Translation, adaption and validation of the total nasal symptom score (TNSS) for Lithuanian population

An association between elevated telomerase reverse transcriptase expression and the immune tolerance disruption of dendritic cells

BACKGROUND

To elucidate the mechanism of dysfunction of tolerogenic dendritic cells (DCs) is of significance. Telomerase involves the regulation of the cell fate and activities. The objective of this study is to investigate the role of telomerase reverse transcriptase (TERT) in regulating the tolerogenic feature of DCs.

METHODS

The telomerase was assessed in DCs, which were collected from patients with allergic rhinitis (AR), healthy control (HC) subjects, and mice. RNAs were extracted from DCs, and analyzed by RNA sequencing (RNAseq), real-time quantitative RT-PCR, and Western blotting.

RESULTS

The results showed that expression of TERT was higher in peripheral DCs of AR patients. The expression of IL10 in DCs was negatively correlated with the levels of TERT expression. Importantly, the levels of TERT mRNA in DCs were associated with the AR response in patients with AR. Endoplasmic reticulum (ER) stress promoted the expression of Tert in DCs. Sensitization with the ovalbumin-aluminum hydroxide protocol increased the expression of Tert in DCs by exacerbating ER stress. TERT interacting with c-Maf (the transcription factor of IL-10) inducing protein (CMIP) in DCs resulted in CMIP ubiquitination and degradation, and thus, suppressed the production of IL-10. Inhibition of Tert in DCs mitigated experimental AR.

CONCLUSIONS

Elevated amounts of TERT were detected in DCs of patients with AR. The tolerogenic feature of DCs was impacted by TERT. Inhibited TERT attenuated experimental AR.

Sleep Disturbance in Chronic Rhinitis: Evaluation of Nasal Symptoms, Sleep Disorder Questionnaires, and Sleep Architecture in Allergic and Non-allergic Rhinitis in Dr. Cipto Mangunkusumo Hospital

Chronic rhinitis is often associated with sleep disturbance and daytime sleepiness. Disturbance in sleep impairs numerous metabolic processes and brain function. However, there is a paucity of data regarding the evaluation of nasal symptoms and sleep disturbance in chronic rhinitis, either allergic or non-allergic group. To evaluate the characteristic of sleep disturbance in allergic and non-allergic rhinitis in Dr. Cipto Mangunkusumo Hospital Jakarta, a cross sectional analytic descriptive study was performed. All recruited subjects were evaluated for total nasal symptom scores (TNSS) and nasal obstruction symptoms evaluation scores (NOSE). Sleep disorder was assessed using Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) questionnaires, and polysomnography (PSG). A total of 22 chronic rhinitis patients, with 11 allergic and 11 non-allergic rhinitis were evaluated. Most subjects with allergic rhinitis experienced daytime sleepiness and poor quality of sleep as well as non-allergic rhinitis, without significant differences in TNSS, NOSE, ESS, and PSQI scores. There was impairment in sleep architecture from PSG parameters in both groups, but the difference was not significant. However, RDI-REM (17.7 ± 14.5 vs. 14.7 ± 18.5) and RERA (2.2 ± 2.1 vs. 1.6 ± 1.7) parameters have a tendency to be higher in the allergic rhinitis compared to non-allergic rhinitis group. Sleep disturbance existed in chronic rhinitis, presented by excessive daytime sleepiness and impairment in sleep architecture, yet no significant difference shown in the severity of TNSS, NOSE, ESS, PSQI scores, and sleep architecture parameters between the allergic and non-allergic rhinitis.

Effect of Repeated Intranasal Administration of Different Doses of Insulin on Postoperative Delirium, Serum τ and Aβ Protein in Elderly Patients Undergoing Radical Esophageal Cancer Surgery

Objective

Postoperative delirium is common after general anesthesia in older patients. However, there are currently no effective preventive measures. This study investigated the effect of repeated intranasal administration of different insulin doses before surgery on postoperative delirium in older patients with esophageal cancer, and the possible mechanism for its efficacy.

Methods

In this randomized, placebo-controlled, double-blind, parallel-group study, 90 older patients were randomly assigned to either a Control (normal saline), Insulin 1 (20 U/0.5 mL intranasal insulin), or Insulin 2 (30 U/0.75 mL intranasal insulin) group. Delirium was assessed on postoperative days 1 (T2), 2 (T3), and 3 (T4) using the Confusion Assessment Method for the Intensive Care Unit. Serum τ and Aβ protein levels were measured at T0 (before insulin/saline administration), T1 (end of surgery), T2, T3 and T4.

Results

The Insulin 2 group had a significantly lower prevalence of delirium compared to the Control and Insulin 1 groups three days after surgery. Compared to baseline, τ and Aβ protein levels increased significantly at T1-T4. Compared to the Control group, the Insulin 1 and 2 groups had significantly lower τ and Aβ protein levels at T1-T4, and the Insulin 2 group had significantly lower levels than the Insulin 1 group at T1-T2.

Conclusion

The administration of 30 U of intranasal insulin twice daily, from 2 days preoperatively until 10 minutes preanesthesia on the day of surgery, can significantly reduce postoperative delirium in older patients undergoing radical esophagectomy. It can also decrease postoperative τ and Aβ protein expression without causing hypoglycemia.

Clinical Trial Registration

This study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, with the unique identifier: ChiCTR2100054245; December 11, 2021).

