Sinonasal disease and olfactory impairment in HIV disease: endoscopic sinus surgery and outcome measures

The utility of olfactory function in distinguishing early-stage Alzheimer's disease from HIV-associated neurocognitive disorders

OBJECTIVES

Given the rising number of older people with HIV (PWH) and the overlap in cognitive dysfunction profiles in HIV-associated neurocognitive disorders (HAND) and Alzheimer's disease and its precursor, amnestic mild cognitive impairment (aMCI), methods are needed to distinguish aMCI/Alzheimer's disease from HAND. As an early indicator of Alzheimer's disease, we examined whether olfactory dysfunction could help to distinguish between aMCI/Alzheimer's disease and HAND among PWH.

DESIGN

An observational cohort study.

METHODS

Eighty-one older (≥50 years) PWH (83% men, 65% white) from the California NeuroAIDS Tissue Consortium completed the University of Pennsylvania Smell Identification Test (UPSIT; higher scores = better smell identification) and a comprehensive seven-domain neuropsychological test battery and neuromedical evaluation. HAND was classified via Frascati criteria. High aMCI risk was defined as impairment (>1.0 SD below normative mean) on two of four delayed recall or recognition outcomes (at least one recognition impairment required) from the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised. We examined UPSIT scores in relation to aMCI risk and HAND status, and continuous memory scores considering adjustments for demographics and relevant clinical or HIV disease characteristics.

RESULTS

Fifty-seven participants were classified with HAND (70%) and 35 participants were classified as high aMCI risk (43%). UPSIT scores were lower (worse) in the high versus low aMCI risk group [F (1,76) = 10.04, P = 0.002], but did not differ by HAND status [F (1,76) = 0.62, P = 0.43]. UPSIT scores positively correlated with all memory outcomes (Ps < 0.05).

CONCLUSION

Olfactory assessments may help in detecting early aMCI/Alzheimer's disease among PWH and allow for appropriate and early disease intervention.

Association between Sex, CD4 Cell Counts, Antiretroviral Medications, and Olfactory and Gustatory Functions of HIV-Infected Adults

Objective To investigate the olfactory and gustatory functions of human immunodeficiency virus (HIV)-infected adults in Ibadan, Nigeria. Study Design A cross-sectional study of olfactory and gustatory functions of HIV-infected adults between March 2015 and December 2015. Setting Tertiary health institution. Subjects and Methods A structured questionnaire was administered to participants to obtain relevant sociodemographic and clinical information. Participants' nadir and most recent CD4 cell count and viral loads were obtained from their medical records. Participants' body mass indices were determined, and each subjectively rated their olfactory and gustatory performances. Objective olfactory and gustatory functions were determined using validated "Sniffin' Sticks" and "Taste Strips" impregnated with 4 different concentrations of sucrose, quinine hydrochloride, sodium chloride, and citric acid. Results In total, 135 HIV-infected adults, comprising 41 (30.4%) men and 94 (69.6%) women, were evaluated. Their ages ranged from 20 to 70 years, mean 43.4 ± 10.4 years. Participants were on highly active antiretroviral therapy for a mean duration of 75.8 ± 36.9 months. The proportions of male participants in HIV stages 1, 2, and 3 were 18 (43.9%), 19 (46.3%), and 4 (9.8%), respectively, while female participants were 46 (48.9%), 41 (43.6%), and 7 (7.4%), respectively. Participants' mean olfactory threshold, discrimination, identification, and TDI scores were 8.0 ± 4.9, 9.9 ± 4.7, 8.8 ± 4.5, and 26.7 ± 11.1, respectively, while total taste score was 25.1 ± 5.7. Conclusion HIV-infected adults have tendency to develop hyposmia and hypogeusia. These are worse with advanced stage of HIV infection.

Chemosensory Loss in Adults Aging with HIV

Given that gustatory and olfactory impairments occur with Human Immunodeficiency Virus (HIV) and the normal aging process, people aging with HIV may experience considerable chemosensory losses. Declines may place such adults at risk for eating contaminated foods, malnutrition, cognitive complaints, and reduced quality of life. Implications for study and treatment are considered.

Otorhinolaryngological Manifestations among HIV Positive Children in Coastal Karnataka

INTRODUCTION

With changed clinical profile of HIV related diseases, our study attempted to analyse otorhinolaryngological manifestations in HIV positive children coming to ART centre of a tertiary referral in South India.

MATERIALS AND METHODS

Records of 137 children registered at ART Centre, Government Wenlock Hospital, Kasturba Medical College, Mangalore from 2004 till 2010 were studied and data for this retrospective study was collected.

RESULTS

Twenty three (16.8%) children developed otorhinolaryngological manifestations, which were upper respiratory tract infection (13.1%), oral candidiasis (1.4%), otitis media (1.4%) and parotitis (1%). With increasing WHO stage, the ENT manifestations increased (p<0.05) while CD4 count decreased (p>0.05), 35% and 44% cases with ENT manifestations had CD4 counts above 500 cells/mm3 and below 200 cells/mm3 respectively (p>0.05). 24% children on HAART and 10.7% not on HAART developed ENT illnesses (p<0.05).

