Predictors of Taste Dysfunction and Its Severity Among Patients With Chronic Kidney Disease.

BACKGROUND: Patients with chronic kidney disease (CKD) often complain of taste dysfunction. The prevalent taste dysfunction among patients with CKD predisposes them to malnutrition, poor quality of life, and worsen disease prognoses. To appropriately treat the taste dysfunction in this group of patients, it's imperative that factors that predict taste dysfunction and its severity are identified for prompt treatment. AIM: To identify factors associated with taste dysfunction and its severity among patients with CKD. MATERIALS AND METHODS: This was a hospital-based case-control study of adult patients with CKD at the University College Hospital, Ibadan, Nigeria. The control group was made up of age- and gender-matched healthy volunteers with no clinical and laboratory evidence of CKD. Relevant clinical and social data obtained include demographics, symptoms, and signs of taste dysfunction and its risk factors. The 4 basic taste modalities namely sweet, sour, bitter, and salt taste senses of the participants were tested with validated "taste strips." Factors that predict taste dysfunction were identified among the spectrum of the disease. RESULTS: There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± standard deviation [SD] = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P = .57). Hypogeusia was found in 27.0% of patients with CKD, while total taste function score of all the control was within normal range. Increasing duration of CKD was identified as a predictor of taste dysfunction among patients with CKD (odds ratio: 4.889, P = .038). The stages of CKD had no statistically significant relationship with the severity of taste dysfunction (P = .629). CONCLUSION: The prevalence of taste dysfunction among patients with CKD was high and this showed significant correlation with increasing duration of CKD; in contrast, the severity of CKD is not significant in the development of taste dysfunction.

Time series analysis and mortality model of dog bite victims presented for treatment at a referral clinic for rabies exposure in Monrovia, Liberia, 2010-2013.

We developed time trend model, determined treatment outcome and estimated annual human deaths among dog bite victims (DBVs) from 2010 to 2013 in Monrovia, Liberia. Data obtained from clinic records included victim's age, gender and site of bite marks, site name of residence of rabies-exposed patients, promptness of care sought, initial treatment and post-exposure-prophylaxis (PEP) compliance. We computed DBV time-trend plot, seasonal index and year 2014 case forecast. Associated annual human death (AHD) was estimated using a standardized decision tree model. Of the 775 DBVs enlisted, care seeking time was within 24h of injury in 328 (42.32%) DBVs. Victim's residential location, site of bite mark, and time dependent variables were significantly associated with treatment outcome (p< 0.05). The equation X^t=28.278-0.365t models the trend of DBVs. The high (n=705, 90.97%) defaulted PEP and average 155 AHD from rabies implied urgent need for policy formulation on national programme for rabies prevention in Liberia.

The rubber plantation environment and Lassa fever epidemics in Liberia, 2008-2012: a spatial regression.

As Lassa fever continues to be a public health challenge in West Africa, it is critical to produce good maps of its risk pattern for use in active surveillance and control intervention. We identified eight spatial features related to the rubber plantation environment and used them as explanatory variables for Lassa fever (LF) outbreaks on the Uniroyal Liberian Agricultural Company (LAC) rubber plantation environment in Grand Bassa County, Liberia. We computed classical and spatial lag regression models on all spatial features, including proximity of residential camp to rubber tree-edge, main road in the plantation, LAC hospital, rice farmland, household refuse dump, human population density, post-harvest storage density of rice and density of rodent deterrent on rice storage. We found significant (p=0.0024) spatial autocorrelation between LF cases and the spatial features we have considered. We concluded that the rubber plantation environment influenced Mastomys species' breeding and transmission of Lassa virus along spatial scale to humans. The risk factors identified in this study offered a baseline for more effective surveillance and control of LF in the post-civil conflict Liberia.

Smell and taste in patients with vascular malformation of the extracranial head and neck region.

