastes have been described. The newest one, umami, has been identified about one hundred years ago by Kikunae Ikeda but widely accepted just in the second half of the twentieth century by international scientific world. There are three umami substances: monosodium glutamate (MSG), inosine-5'-monophosphate (IMP), guanylo-5'-monophosphate (GMP). A real breakthrough in umami history concerned the finding about independent receptors for umami: T1R1 and T1R3 (taste receptors type 1 member 1 and member 3). The palatable, delicious taste of umami and its mechanism determined a lot of research studies on this highlight. Umami substances elicit salivary secretion, enhance appetite and increase food palatability. They are desirable to improve the quality of diet. Moreover, the association between umami substances and the suppression of obesity has been found. Studies suggest that umami is engaged in metabolism but also increases satiety and reduces the post-ingestive recovery of hunger.

Introduction: To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy. Material and methods: The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA< 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment — intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment — endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment — additional MP therapy and/or surgical decompression. Results: A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves’ orbitopathy clinical activity score (p = 0.035). Conclusions: By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON. (Endokrynol Pol 2016; 67 (2): 166–173)

Obstructive sleep-disordered breathing (SDB) is a common clinical problem. An unrecognized and untreated SDB is a serious threat for an intensively developing organism of a child. The consequences of SDB include cardiovascular and neurological complications, growth disorders and enuresis. Therefore, SDB in children becomes an important subject of many scientific investigations, publications, and congresses. In 2015 the European Respiratory Society Task Force published a document concerning the conclusions about the diagnostics and treatment of SDB in children and youth from 2 to 18 years of age (Fig. 1). The scientific data from 362 publications were presented in a condensed form of “seven steps”, very useful in diagnosing and treatment planning (1). The authors underline the limited number of reliable evidence about SDB: prospective studies, randomized double-blinded studies with placebo. The presented evidence was categorized depending on their quality according to the classification of the American Academy of Neurology (ANN) into classes I – IV. Previously, in 2012, the guidelines of the American Academy of Pediatrics on obstructive sleep apnea syndrome (OSAS) in children with tonsillar hypertrophy and/or obesity were published (2, 3) and they were a valuable diagnostic and therapeutic compendium. The European guidelines discussed in this article result from the progress of knowledge in recent years, they cover the subject broadly, consider rare and difficult cases and present the spectrum of potential therapeutic actions. The aim of the guidelines is a better recognition of SDB, a systematization of diagnosis and treatment at every stage of medical care, including the causes of this disorder and its complications.

The patient with bacterial infection sequelae in the form of damage to cranial nerves III, IV, and VI was followed up. He had exhibited clinical and radiographic signs of paranasal sinusitis. Before his physiotherapy, the patient received standard treatment with natural and synthetic antibiotics and steroids. After acute signs of infection resolved without any functional improvement, the patient was referred to a rehabilitation unit to undergo neuromuscular re-education of the paralyzed extraocular muscles. Periorbital hydrocortisone iontophoresis and visuomotor exercises with intense ideomotor stimulation led to complete and rapid resolution of extraocular muscle paralysis and diplopia. Physiotherapy can be an effective treatment of choice after failed pharmacological treatment in patients with damage to cranial nerves III and VI. It has many theoretical advantages, including noninvasiveness and avoidance of first-pass metabolism of drugs administered systemically.

Introduction The association between obstructive sleep apnea and atherosclerosis is confirmed for long time, but the pathomechanism is still not known. The aim of this study was to investigate the prevalence of OSA in patients scheduled for endarterectomy and the influence of this procedure on the sleep study parameters and sleepiness. Materials and methods 46 patients scheduled for open carotid endarterectomy were enrolled in the study. Sleep study and Epworth Sleepiness Scale (ESS) was performed preoperatively. In 11 out of 46 patients, sleep study was performed both before and after the surgery. Results The mean age of the group was 69,9 years (± 8,6), 21 patients (45,7%) were female. For 46 patients mean pAHI, ODI, pRDI and %snoring were 16,2 (± SD=15,2), 10,4 (± SD=12,2) and 18,9 (± SD=14,9), respectively. Normal pAHI was noticed in 14 patients (30%), while mild (pAHI 5-15), moderate (pAHI 15-30) and severe (pAHIgt;30) OSA was observed in 13 (38%), 11 (24%) and 8 (18%) subjects, respectively. The mean ESS score for 27 out of 46 patients was 6,3 (± SD=5,6). The postoperative results of sleep study in 11 patients showed no significant change. Conclusions This study revealed the prevalence of moderate to severe OSA in 42% of patients scheduled for endarterectomy, while no excessive daytime sleepiness was observed in this group. The results of the study show that patients with carotid atherosclerosis should undergo sleep diagnosis in order to rule out obstructive sleep apnea.