CONCLUSION

With the current ART protocols, ENT manifestations are seen in 17% HIV positive children, most of which are aspecific.

An automated framework for hypotheses generation using literature

Background

In bio-medicine, exploratory studies and hypothesis generation often begin with researching existing literature to identify a set of factors and their association with diseases, phenotypes, or biological processes. Many scientists are overwhelmed by the sheer volume of literature on a disease when they plan to generate a new hypothesis or study a biological phenomenon. The situation is even worse for junior investigators who often find it difficult to formulate new hypotheses or, more importantly, corroborate if their hypothesis is consistent with existing literature. It is a daunting task to be abreast with so much being published and also remember all combinations of direct and indirect associations. Fortunately there is a growing trend of using literature mining and knowledge discovery tools in biomedical research. However, there is still a large gap between the huge amount of effort and resources invested in disease research and the little effort in harvesting the published knowledge. The proposed hypothesis generation framework (HGF) finds “crisp semantic associations” among entities of interest - that is a step towards bridging such gaps.

Methodology

The proposed HGF shares similar end goals like the SWAN but are more holistic in nature and was designed and implemented using scalable and efficient computational models of disease-disease interaction. The integration of mapping ontologies with latent semantic analysis is critical in capturing domain specific direct and indirect “crisp” associations, and making assertions about entities (such as disease X is associated with a set of factors Z).

Results

Pilot studies were performed using two diseases. A comparative analysis of the computed “associations” and “assertions” with curated expert knowledge was performed to validate the results. It was observed that the HGF is able to capture “crisp” direct and indirect associations, and provide knowledge discovery on demand.

Conclusions

The proposed framework is fast, efficient, and robust in generating new hypotheses to identify factors associated with a disease. A full integrated Web service application is being developed for wide dissemination of the HGF. A large-scale study by the domain experts and associated researchers is underway to validate the associations and assertions computed by the HGF.

Nasal surgery in patients with systemic disorders

Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener’s granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.

Autoimmune pathology accounts for common manifestations in a wide range of neuro-psychiatric disorders: the olfactory and immune system interrelationship

Smell has traditionally been considered a less important sense when compared to sight or hearing, but recent research has unraveled important features inherent to the sense of smell. Once considered just a chemical sensor for sampling the environment, data from animal models and human studies currently imply numerous and complex effects of smell on behavior, mood, and on the immune response. In this review we discuss a possible inter-relationship between olfactory impairment, autoimmunity and neurological/psychiatric symptoms in several diseases affecting the central nervous system (CNS) such as Parkinson, Alzheimer's disease, autism, schizophrenia, multiple sclerosis and neuropsychiatric lupus erythematosus. We suggest that common manifestations are not mere coincidences. Current data from animal models show that neuropsychiatric manifestations are intimately associated with smell impairment, and autoimmune dysregulation, via autoantibodies (anti-NMDAR, anti-ribosomal P) or other mechanisms. From clues of pathological manifestations, we propose a novel approach to the understanding of the interactions between the CNS, the smell and the immune system.

Chemosensory Declines in Older Adults with HIV: Identifying Interventions

Olfactory and gustatory impairments are observed with aging and with HIV infection. Thus, the synergistic effects of aging with HIV infection on olfactory and gustatory declines may be profound. Such declines can jeopardize several areas for an older adult living with HIV such as safety, appetite and malnutrition, cognition, mood, and quality of life. Potential interventions that need to be investigated include hormone replacement therapy, lifestyle changes, medical assessment, and compensation strategies. Nurses are the primary providers of care and education to address sensory alterations of those who have HIV and those who are aging.

Rinossinusite crônica em pacientes infectados pelo vírus da imunodeficiência humana: avaliação clínica e radiológica

O advento dos inibidores de protease, aumentando a sobrevida dos pacientes infectados com HIV aumentou a procura destes pacientes por médicos otorrinolaringologistas, já que 40% a 70% deles podem apresentar alguma alteração otorrinolaringológica. OBJETIVIVOS: Objetivamos, nesse estudo, comparar os achados radiológicos e sintomatologia nasossinusal entre pacientes infectados com HIV e pacientes com AIDS, com rinossinusite crônica. A literatura sobre o assunto é revisada e discutida. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. CASUÍSTICA E MÉTODOS: Prospectivamente, 39 pacientes em uso de drogas antiretrovirais foram divididos em 2 grupos: pacientes com diagnóstico de AIDS (grupo I) e aqueles apenas infectados pelo HIV (grupo II). Estes grupos foram comparados clinicamente, quanto à contagem de células CD4+ e avaliação tomográfica dos seios paranasais. RESULTADOS: Os pacientes dos grupos I e II apresentaram média de células CD4+ de 118 cél/10-9l e 377 cél/10-9l, respectivamente. Na comparação dos achados tomográficos pelo sistema de Lund e Mackay, o grupo I apresentou escore médio de 12 e o grupo II apresentou média de escore de 5,63 (p<0,001), sendo a febre e a secreção pós-nasal mais prevalente no grupo I (p<0,001). CONCLUSÃO: A prevalência da sinusite crônica nos pacientes infectados pelo HIV foi de 12%. Os sintomas da rinossinusite foram similares nos pacientes sem AIDS e com AIDS, com exceção da presença de febre. Os pacientes com AIDS apresentaram alterações radiológicas mais extensas do que os pacientes HIV positivos.

