Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica

Detalhes bibliográficos
Autor(a) principal: Isamara Simas de Oliveira
Data de Publicação: 2014
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UFMG
Texto Completo: http://hdl.handle.net/1843/BUBD-9ZCP9T
Resumo: Introduction: The Eosinophilic Nasal Polyposis (ENP) is a chronic inflammatory disease characterized by the formation of benign, multiple and bilateral nasal polyps. ENP has a multifactorial pathogenesis, being always associated with chronic inflammation. It is a benign disease, but with severe impairment lifes quality of patients. The treatments (corticosteroids and nasal endoscopic surgery) lead to control symptoms, but relapses are frequent. Macrolides used as immunomodulators are a promising tool for more effective disease control. Objectives: The evaluation of the treatment with low-dose long term azithromycin in ENP was based on subjective patient assessment, staging polyposis and quality of life questionnaire (SNOT-22). To characterize the inflammatory behavior and the percentage of eosinophils, before and after treatment, in biopsies of eosinophilic nasal polyps through score and correlate clinical improvement in patients with the histomorphological change. Patients and Methods: It's self-matched study of series in patients with ENP. Comparison of pretreatment and post-treatment with Azithromycin at a dose of 500 mg, orally, three times per week for 8 weeks were evaluated. Patients underwent clinical examination, staging, application of SNOT-22 and biopsy of nasal polyps at the beginning and the end of treatment. Results: Thirty-three patients completed the study. The medication was well tolerated overall. After treatment, was observed significant clinical improvement: subjective assessment of the patient (60.6%), staging of polyps (69.7%) and SNOT-22 (57.6%). We don`t found significant change in the inflammatory pattern, in the percentage or absolute number of eosinophils per field, in the samples before and after treatment (p> 0.05). There was no difference between the responses of the groups with and without asthma/aspirin intolerance. Patients that have an advanced stage in de beginning of the study showed less subjective improvement and reduced staging. Conclusion: Azithromycin, based on the study, could be considered a therapeutic option for ENP. More studies are needed to define the real mechanism of action involved.
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spelling Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológicaEosinófilosQuestionáriosImagem tridimensionalPólipos nasaisAzitromicinaEndoscopiaPólipos nasais/metabolismoCélulas epiteliaisQuestionáriosImagem tridimensionalApoptose/efeitos de drogasPólipos nasaisAzitromicina/administração & dosagemEritromicina/uso terapêuticoIntroduction: The Eosinophilic Nasal Polyposis (ENP) is a chronic inflammatory disease characterized by the formation of benign, multiple and bilateral nasal polyps. ENP has a multifactorial pathogenesis, being always associated with chronic inflammation. It is a benign disease, but with severe impairment lifes quality of patients. The treatments (corticosteroids and nasal endoscopic surgery) lead to control symptoms, but relapses are frequent. Macrolides used as immunomodulators are a promising tool for more effective disease control. Objectives: The evaluation of the treatment with low-dose long term azithromycin in ENP was based on subjective patient assessment, staging polyposis and quality of life questionnaire (SNOT-22). To characterize the inflammatory behavior and the percentage of eosinophils, before and after treatment, in biopsies of eosinophilic nasal polyps through score and correlate clinical improvement in patients with the histomorphological change. Patients and Methods: It's self-matched study of series in patients with ENP. Comparison of pretreatment and post-treatment with Azithromycin at a dose of 500 mg, orally, three times per week for 8 weeks were evaluated. Patients underwent clinical examination, staging, application of SNOT-22 and biopsy of nasal polyps at the beginning and the end of treatment. Results: Thirty-three patients completed the study. The medication was well tolerated overall. After