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  • Title: The pragmatic role of nasal cytology: a point-of-care testing to implement precision medicine in clinical practice.
    Author: Gelardi M, Landi M, Ciprandi G.
    Journal: Rev Alerg Mex; 2018; 65(3):259-263. PubMed ID: 30176204.
    Abstract:
    BACKGROUND: Precision medicine is an up-to-date strategy aimed at individualizing precise pathophysiological mechanisms. Thus, precision medicine is the basis for personalized medicine, inasmuch as it seeks to define the most appropriate treatment for each patient. Nasal cytology requires only an optical microscope, stains, glasses, and nasal cytology curettes. The procedure may last very few minutes using quick staining and, therefore, it can be considered a reliable point-of-care test in the office setting. METHODS: Cross-sectional study that included 5030 outpatients with nasal disorders: 2612 males and 2418 females, with a mean age of 36.8 ± 17.1 years, who were attended to within a 5-year period. The patients were subdivided according to skin prick-test and nasal cytology results into subjects with allergic rhinitis or non-allergic rhinitis. Cellular forms were further subdivided based on their cytotype: NARNE (> 50% of neutrophils with absence of spores and bacteria); NARES (> 20% of eosinophils); NARMA (> 10% of mast cells); and NARESMA (> 20% of eosinophils and > 10% of mast cells). RESULTS: 453 subjects (9%) had negative nasal cytology, 1056 (21%) had allergic rhinitis, 538 (10.7%) had NARES, 493 (9.8%) had nasal polyposis, 251 (5%) had rhinosinusitis, 221 (4.4%) had NARESMA 201 (4%) had infectious rhinitis, 131 (2.6%) had NARMA, 89 (1.8%) had NARNE, with the remaining subjects having a miscellaneous inflammatory/infectious profile. CONCLUSIONS: Nasal cytology provides quick information about phenotype and endotype and can be repeated during follow-up to assess post-treatment changes. Antecedentes: La medicina de precisión es una estrategia actualizada que apunta a individualizar los mecanismos fisiopatológicos precisos. Entonces, la medicina de precisión es la base de la medicina personalizada, como definir el tratamiento apropiado en cada paciente. La citología nasal solo necesita un microscopio óptico, tinturas, gafas y curetas. El procedimiento puede durar muy pocos minutos usando tinción rápida, por lo tanto, se puede considerar una prueba confiable en el punto de atención en el consultorio. Métodos: Estudio transversal que incluyó 5030 pacientes ambulatorios con trastornos nasales: 2612 hombres y 2418 mujeres, edad promedio de 36.8 ± 17.1 años, quienes fueron atendidos en un periodo de cinco años. Los pacientes se subdividieron conforme a la prueba cutánea y la citología nasal en sujetos con rinitis alérgica y con rinitis no alérgica. Las formas celulares se subdividieron en función del citotipo: rinitis no alérgica con predominio de infiltración eosinofílica (NARNE, neutrófilos > 50 % con esporas y bacterias ausentes); rinitis no alérgica con eosinófilos (NARES, eosinófilos > 20%); rinitis no alérgica con predominio de infiltrado de mastocitos (NARMA, mastocitos > 10 %) y rinitis no alérgica con eosinófilos y mastocitos (NARESMA, eosinófilos > 20 % y mastocitos > 10 %). Resultados: 453 (9 %) sujetos tuvieron citología negativa a nasal, 1056 (21 %) rinitis alérgica, 538 (10.7%) NARES, 493 (9.8%) poliposis nasal, 251 (5%) rinosinusitis, 221 (4.4%) NARESMA, 201 (4%) rinitis infecciosa; 131 (2.6%) NARMA y 89 (1.8%) NARNE; los sujetos restantes tenían un perfil inflamatorio-infeccioso misceláneo. Conclusiones: La citología nasal proporciona información rápida sobre el fenotipo y endotipo y puede repetirse en el seguimiento para evaluar los cambios posteriores al tratamiento.
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