RICHARD LOUIS VOEGELS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Fire simulator exposure alters the innate epithelial response and inflammatory status in the airways of firefighters(2021) CORDEIRO, Telma Gomes; AMARAL, Jonatas Bussador do; PAVAO, Valdir; CARDOSO, Ricardo Galesso; VOEGELS, Richard Louis; PEZATO, Pedro Michaluat; PAIXAO, Vitoria; ALMEIDA, Ewin Barbosa de; BACHI, Andre Luis Lacerda; PEZATO, RogerioBackground: Firefighters are often exposed to high temperatures and by-products of combustion, which can compromise their health. We aimed to evaluate the effect of fire exposure in fire simulators on the airways of firefighters at different time-points. Methodology: Thirty-seven male firefighters exposed to fire simulators were evaluated in three phases: pre-exposure, at the end of the first week, and 4 weeks after. Pulmonary function by spirometry, nasal mucociliary clearance; peripheral oxygen saturation, inflammatory markers in the nasal lavage and CC16 in the sputum, nasal obstruction, and quality of life (using the questionnaires NOSE and SNOT-22) were assessed. Results: Higher levels of IL-8, IL-10, and exhaled carbon monoxide were found more in phase 2 than in phase 1. Higher CC16 levels and lower peripheral oxygen saturation were observed in phase 3 as compared to phase 1. Lower levels of IL-2 and peripheral oxygen saturation were found in phase 3 than in phase 2. Higher nasal mucociliary clearance, as well as the worst quality of life and nasal obstruction, were observed in phases 2 and 3 as compared to phase 1. Conclusions: The firefighters' exposures to high temperatures and by-products of combustion in the fire simulators elicit an inflammatory process in the airways with impairment in the innate epithelial response of the upper airway lining. Furthermore, changes in O2 transport affected the professionals' quality of life negatively.
- International consensus statement on allergy and rhinology: rhinosinusitis 2021(2021) ORLANDI, Richard R.; KINGDOM, Todd T.; SMITH, Timothy L.; BLEIER, Benjamin; DECONDE, Adam; LUONG, Amber U.; POETKER, David M.; SOLER, Zachary; WELCH, Kevin C.; WISE, Sarah K.; ADAPPA, Nithin; ALT, Jeremiah A.; ANSELMO-LIMA, Wilma Terezinha; BACHERT, Claus; BAROODY, Fuad M.; BATRA, Pete S.; BERNAL-SPREKELSEN, Manuel; BESWICK, Daniel; BHATTACHARYYA, Neil; CHANDRA, Rakesh K.; CHANG, Eugene H.; CHIU, Alexander; CHOWDHURY, Naweed; CITARDI, Martin J.; COHEN, Noam A.; CONLEY, David B.; DELGAUDIO, John; DESROSIERS, Martin; DOUGLAS, Richard; ELOY, Jean Anderson; FOKKENS, Wytske J.; GRAY, Stacey T.; GUDIS, David A.; HAMILOS, Daniel L.; HAN, Joseph K.; HARVEY, Richard; HELLINGS, Peter; HOLBROOK, Eric H.; HOPKINS, Claire; HWANG, Peter; JAVER, Amin R.; JIANG, Rong-San; KENNEDY, David; KERN, Robert; LAIDLAW, Tanya; LAL, Devyani; LANE, Andrew; LEE, Heung-Man; LEE, Jivianne T.; LEVY, Joshua M.; LIN, Sandra Y.; LUND, Valerie; MCMAINS, Kevin C.; METSON, Ralph; MULLOL, Joaquim; NACLERIO, Robert; OAKLEY, Gretchen; OTORI, Nobuyoshi; PALMER, James N.; PARIKH, Sanjay R.; PASSALI, Desiderio; PATEL, Zara; PETERS, Anju; PHILPOTT, Carl; PSALTIS, Alkis J.; RAMAKRISHNAN, Vijay R.; RAMANATHAN, Murugappan; ROH, Hwan-Jung; RUDMIK, Luke; SACKS, Raymond; SCHLOSSER, Rodney J.; SEDAGHAT, Ahmad R.; SENIOR, Brent A.; SINDWANI, Raj; SMITH, Kristine; SNIDVONGS, Kornkiat; STEWART, Michael; SUH, Jeffrey D.; TAN, Bruce K.; TURNER, Justin H.; DRUNEN, Cornelis M.; VOEGELS, Richard; WANG, De Yun; WOODWORTH, Bradford A.; WORMALD, Peter-John; WRIGHT, Erin D.; YAN, Carol; ZHANG, Luo; ZHOU, BingBackground: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. Methods: ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. Conclusion: This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
