Two common and three novel PDS mutations in Thai patients with Pendred syndrome

Pendred syndrome is an autosomal recessive disorder characterized by congenital sensorineural deafness, goiter, and impaired iodide organification. It is caused by mutations in the PDS gene. Most published mutation studies of Pendred syndrome have dealt with Western populations. In this study, we examined clinical and molecular characteristics of 16 affected individuals in 6 unrelated Thai families. Of all the affected, 100% (16/16) had bilateral deafness, 68.8% (11/16) goiters, and 25% (4/16) hypothyroidism. Follicular thyroid carcinoma and Hürthle cell adenoma were found in affected members of a family, raising the possibility of an increased risk of thyroid carcinoma in Pendred syndrome patients. Sequence analysis of the entire coding region of the PDS gene successfully identified all 12 mutant alleles in these 6 families. The 12 identified mutant alleles constituted 6 distinct mutations including 3 splice site mutations (IVS4-1G>A, IVS7-2A>G, IVS9- 1G>A), one frame shift mutation (1548insC) and 2 missense mutations (T67S, H723R). Eight mutations out of 12 were constituted by IVS7- 2A>G and 1548insC, each one being present in 4 distinct alleles in our studied group. The identification of these two frequent PDS mutations will facilitate the molecular diagnosis of Pendred syndrome in Thai populations. In addition, three newly identified mutations, T67S, IVS4-1G>A, and IVS9-1G>A, were not observed in 50 unrelated healthy Thai controls.

Comparison of pain after radiofrequency tonsillectomy compared with conventional tonsillectomy: a pilot study

Tonsillectomy results in a severe sore throat, especially in the first few days, until the exposed and inflamed muscle becomes covered with regenerated mucosa. There are a variety of techniques of tonsillectomy including monopolar and bipolar diathermy, blunt dissection, and most recently radiofrequency tonsil ablation and coblation. The objective of the present study was to assess the postoperative pharyngeal or ear pain of radiofrequency tonsillectomy and compared with traditional blunt dissection tonsillectomy with loop ligation hemostasis.

Treatment of the common cold

BACKGROUND

Common colds are usually treated by the patients themselves with over-the-counter (OTC) cold medications. Many cough and cold remedies are available and sold freely without prescription. The authors conducted a study to compare the efficacy, adverse effects, the quality of life (QOL) and the patient's opinion and appreciation on the drugs (POD) between Dayquil/Nyquil and Actifed DM plus paracetamol syrup.

METHOD

In this prospective, investigator-blinded clinical trial, 120 patients, aged between 15 and 60 years old, with common colds within 72 hours, who accepted the trial and gave informed written consent, were randomized into two treatment groups. One patient was excluded due to evidence of bacterial infection. Fifty-nine patients were treated with Dayquil/Nyquil (D/N group), while the other 60 patients had Actifed DM plus paracetamol (ADM/P group) for three days. On day 1 the patient's demographic data (sex, age, body weight, blood pressure, co-existing diseases/conditions, drug use, and allergy to any drugs), the most prominent symptoms and its duration were recorded. All patients were screened for bacterial infection by physical examination, complete blood count and sinus radiographs. The symptoms (nasal obstruction, rhinorrhea, sneezing, cough, sore throat, fever and headache) and signs (injected nasal mucosa, nasal discharge and pharyngeal discharge) were scored, based on 4-point scale (0 to 3), on days 1 and 4. Changing of the symptoms and QOL were recorded on the diary card. The patient's opinion and appreciation on the drugs (POD) was assessed on day 4. The effectiveness (the ability to lessen the symptoms and signs), QOL and POD between two treatments were compared.

RESULTS

The demographic data between the two groups were similar. The four most common prominent symptoms of common colds in our series were cough (47.9%), sore throat (26.17%), rhinorrhea (8.4%) and headache (8.4%). However, both treatments were equally effective in lessening the symptoms (P = 0.426) and signs (P = 0.716) of common cold from days 1 to 4. The adverse effects were significantly higher in ADM/P group than in D/N group (p = 0.006). In contrast, QOL in terms of alertness, freshness and sound sleep improved from day 1 to day 3 in both treatments, but the overall day-3 score was significantly higher in the D/N group than the ADM/P group (1.85 +/- 1.83; 1.25 +/- 1.94: p = 0.024). POD in terms of convenience, flavour of drug, effectiveness of the drug and a need to repeat the drug assessed on day 4, was also significantly higher in the D/N group than the ADM/P group (10.68 +/- 2.56; 8.92 +/- 2.27: p < 0.001).

CONCLUSION

Dayquil/Nyquil are as effective as Actifed DM plus paracetamol in controlling the symptoms and signs of the common cold, but have fewer adverse effects. The quality of life assessed during the use of the drugs was significantly higher in the Dayquil/Nyquil group, and according to the patients, they prefered Dayquil/Nyquil more than Actifed DM plus paracetamol.