treatment, was observed significant clinical improvement: subjective assessment of the patient (60.6%), staging of polyps (69.7%) and SNOT-22 (57.6%). We don`t found significant change in the inflammatory pattern, in the percentage or absolute number of eosinophils per field, in the samples before and after treatment (p> 0.05). There was no difference between the responses of the groups with and without asthma/aspirin intolerance. Patients that have an advanced stage in de beginning of the study showed less subjective improvement and reduced staging. Conclusion: Azithromycin, based on the study, could be considered a therapeutic option for ENP. More studies are needed to define the real mechanism of action involved.Introdução: A Polipose Nasossinusal Eosinofílica (PNSE) é uma doença inflamatória crônica com formação de pólipos nasais benignos, múltiplos e bilaterais. Apresenta patogênese multifatorial, estando a inflamação crônica sempre associada. Trata-se de uma doença benigna, porém com grande comprometimento da qualidade de vida dos portadores. Os tratamentos utilizados (corticosteroides e cirurgia endoscópica nasal) levam ao controle dos sintomas, porém recidivas são frequentes. Os macrolídeos usados como imunomoduladores são uma promissora ferramenta para um controle mais eficaz da doença. Objetivos: Avaliar o tratamento com Azitromicina em baixa dose por tempo prolongado na PNSE com base na avaliação subjetiva do paciente, estadiamento da polipose e questionário de qualidade de vida (SNOT-22). Caracterizar o comportamento inflamatório e o percentual de eosinófilos, antes e após o tratamento, nas biópsias dos pólipos nasais eosinofílicos através de escore e correlacionar a melhora clínica do paciente com a alteração histomorfológica encontrada. Casuística e Metodologia: Trata-se de estudo de casuística auto pareado em pacientes com PNSE. Foi realizada a comparação dos pacientes pré-tratamento e pós-tratamento com Azitromicina na dose de 500mg, VO, três vezes por semana durante 8 semanas. Os pacientes foram submetidos a exame clínico, estadiamento, aplicação do questionário SNOT-22 e biópsia dos pólipos nasais no início e ao final do tratamento. Resultados: Trinta e três pacientes completaram o estudo. A medicação foi bem tolerada de maneira geral. Houve melhora clínica significativa no pós-tratamento nas três variáveis estudadas: avaliação subjetiva do paciente (60,6%), estadiamento da polipose (69,7%) e questionário SNOT-22 (57,6%). Não encontramos alteração significativa no padrão inflamatório, no percentual ou no número absoluto de eosinófilos por campo, nas amostras antes e após o tratamento (p>0,05). Não houve diferença entre as respostas dos grupos com e sem asma/intolerância à aspirina. Pacientes com estadiamento inicial avançado apresentaram menores índices de melhora subjetiva e redução do estadiamento. Conclusão: A Azitromicina, com base no estudo, poderia ser considerada mais uma opção terapêutica da PNSE. Mais estudos são necessários para definir o real mecanismo de ação envolvido.Universidade Federal de Minas GeraisUFMGRoberto Eustaquio Santos GuimaraesPaulo Fernando Tormin Borges CrosaraIsamara Simas de Oliveira2019-08-14T09:02:24Z2019-08-14T09:02:24Z2014-12-10info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfapplication/pdfhttp://hdl.handle.net/1843/BUBD-9ZCP9Tinfo:eu-repo/semantics/openAccessporreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMG2019-11-14T19:30:25Zoai:repositorio.ufmg.br:1843/BUBD-9ZCP9TRepositório InstitucionalPUBhttps://repositorio.ufmg.br/oairepositorio@ufmg.bropendoar:2019-11-14T19:30:25Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
dc.title.none.fl_str_mv Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
title Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
spellingShingle Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
Isamara Simas de Oliveira
Eosinófilos
Questionários
Imagem tridimensional
Pólipos nasais
Azitromicina
Endoscopia
Pólipos nasais/metabolismo
Células epiteliais
Questionários
Imagem tridimensional
Apoptose/efeitos de drogas
Pólipos nasais
Azitromicina/administração & dosagem
Eritromicina/uso terapêutico
title_short Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
title_full Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
