The Reliability of the Reflux Finding Score Among General Otolaryngologists.

BACKGROUND: The reflux finding score (RFS) is a validated clinical severity scale for findings of laryngopharyngeal reflux (LPR) on fiberoptic laryngoscopy. To our knowledge, there have been no studies to determine whether severity of patient symptoms influence the RFS; in addition, the reliability of the RFS has not been tested for general otolaryngologists. OBJECTIVES: The objectives of this study were (1) to determine whether the RFS for LPR is influenced by symptoms of reflux and (2) to determine the inter-rater reliability for general otolaryngologists in diagnosing LPR using the RFS. METHODS: Ten general otolaryngologists were selected to participate. Participants were asked to complete an Internet survey consisting of flexible endoscopic videos of larynges with varying physical findings of reflux and grade the severity of reflux using the RFS. The videos were randomly shown with and without accompanying patient symptoms. RESULTS: Our data suggest that patient symptoms influence the RFS. Inter-rater reliability for general otolaryngologists using the RFS is fair. CONCLUSIONS: Among general otolaryngologists in our study, the reliability and objectivity of the RFS in diagnosing reflux cannot be demonstrated.

Cross-sectional survey of hearing impairment and ear disease in Uganda.

OBJECTIVE: To determine the prevalence and causes of disabling hearing loss in adults and children in Uganda. STUDY DESIGN: Cross-sectional survey of ear disease and hearing impairment. SETTING: A random cluster sample design of the population from the Masindi district of Uganda following the World Health Organization (WHO) guidelines, using a modified version of the WHO Ear Disease Survey Protocol. MAIN OUTCOME MEASURE: The prevalence of disabling hearing impairment using the WHO definitions (excluding 0.5 kHz owing to high background noise levels). RESULTS: In the study, 6041 participants were enrolled and underwent audiometric evaluation and an ear examination. The prevalence of disabling hearing impairment was 11.7% in adults and 10.2% in children. A further 2.3% of children in whom thresholds could not be measured were deemed to have significant hearing loss based on screening questions and/or sound-field stimuli. Correctable causes such as dry perforations, cerumen impaction, and chronic suppurative otitis media resulted in disabling hearing loss in 17% of adult subjects and 41% of children. Preventable hearing loss, such as meningitis and noise-induced hearing loss, was present in a further significant percentage of subjects. CONCLUSIONS: Ear disease and hearing impairment were found to be important health problems in the Ugandan population. Preventable ear disease is a major cause of hearing loss in the population. It is hoped that the findings of this study will draw attention to the problem in Uganda and will lead to proper allocation of resources for the prevention and treatment of hearing loss and ear disease.

Residual human immunodeficiency virus type 1 viremia in some patients on antiretroviral therapy is dominated by a small number of invariant clones rarely found in circulating CD4+ T cells.

Antiretroviral therapy can reduce human immunodeficiency virus type 1 (HIV-1) viremia to below the detection limit of ultrasensitive clinical assays (50 copies of HIV-1 RNA/ml). However, latent HIV-1 persists in resting CD4+ T cells, and low residual levels of free virus are found in the plasma. Limited characterization of this residual viremia has been done because of the low number of virions per sample. Using intensive sampling, we analyzed residual viremia and compared these viruses to latent proviruses in resting CD4+ T cells in peripheral blood. For each patient, we found some viruses in the plasma that were identical to viruses in resting CD4+ T cells by pol gene sequencing. However, in a majority of patients, the most common viruses in the plasma were rarely found in resting CD4+ T cells even when the resting cell compartment was analyzed with assays that detect replication-competent viruses. Despite the large diversity of pol sequences in resting CD4+ T cells, the residual viremia was dominated by a homogeneous population of viruses with identical pol sequences. In the most extensively studied case, a predominant plasma sequence was also found in analysis of the env gene, and linkage by long-distance reverse transcriptase PCR established that these predominant plasma sequences represented a single predominant plasma virus clone. The predominant plasma clones were released for months to years without evident sequence change. Thus, in some patients on antiretroviral therapy, the major mechanism for residual viremia involves prolonged production of a small number of viral clones without evident evolution, possibly by cells other than circulating CD4+ T cells. The sequences have been deposited in GenBank. The accession numbers are DQ 391282 to DQ 391351 (for env) and DQ 391352 to DQ 392955 (for RT).

HIV-1 viral load blips are of limited clinical significance.

Many patients on highly active antiretroviral therapy (HAART) who achieve undetectable HIV-1 RNA levels experience transient episodes of detectable viraemia or blips, suggesting there is incomplete suppression of viral replication. This raises concern that drug resistance mutations could develop and cause eventual treatment failure. However, data from recent studies indicate that most blips are actually random biological and statistical variations around a mean viral load below detectable levels (<50 copies/mL) or due to false elevations of viral load from laboratory processing artefacts. Blips are not typically associated with the development of resistance mutations and most importantly are not associated with virological or clinical failure of previously adequate HAART.