- BMP-7, MMP-9, and TGF-beta tissue remodeling proteins and their correlations with interleukins 6 and 10 in chronic rhinosinusitis(2021) LUCAS, Bernardo Relvas; VOEGELS, Richard Luis; AMARAL, Jonatas Bussador do; BACHI, Andre Luis Lacerda; PEZATO, RogerioIntroduction Chronic rhinosinusitis without nasal polyposis (CRSsNP) and Chronic rhinosinusitis with nasal polyposis (CRSwNP) present distinct tissue remodeling processes. The proteins involved in the process of tissue remodeling have their production and activity related to the inflammatory environment they are. This study aimed to evaluate the protein expression of BMP-7, MMP-9, TGF-beta in chronic sinusitis with and without nasal polyposis and their relations with IL-6 and IL-10. Methods Cross-sectional observational study with 86 participants was divided into three groups: patients with CRSwNP (n = 34), patients with CRSsNP (n = 26), and a control group (CG) without inflammatory disease of the nasal mucosa (n = 26). The primary outcomes were the concentrations of BMP-7, MMP-9, TGF-beta, IL-6, and IL-10. Secondary outcomes were the correlations of these markers. Results The TGF-beta dosage was elevated in the CRSsNP group and reduced in the CSwNP group. The dosage of IL-6 was higher in the CSwNP group, and the IL-10 dosage lower in the groups with sinusitis, and IL-10 was positively correlated with BMP-7 in all groups. There was a negative correlation between IL-6 and IL-10 in all groups observed. The correlation between MMP-9 and interleukins was lost in the CRSsNP group. There was a positive correlation between TGF-beta and IL-6 in the CG, and negative in the CRSsNP group. Conclusion An inflammation shown in rhinosinusitis with an increase in IL-6 and decrease in IL-10 when compared with the control group; only TGF-beta was altered in the tissue remodeling process when compared with BMP-7 and MMP-9 in rhinosinusitis. There is a loss of correlation between tissue remodeling proteins and interleukins studied in CRSsNP.
- Rhinomanometry Versus Computational Fluid Dynamics: Correlated, but Different Techniques(2021) CHEROBIN, Giancarlo B.; VOEGELS, Richard L.; PINNA, Fabio R.; GEBRIM, Eloisa M. M. S.; BAILEY, Ryan S.; GARCIA, Guilherme J. M.Background Past studies reported a low correlation between rhinomanometry and computational fluid dynamics (CFD), but the source of the discrepancy was unclear. Low correlation or lack of correlation has also been reported between subjective and objective measures of nasal patency. Objective: This study investigates (1) the correlation and agreement between nasal resistance derived from CFD (R-CFD) and rhinomanometry (R-RMN), and (2) the correlation between objective and subjective measures of nasal patency. Methods Twenty-five patients with nasal obstruction underwent anterior rhinomanometry before and after mucosal decongestion with oxymetazoline. Subjective nasal patency was assessed with a 0-10 visual analog scale (VAS). CFD simulations were performed based on computed tomography scans obtained after mucosal decongestion. To validate the CFD methods, nasal resistance was measuredin vitro(R-EXPERIMENT) by performing pressure-flow experiments in anatomically accurate plastic nasal replicas from 6 individuals. Results Mucosal decongestion was associated with a reduction in bilateral nasal resistance (0.34 +/- 0.23 Pa.s/ml to 0.19 +/- 0.24 Pa.s/ml, p = 0.003) and improved sensation of nasal airflow (bilateral VAS decreased from 5.2 +/- 1.9 to 2.6 +/- 1.9, p < 0.001). A statistically significant correlation was found between VAS in the most obstructed cavity and unilateral airflow before and after mucosal decongestion (r = -0.42, p = 0.003). Excellent correlation was found between R(CFD)and R-EXPERIMENT(r = 0.96, p < 0.001) with good agreement between the numerical andin vitrovalues (R-CFD/R-EXPERIMENT = 0.93 +/- 0.08). A weak correlation was found between R(CFD)and R-RMN(r = 0.41, p = 0.003) with CFD underpredicting nasal resistance derived from rhinomanometry (R-CFD/R-RMN = 0.65 +/- 0.63). A stronger correlation was found when unilateral airflow at a pressure drop of 75 Pa was used to compare CFD with rhinomanometry (r = 0.76, p < 0.001). Conclusion CFD and rhinomanometry are moderately correlated, but CFD underpredicts nasal resistance measuredin vivodue in part to the assumption of rigid nasal walls. Our results confirm previous reports that subjective nasal patency correlates better with unilateral than with bilateral measurements and in the context of an intervention.
- Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps(2021) BEZERRA, Thiago Freire Pinto; PEZATO, Rogerio; BARROS, Pamella Marletti de; COUTINHO, Larissa Leal; COSTA, Leidianny Firmino; PINNA, Fabio; VOEGELS, RichardIntroduction: The antiinflammatory effects of macrolides, especially clarithromycin, have been described in patients with chronic rhinosinusitis without polyps and also other chronic inflammatory airway diseases. There is no consensus in the literature regarding the effectiveness of clarithromycin in patients with chronic rhinosinusitis with sinonasal polyposis and the national literature does not report any prospective studies on the efficacy of clarithromycin in chronic rhinosinusitis in our population. Objective: To evaluate the effect of clarithromycin in the adjunctive treatment of recurrent chronic rhinosinusitis with sinonasal polyposis refractory to clinical and surgical treatment. Methods: Open prospective study with 52 patients with chronic rhinosinusitis and recurrent sinonasal polyposis. All subjects received nasal lavage with 20 mL 0.9% SS and fluticasone nasal spray, 200 mcg / day, 12/12 h for 12 weeks; and clarithromycin 250 mg 8/8 h for 2 weeks and, thereafter, 12/12 h for 10 weeks. The patients were assessed by SNOT 20, NOSE and Lund-Kennedy scales before, immediately after treatment and 12 weeks after treatment. The patients were also evaluated before treatment with paranasal cavity computed tomography (Lund-Mackay) and serum IgG, IgM, IgA, IgE and eosinophil levels. The outcomes evaluated were: SNOT-20, NOSE and Lund-Kennedy. Results: Most patients were women, aged 47 (15) years (median / interquartile range), and 61.5% (32/52) had asthma. All patients completed the follow-up after 12 weeks and 42.3% (22/52) after 24 weeks. Treatment resulted in a quantitative decrease in the SNOT-20 [2.3 (1.6) vs. 1.4 (1.6); Delta = -0.9 (1.1); p < 0.01]; NOSE [65 (64) vs. 20 (63); Delta = -28 (38), p < 0.01] and Lund-Kennedy [11 (05) vs. 07 (05); Delta = -2 (05); p < 0.01] scores. SNOT-20 showed a qualitative improvement (>0.8) in 54% (28/52, p < 0.04) of patients, a group that showed lower IgE level [108 (147) vs. 289 (355), p < 0.01]. The group of patients who completed follow-up 12 weeks after the end of treatment (n = 22) showed no worsening of outcomes. Conclusion: Long-term adjuvant use of low-dose clarithromycin for chronic rhinosinusitis patients with recurrent sinonasal polyposis refractory to clinical and surgical treatment has resulted in improved quality of life and nasal endoscopy findings, especially in patients with normal IgE levels. This improvement persisted in the patient group evaluated 12 weeks after the end of the treatment. (C) 2021 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Chemosensory Dysfunction in COVID-19: Prevalences, Recovery Rates, and Clinical Associations on a Large Brazilian Sample(2021) BRANDAO NETO, Deusdedit; FORNAZIERI, Marco Aurelio; DIB, Caroline; FRANCESCO, Renata Cantisani Di; DOTY, Richard L.; VOEGELS, Richard Louis; PINNA, Fabio de RezendeObjective. Our study aimed to measure the percentage of reported olfactory or taste losses and their severity, recovery time, and association with other features in a large cohort of patients with COVID-19. Study Design. Prospective survey. Setting. Quaternary medical center and online survey. Methods. The perceived chemosensory capacities of 655 patients with confirmed COVID-19 were assessed with 11-point category rating scales (0, no function; 10, normal function). Patients were contacted in hospital, by phone calls, or by internet regarding their ability to smell or