Medication Adherence to Intranasal Corticosteroids in Allergic Rhinitis Patients with Comorbid Medical Conditions

Background: To determine medication adherence to intranasal corticosteroid spray (INCS) among allergic rhinitis (AR) patients with comorbid medical conditions. Methods: A cross-sectional study was conducted. Adults above 18 years old with persistent symptoms of AR and comorbid physician-diagnosed asthma, eczema, diabetes mellitus (DM) and hypertension (HPT) were included. The severity of symptoms was assessed by the total nasal symptom score (TNSS), medication adherence was based on the patients’ diaries and barriers to adherence were analyzed by the Brief Medication Questionnaire. Results: 185 participants were enrolled. The medication adherence was 58.9%. Medication adherence was significantly superior in participants with elevated total serum immunoglobulin E (IgE) (χ2 = 8.371, p < 0.05), house dust mite (HDM) allergy to Dermatophagoides pteronyssinus (DP) type (χ2 = 5.149, p < 0.05) and severe TNSS at the first visit (χ2 = 37.016, p < 0.05). Adherence was twice more likely in DP allergy, 2.7 times more likely in elevated total IgE and 15 times more likely in severe TNSS at the first visit. Among the barriers to adherence was lack of symptoms, taking medication only when necessary, fear of adverse effects, running out of medication, experiencing bothersome effects, ineffective response, forgetfulness and taking too many medications. Only lack of symptoms, taking medication when symptomatic, fear of adverse effects and running out of medication were significant. No significant association was found between asthma/eczema (χ2 = 0.418, p > 0.05), HPT/DM (χ2 = 0.759, p > 0.05) and multi-medicine use (χ2 = 1.027, p > 0.05) with medication adherence. Conclusions: Patients having AR with severe nasal symptoms at first presentation, who are sensitized to DP HDM and who have elevated total serum IgE levels have a higher adherence to INCS use. The use of multiple medicines had no impact on the adherence to INCS. As a lack of symptoms was a barrier towards adherence, the benefits of using INCS according to the prescribed dose and frequency must be emphasized to patients with mild and moderate AR at each medical visit. A good rapport between patients and their health care providers is needed to build trust and overcome the barriers, particularly to allay the fears of adverse effects of INCS. The other barriers, such as running out of supply, can be overcome by posting medications directly to patients by the healthcare providers.

Anxiety in Adults with Allergic Rhinitis During the Coronavirus Disease 2019 Pandemic: A Canadian Perspective

Background

Despite the symptom overlap between allergic rhinitis (AR) and coronavirus disease 2019 (COVID-19), pandemic-time anxiety in people with AR remains an area of limited study.

Objective

To assess the AR-anxiety relationship in the unique context of the COVID-19 pandemic from a Canadian perspective.

Methods

The COVID-19 Associated Anxiety in patients with Asthma and AR Experiencing Symptoms survey was distributed on the “Qualtrics XM” platform, with 835 adult participants responding to the first iteration from April to August 2020. Anxiety was assessed on the Generalized Anxiety Disorder Assessment-7 (GAD-7), and AR burden of disease was assessed on the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). All analyses were conducted using IBM SPSS Statistics 27.

Results

High levels of anxiety were found, with 28.0% of the AR group and 27.5% of the control group meeting the diagnostic criteria for generalized anxiety disorder. After controlling for covariates, AR status had no significant predictive effect on GAD-7 in a hierarchal multiple regression model (ΔR² = .00, P = .69). In the AR subgroup, there were significant positive correlations between anxiety and burden of disease for the total RQLQ score and all 7 domain scores (P < .001 for all), with the non-nose or eye symptom domain having the strongest correlation (r = .63). After controlling for covariates, total RQLQ score had a predictive effect on GAD-7 in a hierarchal multiple regression model (ΔR² = .049, P < .001).

Conclusion

High levels of anxiety exist during the COVID-19 pandemic regardless of AR status, indicating the importance of early anxiety screening in all patients. This study also highlights the importance of non-nose or eye symptoms in AR management.

Higher Wheal Sizes of Dermatophagoides farinae Sensitization Exhibit Worse Nasal Symptoms in Allergic Rhinitis Patients

Allergic rhinitis (AR) is a global health burden and it manifests in both nasal and non-nasal symptoms. Skin prick test (SPT) is a routine procedure to diagnose AR sensitized to common allergens including house dust mites (HDMs). The degree of sensitivity of a patient toward allergens is determined by the size of the wheal formed by SPT procedure. SPT wheal sizes are influenced by recent anti-histamine usage, however it remains unclear if SPT wheal sizes are also influenced by other factors. In this study, we set out to investigate the association between SPT wheal sizes with the demographical, clinical and environmental characteristics, as well as nasal and non-nasal symptoms severity scores, of AR patients (n = 30) sensitized to common HDMs (i.e., Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis). We showed that SPT wheal sizes of HDM allergens were not associated with clinical, demographical and environmental characteristics examined. Nonetheless, significant correlations were observed between SPT wheal sizes of D. farinae sensitization with worse severity scores of all five nasal symptoms examined (i.e., sneezing, runny nose, itchy nose, congestion and postnasal drip) and four of the six non-nasal symptoms examined (i.e., throat symptoms, ear symptoms, headache and mental function). Such relationships were not observed in SPT wheal sizes of D. pteronyssinus and B. tropicalis sensitization. We suggest that increased SPT wheal sizes for D. farinae sensitization may predict the likelihood of more severe nasal and, to a lesser extent, non-nasal manifestations in AR patients.