The prescribing patterns of Wisconsin family physicians surrounding saline nasal irrigation for upper respiratory conditions.

CONTEXT: Upper respiratory conditions are common and have a significant impact on patient quality of life, medical resource expenditure, and antibiotic use. Saline nasal irrigation (SNI) is an adjunctive therapy for upper respiratory conditions; clinical studies suggest that use of SNI may be effective for symptoms of upper respiratory conditions, and its popularity seems to be growing. The prescribing patterns of physicians regarding SNI have not yet been studied. OBJECTIVE: To assess the use among family physicians in Wisconsin of SNI, determine how and for which conditions they recommend SNI, and the degree to which they experience clinical success with SNI. METHOD: This was assessed by an electronic questionnaire of 330 practicing family physicians in the Wisconsin Academy of Family Physicians and Wisconsin Research and Education Network. RESULTS: Analysis showed 286 of 330 respondents (87%) have used SNI as adjunctive care for a variety of upper respiratory conditions including chronic rhinosinusitis (91%), acute bacterial rhinosinusitis (67%), seasonal allergic rhinitis (66%), viral upper respiratory infection (59%), other allergic rhinitis (48%), irritant-based congestion (48%), and rhinitis of pregnancy (17%). Respondents also reported having used SNI prior to antibiotics for acute bacterial rhinosinusitis (77%). Use patterns varied regarding type of SNI administration, dosing frequency, saline concentration, and patient education. CONCLUSIONS: This questionnaire-based study suggests that SNI is used by family physicians for a variety of upper respiratory conditions though recommendation and patient education styles, dosing schedules, and solution types vary.

Narcolepsy is strongly associated with the T-cell receptor alpha locus.

Narcolepsy with cataplexy, characterized by sleepiness and rapid onset into REM sleep, affects 1 in 2,000 individuals. Narcolepsy was first shown to be tightly associated with HLA-DR2 (ref. 3) and later sublocalized to DQB1*0602 (ref. 4). Following studies in dogs and mice, a 95% loss of hypocretin-producing cells in postmortem hypothalami from narcoleptic individuals was reported. Using genome-wide association (GWA) in Caucasians with replication in three ethnic groups, we found association between narcolepsy and polymorphisms in the TRA@ (T-cell receptor alpha) locus, with highest significance at rs1154155 (average allelic odds ratio 1.69, genotypic odds ratios 1.94 and 2.55, P < 10(-21), 1,830 cases, 2,164 controls). This is the first documented genetic involvement of the TRA@ locus, encoding the major receptor for HLA-peptide presentation, in any disease. It is still unclear how specific HLA alleles confer susceptibility to over 100 HLA-associated disorders; thus, narcolepsy will provide new insights on how HLA-TCR interactions contribute to organ-specific autoimmune targeting and may serve as a model for over 100 other HLA-associated disorders.