BACKGROUND: Olfactory and gustatory functions have not been investigated in patients with vascular malformation of the extracranial head and neck region with validated smell and taste tests. Although olfactory and gustatory deficiencies are often not outwardly apparent, they substantially affect daily life. METHODS: Smell and taste tests using sniffin sticks and taste strips were administered in 40 patients. RESULTS: For all age groups and both sexes, odor threshold (THR) values were, on average, lower in patients than in healthy individuals; whereas, values of odor identification and discrimination were not significantly lower. Regarding odor THR, 33 (82.5%) patients were hyposmic. Taste values (sweet, sour, salty, bitter, and total taste) were, on average, lower in patients than in healthy individuals; 21 (52.5%) patients were hypogeusic. Disease duration did not correlate with smell and taste test values. Patients with and without tongue involvement had decreased odor threshold and taste values. No significant differences were identified when taste values on the left and right sides of the tongue were compared in patients without tongue involvement and with unilateral and bilateral tongue involvement. Patients with venous malformations had lower smell test values, and patients with lymphatic malformations had lower taste test values than patients with other malformations. CONCLUSION: Patients exhibit significantly reduced olfactory and gustatory function even when the nose and/or tongue are not malformed. Patients should be tested with validated smell and taste tests to adequately inform and advise them about overcoming smell and taste deficits.

Smell and taste in patients with vascular malformation of the extracranial head and neck region.

BACKGROUND: Olfactory and gustatory functions have not been investigated in patients with vascular malformation of the extracranial head and neck region with validated smell and taste tests. Although olfactory and gustatory deficiencies are often not outwardly apparent, they substantially affect daily life. METHODS: Smell and taste tests using sniffin sticks and taste strips were administered in 40 patients. RESULTS: For all age groups and both sexes, odor threshold (THR) values were, on average, lower in patients than in healthy individuals; whereas, values of odor identification and discrimination were not significantly lower. Regarding odor THR, 33 (82.5%) patients were hyposmic. Taste values (sweet, sour, salty, bitter, and total taste) were, on average, lower in patients than in healthy individuals; 21 (52.5%) patients were hypogeusic. Disease duration did not correlate with smell and taste test values. Patients with and without tongue involvement had decreased odor threshold and taste values. No significant differences were identified when taste values on the left and right sides of the tongue were compared in patients without tongue involvement and with unilateral and bilateral tongue involvement. Patients with venous malformations had lower smell test values, and patients with lymphatic malformations had lower taste test values than patients with other malformations. CONCLUSION: Patients exhibit significantly reduced olfactory and gustatory function even when the nose and/or tongue are not malformed. Patients should be tested with validated smell and taste tests to adequately inform and advise them about overcoming smell and taste deficits.

Is routine audiometric evaluation necessary in gynaecologic tumour patients undergoing chemotherapy?

BACKGROUND: Our objective was to assess the auditory function of gynaecological tumour patients who had received cytotoxic agents and to determine their associated risk of ototoxicity. PATIENTS AND METHODS: 87 patients who had undergone chemotherapy for gynaecological malignancies were investigated. Of these patients, 79% had breast cancer, and 14% ovarian cancer. All of the patients had a subjective assessment of their hearing function on a visual analogue scale. Audiometric tests were performed before and at 9 weeks, 18 weeks and 3 months after completion of chemotherapy. RESULTS: The age of the patients ranged from 32 to 71 years (mean age of 53.5 ± 10.5 years). The average subjective rating of the patients' hearing function was 83.0 ± 17.2 before and 84.8 ± 16.9 3 months after completion of chemotherapy. No significant audiometric change at either the speech hearing frequency range (0.5-2 KHz) or high frequencies was observed in the patients after chemotherapy. There was also no significant difference in the hearing threshold of the patients who had received platinum analogue-based chemotherapy compared to non-platinum analogue-based chemotherapy. CONCLUSION: Hearing loss is uncommon in patients treated with the typical gynaecological chemotherapy protocols. Hence, routine audiometric testing in these patients is not necessary.

Does hereditary hemorrhagic telangiectasia affect olfactory or gustatory function?