Purpose of the study: The aim of the study was to present the treatment outcomes after vertical partial laryngectomy with or without pedunculated sternothyroid muscle flap reconstruction following the resection of neoplasm-infiltrated vocal fold. The procedure was used in a patient with glottic cancer. Oncological outcomes, morphology of neo-vocal fold and the act of swallowing were evaluated. Material and methods: 45 patients with T1-T2 glottic cancer were subjected to vertical partial laryngectomy with 26 patients undergoing a procedure with pedunculated sternothyroid muscle flap reconstruction and the remaining 19 patients undergoing a procedure without such a reconstruction. Two female and 43 male patients aged 35-82 years (mean age of 62.5 years) were enrolled in the study. Local tumor spread and the condition of reconstructed vocal fold were assessed in sequential videofiberoscopy examination conducted each month after surgery whereas the regional spread was assessed in ultrasound scans. Postoperative aspiration was graded according to the Pearson’s scale. Results: Six patients experienced local recurrence while 2 patients experienced regional recurrence of the tumor. The pedunculated sternothyroid muscle flap neo-fold was structurally resemblant of the non-affected vocal fold. Episodic, daily dysphagia was observed in 1 patient while normal act of swallowing with no Pearson’s scale symptoms was observed in the remaining 44 patients. No necrosis of pedunculated flap was observed. Conclusions: Vertical partial laryngectomy with or without pedunculated sternothyroid muscle flap reconstruction is a good method for the treatment of low- or intermediate-stage glottic cancer, especially when endoscopic access to the tumor is limited and when CO2 laser cannot be used. No significant functional disorders were observed in operated larynges.

Microvessel density (MVD) corresponds to the intensity of neo-angiogenesis. MVD assessments are based on the expression levels of the vascular endothelium markers such as, e.g., CD34 or CD105. The goal of this study was to assess MVD among patients with head and neck squamous cell carcinoma (HNSCC), and to evaluate the predictive value of MVD in head and neck cancers. The study included 49 patients treated for HNSCC and 11 patients with dysplasia of the upper respiratory tract epithelium. Control tissues consisted of 12 normal mucous membranes of the throat. Expression levels of MVD markers were assessed by immunohistochemistry (IHC) using tissue microarrays (TMA). Clinicopathological factors and patients’ survival over the 5-year follow-up period were analyzed. The MVD/CD34 values were found to be significantly elevated in the HNSCCs compared to the non-malignant control tissues (p = 0.001) and to dysplastic tissues. (p = 0.02). Significantly higher MVD/CD105 values were also seen in the tumor compared to the control tissues (p = 0.001) or the dysplastic tissues (p = 0.001). Unexpectedly, significantly lower MVD/CD34 values were seen in the tumor tissues of patients with the T3–T4 tumors compared to those with T1–T2 tumors (p = 0.01). HNSCCs have statistically higher MVD values compared to dysplasia of the upper respiratory tract epithelium. However, the MVD/CD34 values did not correlate with local invasiveness (the T feature) of HNSCCs. This counterintuitive observation suggests that assessments of MVD as performed on TMA by IHC using anti-CD34 or anti-CD105 antibodies considered to be specific for endothelial cell markers might underestimate the extent of the tumor vascularity in HNSCC.

Laryngopharyngeal reflux (LPR) is a common defect among laryngological and phoniatric patients. Although LPR is categorized as a superficial gastroesophageal reflux disease (GERD), differential diagnosis should treat these two diseases separately. LPR symptoms can be assessed in the interview using as a tool the reflux symptom index (RSI). In addition, changes in the larynx that occur during LPR might be seen during laryngoscopy and classified according to the reflux finding score (RFS). One of the main mucosal irritants in LPR is pepsin which digests proteins and impairs the functions of the upper respiratory tract cells by affecting carbonate anhydrase (CAIII) and the Sep 70 protein. Pepsin initiates inflammatory changes within the larynx, nasopharynx and nasal cavity. The use of pepsin detection in upper and lower throat secretions is a new direction in LPR diagnostics.