taste, and 143 were interviewed by phone 1 to 4 months later to assess the recovery of their chemosensory abilities. Results. The prevalence of self-reported olfactory, general taste, and taste quality-specific disturbances (sweet, sour, bitter, and salty) in the patients with COVID-19 were 82.4% (95% CI, 79.5%-85.3%), 76.2% (95% CI, 72.9%-79.4%), and 52.2% (95% CI, 48.3%-56.1%), respectively. The majority reported anosmia (42.9%). The presence of chemosensory symptoms was not associated with COVID-19 severity. At a median time >2 months after the onset of symptoms, rates of total and partial olfaction recovery were 53.8% and 44.7%, while complete or partial return to previous taste function was 68.3% and 27.6%. Less than 5% of the patients reported no chemosensory function improvement at all. Conclusion. The prevalence of self-reported chemosensory dysfunction is high among patients with COVID-19. Almost all patients seem to recover a significant part of their smell and taste abilities in the first 4 months after the onset of symptoms.
- Olfactory Dysfunction in Frontline Health Care Professionals During COVID-19 Pandemic in Brazil(2021) SBRANA, Mariana Ferreira; FORNAZIERI, Marco Aurelio; BRUNI-CARDOSO, Alexandre; I, Vivian Avelino-Silva; SCHECHTMAN, Deborah; VOEGELS, Richard Louis; MALNIC, Bettina; GLEZER, Isaias; PINNA, Fabio de RezendeUpper respiratory viral infections can decrease the sense of smell either by inflammatory restriction of nasal airflow that carries the odorant molecules or through interference in olfactory sensory neuron function. During the coronavirus disease 2019 (COVID-19) pandemic, triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), worldwide reports of severe smell loss (anosmia/hyposmia) revealed a different type of olfactory dysfunction associated with respiratory virus infection. Since self-reported perception of smell is subjective and SARS-CoV-2 exposure is variable in the general population, we aimed to study a population that would be more homogeneously exposed to the virus. Here, we investigated the prevalence of olfactory loss in frontline health professionals diagnosed with COVID-19 in Brazil, one of the major epicenters of the disease. We also analyzed the rate of olfactory function recovery and the particular characteristics of olfactory deficit in this population. A widely disclosed cross-sectional online survey directed to health care workers was developed by a group of researchers to collect data concerning demographic information, general symptoms, otolaryngological symptoms, comorbidities, and COVID-19 test results. Of the 1,376 health professionals who completed the questionnaire, 795 (57.8%) were working directly with COVID-19 patients, either in intensive care units, emergency rooms, wards, outpatient clinics, or other areas. Five-hundred forty-one (39.3%) participants tested positive for SARS-CoV-2, and 509 (37%) were not tested. Prevalence of olfactory dysfunction in COVID-19-positive subjects was 83.9% (454 of 541) compared to 12.9% (42 of 326) of those who tested negative and to 14.9% (76 of 509) of those not tested. Olfactory dysfunction incidence was higher in those working in wards, emergency rooms, and intensive care units compared to professionals in outpatient clinics. In general, remission from olfactory symptoms was frequent by the time of responses. Taste disturbances were present in 74.1% of infected participants and were significantly associated with hyposmia. In conclusion, olfactory dysfunction is highly correlated with exposure to SARS-CoV-2 in health care professionals, and remission rates up to 2 weeks are high.