Chronic rhinosinusitis in HIV-infected patients: radiological and clinical evaluation

The advent of protease inhibitors, which enhances the survival rate of HIV-infected individuals, leads patients to search for otorhinolaryngologists, as 40-70% of them may present some sort of otorhinolaryngological disorder.

AIM

We aimed at comparing the CT scan findings and the nasosinusal complaints of HIV-infected and AIDS patients with clinical diagnosis of chronic rhinosinusitis. The literature on the subject is revised and discussed.

STUDY DESIGN

Clinical prospective with transversal cohort.

MATERIAL AND METHODS

Prospectively, 39 patients with chronic rhinosinusitis, in use of antiretroviral therapy, were included in the present study and divided into two groups: patients with diagnosis of AIDS (group I) and those infected by HIV (group II). Clinical and laboratorial assessments, with CD4+ cell count and CT evaluation, were performed and compared among groups I and II.

RESULTS

Group I and II presented mean CD4+ cell count of 118 cells/10-9l and 377 cells/10-9l, respectively. Comparison of the tomographic findings by the Lund-Mackay staging system presented a score of 12 for group I and 5.63 (pd" 0.001) for group II. Fever and postnasal discharge were more prevalent in group I (pd" 0.001).

CONCLUSIONS

In our Service, prevalence of chronic rhinosinusitis in HIV-infected patients was 12%. AIDS patients had a higher incidence of fever and postnasal discharge than those of group II. Moreover, extensive radiological findings were prevalent in patients with AIDS (group I) than in HIV-infected individuals (group II).

Measures of health-related quality of life for adults with acute sinusitis. A systematic review

CONTEXT

Symptoms suggestive of acute sinusitis are a common reason for patients to visit primary care providers. Since objective measures of outcome have not been shown to be related to patient reported outcomes, measures of treatment success have focused on symptom relief and improved health-related quality of life (HRQL). Assessing the appropriate role of treatment - for example, antibiotics for patients with acute sinusitis - requires valid, reliable, and responsive measures of outcome. We identified symptom scores and HRQL instruments for adults with sinusitis and assessed their performance characteristics.

DATA SOURCES

Articles identified through computer searches of the medline, premedline, and embase databases, the Cochrane Library, and internet documents; inquiries to experts in sinusitis and outcomes assessment; and review of reference lists.

STUDY SELECTION

Studies that used HRQL instruments or evaluated the performance characteristics of symptom scores in adults with sinusitis, published in English after 1966.

DATA EXTRACTION

Two reviewers independently extracted data on study design, setting, and patient characteristics; instrument length and format; and instrument validity, reliability, responsiveness to change, and interpretability. Study quality was assessed using a 10-point score.

DATA SYNTHESIS

Of 1,340 articles in the original search, 29 articles using 16 HRQL instruments and 5 symptoms scores met inclusion and exclusion criteria. The overall quality of these studies was low; only 4 studies scored higher than 4 of 10 points. Four studies included patients with acute sinusitis, but only 2 included exclusively acute sinusitis patients. Three instruments have been shown to meet basic requirements for validity, reliability, and responsiveness: the Chronic Sinusitis Survey, the Rhinosinusitis Outcome Measure-31, and the Sinonasal Outcome Test-16. No instrument has been validated in a primary care setting or for patients with acute sinusitis.

CONCLUSIONS

Few validated measures of sinusitis-specific HRQL are available. The 3 instruments shown to be valid, reliable, and responsive have been assessed in patients with chronic sinusitis. No measure has been validated in primary care settings or for patients with acute sinusitis. A lack of valid, responsive outcome measures may limit current treatment recommendations for patients with acute sinusitis.

Surgical intervention for sinusitis in children

Pediatric rhinosinusitis represents a common endpoint of many potential etiologic factors, but fixed anatomic obstruction of sinus outflow is relatively unusual in pediatric patients. Surgical therapy is considered when medical therapy for underlying mucosal inflammation fails. Adenoidectomy is usually the first surgical intervention to be considered for young children, with the goal of improving sinus drainage and eliminating a potential source of bacteria. Endoscopic sinus surgery is considered for the small percentage of patients, most commonly those with underlying pulmonary disease, who fail less aggressive treatment measures. Every decision for surgery involves a risk-benefit analysis.