Objective: To investigate the pathways of inflammatory spread of extratemporal otogenic complications and present the classification including extratemporal spread of otitis media and mastoiditis. Study design: A retrospective case series at an academic referral center, observational study. Methods: Literature review of rare emergency cases in the course acute otitis media with the development of head and neck abscess. Presentation of different pathways on the lateral and inferior wall of the temporal bone found in computed tomography and during surgery. Results: Inflammatory spread to head and neck following acute otitis media may lead through the mastoid cells (with mastoiditis), external auditory canal, or Eustachian tube. Bezold abscess is the most common extratemporal otogenic neck abscess, but the inflammation may pass through any area of either inferior or lateral wall of the temporal bone, leading to extratemporal complications. Conclusion: Head and neck abscess may complicate the course of AOM and emerges when destruction of lateral or inferior temporal bone surface develops. We can distinguish pathways of inflammatory spread from middle ear to extracranial compartment what should find place in classification of AOM complications.

Objective Congenital cholesteatoma (CC) becomes clinically apparent as a cholesteatoma usually during childhood. Nontraumatic otogenic cerebrospinal fluid (CSF) rhinorrhea with an intact tympanic membrane is a very rare symptom. Methods The review of recent literature and case report of the 60-year old patient – a trumpeter presented with nontraumatic otogenic CSF rhinorrhea, intact tympanic membrane on microotoscopy, and besides colorless fluid in right nasal cavity, normal finding on nasal endoscopy examination. Results CSF rhinorrhea was caused by CC in the petrous bone apex. Early diagnosis was facilitated by computed tomography scanning. Complete cholesteatoma removal was accomplished using a middle fossa craniotomy and an open non-radical antromastoidectomy. Conclusion The diagnosis of otogenic cerebrospinal fluid (CSF) rhinorrhea is challenging and it can easily be misdiagnosed. Congenital cholesteatoma is a rare entity. We present a non-classical presentation of CC in an adult male, with a previously unreported symptom of CSF rhinorrhea. Symptomatic improvement occurred after surgical treatment of the disease.

Introduction. Chronic rhinosinusitis (CRS) affects 14% of the world population. The high motility group box 1 (HMGB1) protein triggers inflammation, cell proliferation and cell survival through its receptor for advanced glycation end products (RAGE) upon release from stressed or necrotic cells. The aim of the study was to analyze the expression and function of HMGB1 and RAGE in CRS, providing more information about HMGB1 signaling pathway in CRS, to determine its potential clinical significance. Material and methods. Thirty-seven patients with CRS and 26 normal controls (NC) were enrolled in this study. Classification of disease severity using the SNOT-20 questionnaire, nasal endoscopy, CT scan, assessment of allergy status, microbiological and cytological analysis was performed in patients. Fresh sinus mucosa samples were obtained and analyzed by immunohistochemistry for HMGB1 and RAGE expression in epithelial cells. ELISA assay was performed to evaluate the concentration of HMGB1 in the patients’ sera. Results. No differences were found in HMGB1 immunoexpression between CRS patients and NC, however there was a highly significant difference in RAGE immunoexpression between both groups. There was a correlation between RAGE expression and number of tissue-infiltrating lymphocytes. Further, RAGE expression positively correlated with disease severity and a positive history for allergies. Conclusions. Interaction of HMGB1 and RAGE might be relevant to CRS pathomechanisms leading to sinus mucosa hyperproliferation. CRS pathogenesis might be especially related to the RAGE overexpression correlated with disease severity and allergy.

Sternberg's canal is a congenital bony defect in the lateral wall of the sphenoid sinus. If it persists to adulthood, it may become a source of spontaneous cerebrospinal fluid leak (CSF) and meningoencephalocele. The aim of the study was to describe the authors’ experience and review articles related to spontaneous sphenoid sinus CSF leaks and Sternberg's canal. We analysed patients managed surgicallly due to sphenoid sinus CSF leak and performed a PubMed database search. Two female patients with spontaneous CSF leak of sphenoid origin were found. Both patients underwent surgery with the endoscopic endonasal approach, and the defect was closed using the multi-layer technique. Twelve articles related to CSF leaks of sphenoid origin (due to Sternberg's canal) were found in the PubMed database. Lines of lesser resistance within sphenoid bone may underlie CSF leak pathology together with intracranial hypertension. The endoscopic transnasal approach to the sphenoid sinus is an excellent alternative to standard transcranial procedures.

Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma in children. It is localized in the head and neck region in 40% of cases. Treatment of RMS is complex, including multi-drug chemotherapy, radiotherapy and surgery. The progress that has been accomplished in oncology in recent decades significantly improved outcomes. The 5-year survival rate raised from 25% in 1970 to 73% in 2001, according to IRS-IV data. The outcome is influenced by primary tumor localization, clinical staging, histological tumor type and age at the moment of diagnosis. The relatively rare incidence of these tumors resulted in difficulties in creating more standardized therapeutic protocols. Comparison of outcomes in large patients groups led to an increase in the number of patients with complete remission. Although survival rates of RMS patients have improved, searching for new therapeutic modalities and substances is still essential to improve outcomes in cases of more advanced stages and unfavorable tumor localizations.

