Effect of a dairy diet on nasopharyngeal mucus secretion.

OBJECTIVES/HYPOTHESIS: To examine the effects of dairy versus nondairy diets on self-reported levels of nasopharyngeal mucus secretion. STUDY DESIGN: Prospective, randomized, double-blinded controlled study. METHODS: Twenty-six men and 82 consecutive women over the age of 15 years attending the otolaryngology department at East and North Hertfordshire NHS Trust who reported experiencing increased levels of nasopharyngeal mucus secretions were selected for a double-blinded trial of dairy versus dairy-free dietary supplementation for the last 4 days of a 6-day dairy-free diet. Main outcome measures were comparisons of mean daily reporting of subjective levels of nasopharyngeal secretions by linear scoring (1-100) and by an ordinal scale of 1 to 4. On each day, t tests were used to compare differences. RESULTS: There was a significant reduction in the reported linear secretion score seen from day 1 to 4 in nondairy (t[53] = 4.39, P < .01) and in dairy (t[53] = 3.94, P < .01) arms. There was a significant increase in secretion score days 4 to 7 in the dairy arm (t[53] = -2.56, P = .01), and a continued but nonsignificant reduction in the nondiary arm (t[53] = 1.54, P = .13, with an overall significant reduction between day 1 and 7 in the nondairy arm (t[53] = 4.79, P < .00). In the ordinal secretion scale, both dairy arm (t[53] = 2.754, P < .01) and nondiary arm (t[53] = 5.52, P < .01) scores decreased significantly from days 1 to 4. There was a significant decrease in scores from days 1 to 7 in the nondairy group (t[53] = 5.12, P < .01). CONCLUSIONS: In this blinded trial, a dairy-free diet was associated with a significant reduction in self-reported levels of nasopharyngeal secretions in adults who previously complained of persistent nasopharyngeal mucus hypersecretion. LEVEL OF EVIDENCE: 1b Laryngoscope, 129:13-17, 2019.

A clinical study of kuru patients with long incubation periods at the end of the epidemic in Papua New Guinea.

Kuru is so far the principal human epidemic prion disease. While its incidence has steadily declined since the cessation of its route of transmission, endocannibalism, in Papua New Guinea in the 1950s, the arrival of variant Creutzfeldt-Jakob disease (vCJD), also thought to be transmitted by dietary prion exposure, has given kuru a new global relevance. We investigated all suspected cases of kuru from July 1996 to June 2004 and identified 11 kuru patients. There were four females and seven males, with an age range of 46-63 years at the onset of disease, in marked contrast to the age and sex distribution when kuru was first investigated 50 years ago. We obtained detailed histories of residence and exposure to mortuary feasts and performed serial neurological examination and genetic studies where possible. All patients were born a significant period before the mortuary practice of transumption ceased and their estimated incubation periods in some cases exceeded 50 years. The principal clinical features of kuru in the studied patients showed the same progressive cerebellar syndrome that had been previously described. Two patients showed marked cognitive impairment well before preterminal stages, in contrast to earlier clinical descriptions. In these patients, the mean clinical duration of 17 months was longer than the overall average in kuru but similar to that previously reported for the same age group, and this may relate to the effects of both patient age and PRNP codon 129 genotype. Importantly, no evidence for lymphoreticular colonization with prions, seen uniformly in vCJD, was observed in a patient with kuru at tonsil biopsy.

Do information sheets improve patient satisfaction in the out-patient department?

INTRODUCTION: Time spent waiting to see a doctor in the out-patient department is a significant source of dissatisfaction for patients. Out-patient staff are often repeatedly questioned about the running of the clinic and why a delay has developed. These complaints and requests often result in further delays to the clinic. PATIENTS AND METHODS: An information sheet was written to answer these questions. We set out to determine if the distribution of these sheets increased patient satisfaction with waiting times in the outpatient setting. Twelve sequential ENT clinics at the Lister Hospital, Stevenage were randomised into two groups. Patients attending clinics in Group A (n = 103) received an information sheet while those attending clinics in Group B (n = 124) received no information sheet. At the end of their clinic visit, all patients completed a questionnaire in which they were asked to provide a rating of their levels of satisfaction with various experiences in the out-patient department on a rating score from 1 to 5. RESULTS: We found levels of satisfaction regarding waiting times to be significantly higher in the group who received information sheets (P < 0.001). No verbal complaints were received by the nursing staff at clinics where the information sheet was distributed. Four verbal complaints were received at the clinics where no sheets were distributed. CONCLUSIONS: We believe that the use of information sheets is a cost-effective method of improving patient satisfaction and that this is a useful tool both in the primary care setting and in hospital out-patient departments.

Analysis of 2000 consecutive UK tonsillectomy specimens for disease-related prion protein.

Variant Creutzfeldt-Jakob disease (CJD) is thought to be caused by dietary or other exposure to bovine spongiform encephalopathy (BSE) prions. The prevalence of preclinical or subclinical prion infection in the UK is currently unknown. Since clinical variant CJD is uniformly associated with tonsillar prion infection, we screened 2000 anonymous surgical tonsillectomy specimens for disease-associated prion protein. Analysis by both high sensitivity immunoblotting and immunohistochemistry detected no positive cases. However, this negative result cannot provide reassurance that relevant community infection is unlikely because of the fairly small sample size, demographic and age-related factors, and unknown test sensitivity during the prolonged incubation period. Nevertheless, our findings establish a protocol for prevalence screening on a national scale.