title_fullStr Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
title_full_unstemmed Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
title_sort Azitromicina no tratamento da polipose nasossinusal eosinofílica: análise clínica e histomorfológica
author Isamara Simas de Oliveira
author_facet Isamara Simas de Oliveira
author_role author
dc.contributor.none.fl_str_mv Roberto Eustaquio Santos Guimaraes
Paulo Fernando Tormin Borges Crosara
dc.contributor.author.fl_str_mv Isamara Simas de Oliveira
dc.subject.por.fl_str_mv Eosinófilos
Questionários
Imagem tridimensional
Pólipos nasais
Azitromicina
Endoscopia
Pólipos nasais/metabolismo
Células epiteliais
Questionários
Imagem tridimensional
Apoptose/efeitos de drogas
Pólipos nasais
Azitromicina/administração & dosagem
Eritromicina/uso terapêutico
topic Eosinófilos
Questionários
Imagem tridimensional
Pólipos nasais
Azitromicina
Endoscopia
Pólipos nasais/metabolismo
Células epiteliais
Questionários
Imagem tridimensional
Apoptose/efeitos de drogas
Pólipos nasais
Azitromicina/administração & dosagem
Eritromicina/uso terapêutico
description Introduction: The Eosinophilic Nasal Polyposis (ENP) is a chronic inflammatory disease characterized by the formation of benign, multiple and bilateral nasal polyps. ENP has a multifactorial pathogenesis, being always associated with chronic inflammation. It is a benign disease, but with severe impairment lifes quality of patients. The treatments (corticosteroids and nasal endoscopic surgery) lead to control symptoms, but relapses are frequent. Macrolides used as immunomodulators are a promising tool for more effective disease control. Objectives: The evaluation of the treatment with low-dose long term azithromycin in ENP was based on subjective patient assessment, staging polyposis and quality of life questionnaire (SNOT-22). To characterize the inflammatory behavior and the percentage of eosinophils, before and after treatment, in biopsies of eosinophilic nasal polyps through score and correlate clinical improvement in patients with the histomorphological change. Patients and Methods: It's self-matched study of series in patients with ENP. Comparison of pretreatment and post-treatment with Azithromycin at a dose of 500 mg, orally, three times per week for 8 weeks were evaluated. Patients underwent clinical examination, staging, application of SNOT-22 and biopsy of nasal polyps at the beginning and the end of treatment. Results: Thirty-three patients completed the study. The medication was well tolerated overall. After treatment, was observed significant clinical improvement: subjective assessment of the patient (60.6%), staging of polyps (69.7%) and SNOT-22 (57.6%). We don`t found significant change in the inflammatory pattern, in the percentage or absolute number of eosinophils per field, in the samples before and after treatment (p> 0.05). There was no difference between the responses of the groups with and without asthma/aspirin intolerance. Patients that have an advanced stage in de beginning of the study showed less subjective improvement and reduced staging. Conclusion: Azithromycin, based on the study, could be considered a therapeutic option for ENP. More studies are needed to define the real mechanism of action involved.
publishDate 2014
dc.date.none.fl_str_mv 2014-12-10
2019-08-14T09:02:24Z
2019-08-14T09:02:24Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
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dc.identifier.uri.fl_str_mv http://hdl.handle.net/1843/BUBD-9ZCP9T
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dc.publisher.none.fl_str_mv Universidade Federal de Minas Gerais
UFMG
publisher.none.fl_str_mv Universidade Federal de Minas Gerais
UFMG
dc.source.none.fl_str_mv reponame:Repositório Institucional da UFMG
instname:Universidade Federal de Minas Gerais (UFMG)
instacron:UFMG
instname_str Universidade Federal de Minas Gerais (UFMG)
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institution UFMG
reponame_str Repositório Institucional da UFMG
collection Repositório Institucional da UFMG
repository.name.fl_str_mv Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)
repository.mail.fl_str_mv repositorio@ufmg.br
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