A receptor for advanced glycation end products (RAGE) and its ligand high mobility group box 1 (HMGB1) protein has been linked to several chronic diseases, and acts as a trigger for inflammation signaling. Here, we study RAGE and HMGB1 expression in chronic, recalcitrant rhinosinusitis with nasal polyps (CRSwNP) to determine its potential clinical significance, i.e., disease recurrence and severity. RAGE and HMGB1 expression in CRSwNP was evaluated by immunohistochemistry in epithelial cells of fresh sinonasal mucosa samples obtained from the patients diagnosed with recalcitrant CRSwNP (n = 25) and normal control mucosa (NC) (n = 26). RAGE and HMGB1 expression levels in tissues were correlated with disease severity assessed by nasal endoscopy, CT scan, number of previous sinus surgeries, allergy status and nasosinusal microbiology. RAGE and HMGB1 were moderately or strongly expressed in CRSwNP tissue. No or weak RAGE expression was found in NC. HMGB1 was equally strongly expressed in NC. We observed a strong correlation between RAGE and disease severity, recurrence, undergone operations, asthma and aspirin exacerbated respiratory disease (AERD). Elevated RAGE expression is associated with increased disease severity, as well as allergy and AERD in patients with recalcitrant CRSwNP. It is possible that the explanation for recurrent CRSwNP pathogenesis might be related to RAGE overexpression with subsequent sinus mucosa hyperproliferation, necessitating several operations.

Objective: The aim of the study was to assess the safety and efficacy of high- and low-dose oral, delayed-release mesalamine in a randomized, double-blind, active control study of children with mild-to-moderately active ulcerative colitis. Methods: Patients ages 5 to 17 years, with a Pediatric Ulcerative Colitis Activity Index (PUCAI) score of ≥10 to ≤55 and a truncated Mayo Score of ≥1 for both rectal bleeding and stool frequency, were enrolled. They received body weight–dependent doses of oral, delayed-release mesalamine for 6 weeks in a low- (27–71 mg · g−1 · day−1) or high-dose group (53–118 mg · g−1 · day−1). The primary endpoint was treatment success, defined as the proportion of patients who achieved remission (PUCAI score

Objective: The aim of the study was to estimate usability of the piezoelectric knife in larynx surgery. Prove that the piezoelectric staff can be used to do any different shape incision within the larynx cartilages. Material and methods: 35 patients hospitalized in our Department in 2014–2016 were enrolled in our study. 24 patients went vertical partial laryngectomy and 1 patient went horizontal partial laryngectomy because of larynx cancer. 5 patients went partial laryngectomy because of low stage of piriformis recess cancer. Piezoelectric staff was used to do thyroidectomy and resection of thyroid cartilage suspected of carcinomatosis infiltration. The rest 4 patients had done widening of larynx lumen due to larynx stenosis or slenderness. The piezoelectric tool was used to do different incision or resection within the larynx cartilages in case of widening lumen of the larynx. Results: The larynx cartilages, especially thyroid cartilage could be cut in different shapes using piezoelectric tools. The usage of this equipment causes the minimal loss and small destruction of local healthy tissues. Conclusions: The Piezoelectric instrument is useful instrument suit to operate within larynx cartilages. Exchangeable tip available in different shapes enables different resections of cartilages. Using the piezoelectric staff we can remove pathological tissue with minimal local destruction. Our observation shows that larynx operation with a usage of the piezoelectric knife is safe and effective. Current English literature does not describe usage piezoelectric tools in larynx surgery. It is essential to do more observation about that type of operations.

Vascular anomalies are divided according to the contemporary system of classification into two groups: tumors and malformations. However, there is no consensus on juvenile angiofibroma’s place in that system. The general characteristics of selected markers of angiogenesis and tissue remodeling are presented in the series in the context of current knowledge in the field of pathophysiology of vascular lesions. The mentioned markers are currently the subjects of multidirectional studies in oncology, as they take part in the process of neoangiogenesis and proliferation of tumors. Nevertheless, they have not been widely examined in vascular lesions. The indirect goal of that series is to indicate the possible research direction on vascular lesions to determine their molecular profile, to create a more specific system of classification, and above all to develop new diagnostic and treatment methods.