Eosinophilic mucin rhinosinusitis: terminology and clinicopathological presentation

Many terms related to allergic fungal rhinosinusitis (AFRS) such as eosinophilic mucin rhinosinusitis (EMRS), eosinophilic fungal rhinosinusitis (EFRS), and AFRS-like syndrome have been proposed. The authors define EMRS as patients with rhinosinusitis who demonstrate eosinophilic mucin on histopathological examination. EMRS patients who demonstrate fungal hyphae within the mucin are diagnosed as having EFRS and those who cannot demonstrate fungal hyphae within the mucin are diagnosed as having EFRS-like syndrome. EFRS patients who demonstrate an allergic response to the fungi are diagnosed as having AFRS and those who cannot demonstrate any allergic responses to the fungi are diagnosed as having non-allergic fungal rhinosinusitis (NAFRS). In the United States, the prevalence of AFRS in chronic rhinosinusitis patients who require surgery is 5-10 per cent. However, the prevalence of AFRS in Thailand is not known because AFRS has never been reported and studied in Thailand. This study shows the clinical and pathological entities of patients with EMRS in King Chulalongkorn Memorial Hospital from July 2001 to July 2002. From a total of two hundred and fourteen rhinosinusitis patients who required surgery, six were diagnosed as having EMRS. Two of six EMRS patients were diagnosed as having EFRS (both of them were also diagnosed as having AFRS) and four patients were diagnosed as having EFRS-like syndrome. In this study, the prevalence of AFRS is much less than in the United States because of the limited understanding of this disease, the lack of commercially available antigens for dematiaceous fungi, and the lack of awareness and knowledge of pathologists to diagnose eosinophilic mucin and fungi within the mucin. The terms related to AFRS are also discussed in this study.

Fluticasone nasal spray and the combination of loratadine and montelukast in seasonal allergic rhinitis

OBJECTIVE

To compare the effectiveness of an intranasal steroid treatment with that of the combination of a histamine1 receptor antagonist and a leukotriene D receptor antagonist in the treatment of seasonal allergic rhinitis.

DESIGN

A 2-week, parallel, randomized, double-blind, double-dummy study with rolling enrollment.

SETTING

Tertiary care medical center. Subjects A total of 63 adults with a 2-year history of ragweed sensitivity in the Chicago, Ill, area and a positive skin-prick reaction to ragweed pollen. Intervention Subjects were randomized to receive either 100 micro g of fluticasone propionate aqueous nasal spray in each nostril or 10 mg of loratadine and 10 mg of montelukast sodium by mouth once daily in the evening for 2 weeks. At visits 1 and 2, subjects completed a quality-of-life questionnaire and underwent nasal lavage to determine total eosinophil count and eosinophil cationic protein (ECP) measurements. Daily symptom diaries were kept for 2 weeks.

MAIN OUTCOME MEASURES

Questionnaire answers, daily nasal symptom scores, eosinophil counts, and ECP levels.

RESULTS

Median total nasal symptom scores were lower in the fluticasone group (4.5 vs 6), but the difference was not statistically significant. The questionnaire answers showed dramatic improvement in overall and individual domains for both groups (P<.01 vs visit 1) with significantly greater reduction in nasal symptoms in the fluticasone group (P<.05). Eosinophil counts and ECP levels were significantly reduced in the fluticasone group.

CONCLUSION

Both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate.

A comparative study of the side effects between pseudoephedrine in Loratadine plus Pseudoephedrine Sulfate Repetabs Tables and loratadine + pseudoephedrine tablet in treatment of allergic rhinitis in Thai patients

The objective of the study was to evaluate the adverse reactions of Loratadine plus Pseudoephedrine Sulfate Repetabs Tables (LTD+PSE Repetabs) (Loratadine 5 mg + Pseudoephedrine 120 mg) twice daily with that of loratadine (5 mg) twice daily and pseudoephedrine (60 mg) quarter daily in the treatment of patients with allergic rhinitis. The study was designed as an investigator-blind, parallel group study. In this study, 56 patients were equally separated into 2 groups and treated for 14 days with either LTD+PSE Repetabs or loratadine + pseudoephedrine tablet. Both groups were comparable in age, gender, weight; baseline systolic blood pressure, diastolic blood pressure and pulse rate. The change of systolic blood pressure, diastolic blood pressure, and pulse rate did not reach clinical significance throughout the study period. There was no significant difference in occurrences of insomnia, palpitation, mouth dryness and anxiety. However, the incidence of patients with tremor at day 14 in the loratadine + pseudoephedrine tablet group was significantly higher than the LTD+PSE Repetabs group (39% vs 10.7%, p-value = 0.03). Furthermore, one patient in the loratadine + pseudoephedrine tablet group had to discontinue medication at day 7 due to insomnia. In conclusion, LTD+PSE Repetabs is well tolerated and has fewer adverse effects when compared to the loratadine + pseudoephedrine tablet.

Effects of intranasal azelastine on the response to nasal allergen challenge

OBJECTIVES/HYPOTHESIS

Azelastine, a second-generation H1-receptor antagonist, is available for topical administration. The aim of the study was to evaluate the effects of topical intranasal azelastine on the early-phase and the late-phase allergic responses and on nasal hyper-responsiveness to methacholine.