BACKGROUND: The olfactory and gustatory functions of hereditary hemorrhagic telangiectasia (HHT) patients have not been documented by validated tests. Disorders of the nasal/oral cavity may interfere with the olfactory and gustatory functions. Fifty-four HHT patients were investigated by smell/taste tests. METHODS: HHT patients provided subjective ratings in areas such as ability to perceive smell/taste. "Sniffin' Sticks" were used for smell tests, and taste strips were used for taste tests. RESULTS: HHT patients rated their subjective olfactory and gustatory function on a visual analog scale from 0 (none) to 100 (high) as 65.3 ± 27.7 and 68.1 ± 25.1, respectively. Comparison of smell test results of HHT patients with normative data of sex- and age-matched controls from Hummel et al. revealed that HHT patients had lower threshold values, whereas there was no difference in identification and discrimination values. HHT patients were hyposmic. In the case of taste qualities, all values (sweet, sour, salty, and bitter) in HHT patients were lower than those in normative data of Mueller et al. However, HHT patients were not hypogeusic. The duration of disease, extranasal manifestation, and treatments did not significantly correlate with smell/taste test values. CONCLUSION: Compared with healthy people, HHT patients exhibit reduced olfactory and gustatory function; however, HHT patients are hyposmic and not hypogeusic. This chemosensory deficit may highlight an early sign of disease and has no correlation with disease severity. HHT patients should be informed about these potential disease manifestations, thus enabling them to improve their quality of life.

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck.

There is still no consensus on the optimal treatment of the neck in oral cavity cancer patients with clinical N0 neck. The aim of this study was to assess a possible benefit of elective neck dissection in oral cancers with clinical N0 neck. A comprehensive search and systematic review of electronic databases was carried out for randomized trials comparing elective neck dissection to therapeutic neck dissection (observation) in oral cancer patients with clinical N0 neck. A meta-analysis of the studies which met our defined selection criteria was performed using disease-specific death as the primary outcome, and the relative risk (RR) of disease-specific death was calculated for each of the identified studies. Both fixed-effects (Mantel-Haenszel method) and random-effects models were applied to obtain a combined RR estimate, although between-study heterogeneity was not found to be significant as indicated by an I(2) of 8.5% (p=0.350). Four studies with a total of 283 patients met our inclusion criteria. The results of the meta-analysis showed that elective neck dissection reduced the risk of disease-specific death (fixed-effects model RR=0.57, 95% CI 0.36-0.89, p=0.014; random-effects model RR=0.59, 95% CI 0.37-0.96, p=0.034) compared to observation. This reduction in disease-specific death rate supports the need to perform elective neck dissection in oral cancers with clinical N0 neck.

Low flow vascular malformations of the head and neck: a study on brightness mode, color coded duplex and spectral Doppler sonography.

The clinical presentation of low flow vascular malformations of the head and neck (LFVM) can range from a birthmark to severe disfigurement, functional impairment or relevant hemorrhage. The values of Brightness mode (B-mode) ultrasound and Doppler sonography in the investigation, identifying and differentiating of these lesions has been sparingly documented in the literature. This study evaluates the sonografic features of different morphological subtypes of LFVM. This is a 2-year retrospective study of 51 patients who presented with LFVM based on routine ultrasound exam in the context of their clinical consultation. Diagnosis was based on the clinical and histological findings. B-mode, color coded duplex and spectral Doppler measurements were performed for venous, lymphatic, capillary, and mixed venous-lymphatic lesions of the head and neck. The echogenicity of the majority of venous malformations was heterogenic, of most lymphatic malformations hypoechoic, and of all capillary malformations isoechoic. Blood flow was detected in only 11 cases (36.7%) of venous malformations with a monophasic pattern. There was a statistical significant difference in the mean minimum and maximum Doppler shifts between venous and lymphatic malformation for cases when the blood flow was evident. No statistical significant difference in Doppler parameters existed between capillary and lymphatic, neither between venous and capillary nor mixed malformations. Phleboliths were present in eight cases (26.7%) of venous malformations and were not detectable in any other subtype of LFVM. The detection of flow in ultrasound was only possible in a small portion of LFVM. When considering differentiating among LFVM, features such as the echogenecity, spectral Doppler wave forms, and the evidence of phleboliths contribute to establish the correct diagnosis.

Nasal septal lobular capillary haemangioma in West Africa sub-region: a case report.