- Effectiveness and Adverse Effects of Tranexamic Acid in Bleeding during Adenotonsillectomy: A Randomized, Controlled, Double-blind Clinical Trial(2021) FORNAZIERI, Marco Aurelio; KUBO, Henrique Kazuo Lima; FARIAS, Lisandra Coneglian de; SILVA, Adriano Morita Fernandes da; GARCIA, Ellen Cristine Duarte; SANTOS, Gustavo de Alcantara Lopes dos; PINNA, Fabio de Rezende; VOEGELS, Richard LouisIntroduction Intra and postoperative bleeding are the most frequent and feared complications in adenotonsillectomy (AT). Tranexamic acid (TXA), which is known for its antifibrinolytic effects, has a proven benefit in reducing bleeding in hemorrhagic trauma and cardiac surgery; however, the effectiveness and timing of its application in AT have not yet been established. Objectives We aimed to evaluate the efficacy of TXA in controlling bleeding during and after AT and assess its possible adverse effects in children. Methods The present randomized, controlled, double-blind clinical trial included 63 children aged 2 to 12 years. They were randomly assigned to receive either intravenous TXA (10 mg/kg) or placebo 10 minutes before surgery. The volume of intraoperative bleeding, presence of postoperative bleeding, and adverse effects during and 8 hours after the surgery were assessed. Results No difference in bleeding volume was noted between the 2 groups (mean, 122.7ml in the TXA group versus 115.5ml in the placebo group, p = 0.36). No intraoperative or postoperative adverse effects were noted because of TXA use. Furthermore, no primary or secondary postoperative bleeding was observed in any of the participants. Conclusion In our pediatric sample, TXA (10mg/ kg) administration before AT was safely used, without any adverse effects. It did not reduce the bleeding volume in children during this type of surgery. Future studies should assess the use of higher doses of TXA and its administration at other time points before or during surgery.
- Sinonasal inverted papilloma: rate of recurrence and malignant transformation in 44 operated patients(2021) SBRANA, Mariana Ferreira; BORGES, Renata Ferraz Rafael; PINNA, Fabio de Rezende; NETO, Deusdedit Brandao; VOEGELS, Richard LouisIntroduction: Although sinonasal inverted papillomas are benign lesions, they are locally aggressive and have a potential malignant transformation ranging from 5% to 15%, with a high recurrence rate. Objective: The aim of this article is to describe the rate of recurrence and malignant transformation in patients with a diagnosis of inverted papilloma who underwent surgery in a tertiary hospital in Sao Paulo. Methods: We performed a retrospective analysis of patients diagnosed with sinonasal papilloma who had undergone surgery in a tertiary hospital in Sao Paulo, between August 1998 and August 2017. A patient chart review was conducted to assess data of patients' demographics, tumors characteristics, follow-up appointments, recurrence and malignancy. Inverted papillomas were analyzed and classified under the Krouse staging system. Results: A total of 69 surgeries were performed in patients with diagnosis of sinonasal papilloma. Inverted papilloma was the most prevalent subtype (49 cases - 80.33%), followed by exophytic papilloma (6 cases - 9.84%) and by oncocytic papilloma (6 cases - 9.84%). The recurrence rate was 34.09% for inverted papilloma (15/44) and the mean time of recurrence was 24.6 months. Malignant transformation occurred in 6 patients (13.64%). Three of these patients presented carcinoma in the first surgery and three patients developed carcinoma during the follow-up. Conclusion: The high recurrence rate and malignancy potential allow us to consider inverted papillomas as aggressive tumors. In a tertiary hospital in Sao Paulo the recurrence rate the mean time to recurrence is 24.6 months. The recurrence after 10 years implies was 34.09% and the need for long-term follow up. It is possible that the high recurrence rate and the high malignant transformation rate we found are due to the large number of tumors discovered at an advanced stage (most of them staged T3 and T4), secondary to poor access to health system, in developing countries. (C) 2019 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.