STUDY DESIGN

Double-blind, placebo-controlled, two-way crossover study in 20 subjects with seasonal allergic rhinitis, out of their allergy season.

METHODS

Subjects were randomly assigned to receive either placebo or two puffs of azelastine twice a day (548 microg/d) for 2 weeks followed by nasal challenge with allergen. Twenty-four hours later, while still receiving treatment, subjects underwent a nasal lavage and a nasal challenge with methacholine. End points included symptom scores, levels of mediators and number of eosinophils in nasal lavages, and the weight of secretions after methacholine challenge.

RESULTS

Compared with placebo, treatment with intranasal azelastine resulted in significant reductions in allergen-induced sneezing, rhinorrhea, itching, nasal congestion, and levels of albumin during the early-phase response (P <.05). Azelastine had no effect on levels of histamine or tryptase during the early-phase response. There was a significant eosinophil influx 24 hours after challenge, which was not inhibited by azelastine. Treatment with azelastine had no effect on the levels of albumin, interleukin-4, interleukin-5, intercellular adhesion molecule-1, tumor necrosis factor-alpha, and eosinophil cationic protein during the late-phase response. However, azelastine did show a significant inhibitory effect on the methacholine response 24 hours after nasal allergen challenge (P <.05).

CONCLUSIONS

The effects of intranasal azelastine are similar to those of oral second-generation antihistamines.

The otolaryngology research paradox

OBJECTIVE

To determine the attitude toward and the state of research within the field of otolaryngology-head and neck surgery.

DESIGN

A questionnaire was sent to the chairpersons of departments of otolaryngology where residency training is provided.

PARTICIPANTS AND SETTING

Program directors of academic otolaryngology training programs.

MAIN OUTCOME MEASURE

Responses to questionnaire.

RESULTS

Questionnaires were sent to 95 programs from which 86 responses were received. Respondents believed strongly that research was important to the specialty. Only two thirds of the full-time clinical faculty, however, do research, and on average they devote only 17% of their time to this activity. About a third of those doing research have funding, and the National Institutes of Health support only 12% of clinician-investigators. Although program directors believe that clinicians should do research, three fourths stated that clinicians were too busy to accomplish this goal. Surprisingly, half of the respondents were unaware of residency programs that offered 2 years of research training, aimed to develop clinician-investigators, who can become competitive for attainment of research funding.

CONCLUSIONS

Although leaders within our specialty believe that research is important, clinicians are not provided with enough time to conduct research. Furthermore, pathways that would enhance their competitiveness to obtain research funding are not recommended to our future clinicians.

Nasolacrimal duct injury from microscopic sinus surgery: preliminary report

Nasolacrimal duct injury is a well established complication of functional endoscopic sinus surgery. In 1992, Bolger reported an incidence of nasolacrimal duct injuries in endoscopic sinus surgery of up to 15 per cent, but there is no documentation in microscopic sinus surgery. Fluorescein instillation into the lacrimal system via the punctum was done to determine the incidence of nasolacrimal duct injuries in 16 patients who underwent 32 microscopic sinus procedures. Only one patient exhibited nasolacrimal duct injury intraoperatively on the left side (0.3%). He had complete healing of the nasolacrimal duct at 2 months and no postoperative epiphora developed.

Upper aerodigestive tract burn: a case report of firework injury

The case of a 46 year-old German man with upper aerodigestive burn by firework was reported. He presented with the symptoms and signs of upper airway obstruction. Tracheostomy was done and direct laryngoscopy with microscopic examination revealed swelling and denudation of the mucosa of the oral cavity and supraglottic area. Intravenous steroids and antibiotics were administrated for treatment. It is suggested that proper management needs an understanding of the mechanism and effect of the corrosive agent. Careful airway management resulted in a good outcome in this patient.

Telomerase assay and nested polymerase chain reaction from nasopharyngeal swabs for early noninvasive detection of nasopharyngeal carcinoma

The main purpose of this study was to analyze sensitivity and specificity of combining nested polymerase chain reaction for detection of Epstein-Barr virus (EBV) genome and telomerase assay for identifying nasopharyngeal carcinoma (NPC). Eighty patients with NPC and 27 healthy control subjects were included in this study; 97. 5% and 94.9% of NPC patients were positive for EBV genome and telomerase activity, respectively. When nasopharyngeal swabs were tested, 95.7% presented the EBV genome and 85.5% were positive for telomerase expression. The sensitivity for counting either positive result of these two techniques was 100%. Among the 27 control subjects, only 6 and 5 cases were positive for EBV DNA and telomerase activity, respectively. This indicated a specificity of 92.6% when both positive results were included. At present, early diagnosis of NPC requires multiple biopsy specimens, especially to identify subclinical cases. Because this study showed a very high sensitivity for detecting NPC from swabs when combining the telomerase assay and nested polymerase chain reaction technique, this noninvasive technique may be a good candidate for screening of subclinical NPC, especially before multiple biopsy specimens are obtained.