INTRODUCTION: Lobular capillary haemangioma is a rare vascular lesion of the nose. It is the aim of this communication to highlight the importance of considering this lesion as an important differential diagnosis of bleeding lesion in the nasal cavity. CASE PRESENTATION: A case report of a 41-year-old female who presented with an obstructive, bleeding, pedunculated left nasal mass arising from the nasal septum in the anterior nasal cavity. An initial diagnosis of squamous papilloma was made and she had excision of the mass done under local anaesthesia. Tissue histology revealed lobular capillary haemangioma. The patient has been followed up for over 15 months and is still free of the lesion. CONCLUSION: To the best of our knowledge, this is the first report in the literature of lobular capillary haemangioma in the nasal septum in West Africa. The case is reported due to the rarity of this lesion in our environment.

Sinonasal paraganglioma: a case report.

OBJECTIVE: To highlight the importance of a high index of suspicion and meticulous evaluation of a patient with bleeding sinonasal mass in the diagnosis of sinonasal paraganglioma. METHOD: Case report of a 39-year-old female who presented with a bleeding lobulated left nasal mass necessitating multiple blood transfusions is presented. RESULT: Diagnostic investigations revealed that the patient was HIV-positive (ELISA and Western blot) and a tumour histology of paraganglioma. She had a CD4+ count of 487 cells/mm3. The urinary vanillylmandelic acid assay and echocardiography were normal. Subsequently, she had complete tumour excision through a medial maxillectomy and has remained without a recurrence 12 months after. CONCLUSION: To our knowledge, this is the first report in the world literature of sinonasal paraganglioma in a HIV-positive patient and the first reported case of sinonasal paraganglioma in Africa. It is, however, not clear from this report if the patient's HIV status preceded her development of the paraganglioma or not.

Healthcare givers' skill and foreign bodies in the ears of children in the tropics.

OBJECTIVE: The aim is to find out the place of clinical skill in the management of foreign bodies in the ear of children by various healthcare givers. METHOD: Case files of children with foreign bodies in the ears seen in the Otorhinolaryngology Department of University College Hospital, Ibadan, Nigeria from 1996 to 2005 were reviewed for all essential clinical data. RESULT: Of 323 patients studied, 171 (53.00%) males and 152 (47.00%) females, 168 (52.01%) had prior removal attempts done by anxious caregivers or general practitioners before referral; 154 (91.67%) of these had complications. Only 10 (6.45%) of the 155 (47.99%) with removal by ENT registrars had complications. CONCLUSION: Complications found appear to be related to level of clinical skill of individual health caregiver. Wherever possible, first attempt at removing aural foreign bodies should be done by an otorhinolaryngologist. Anxious parents must be discouraged from attempts but if they must attempt to remove ear foreign body, it must be by a safe ear syringing. General practitioners must be aware of their limitations and ENT registrars must be supervised by senior registrars with help of operating microscope to remove foreign bodies from the ears.

Sinonasal malignancies: a 10-year review in a tertiary health institution.

Sinonasal malignancy is a cause of otorhinolaryngologic morbidity and mortality in West Africa. However, there is a dearth of information in the literature on its clinicopathologic presentation in West Africa. It is our aim to determine the prevalence of sinonasal malignancy and highlight the clinicopathologic features in our environment. A 10-year retrospective review of cases with histologically diagnosed malignant sinonasal tumors in University College Hospital, Ibadan, Oyo State, Nigeria was carried out. There were 82 cases-56 (68.29%) males and 26 (31.71%) females-whose ages ranged from 4-69 years. Epistaxis, rhinorrhea and nasal blockage were seen in all patients; other symptoms were facial [76 (93%)], oral cavity [48 (59%)], ophthalmic [33 (40%)] and [otologic 21 (25%)]. Squamous cell carcinoma accounted for 69/75 (92%) of epithelial tumors, and malignant lymphoma accounted for 4/7 (57%) of nonepithelial tumors. Advanced disease was the predominant presentation in our series, stage 3 in 59 (79%) and stage 4 in 12 (16%) cases. Therefore, health education on early presentation to hospitals and efforts at early detection of the disease are needed in order to achieve cure. Industrial workers should always wear face masks to protect their nasal cavity.

Rhinosinusitis; a potential hazard of nasogastric tube insertion.

The nasogastric tube has been used frequently for enteral feeding and as an intranasal oxygen catheter. This practice is however associated with complications. We present a case of rhinosinusitis and sepsis in a diabetic patient following the insertion of a nasogastric tube. Physicians should be aware of sinusitis as a possible cause of sepsis in patients with nasogastric tube insertion.