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PubMed2005

Pathophysiology and therapy of chronic cough.

Cough is an essential protective mechanism for the airways and lungs. Cough receptors are situated in the larynx and tracheobronchial tree, and are mediated by rapidly-adapting (irritant) Adelta fibers, although other receptors such as C-fiber receptors may contribute. Cough plasticity and interactions of cough pathways may occur centrally to enhance the cough reflex. The presence of an increased cough reflex as measured by a tussive response to capsaicin or citric acid in patients with a chronic cough indicate that there is sensitisation of the cough reflex. The most common cause of acute cough is that after a common cold, which usually lasts for less than 2 weeks. Cough that persists longer may be due to asthma and its variant forms (cough variant asthma and eosinophilic bronchitis), rhinosinusitis (postnasal drip), gastro-esophageal reflux, bronchiectasis, chronic bronchitis, and angiotensin-converting enzyme (ACE) inhibitor therapy. Chronic persistent cough can contribute to a significant worsening of quality of life measures. Bronchial tumors must be excluded with a chest radiograph. The management of chronic cough includes investigation and treatment of any associated causes, which sometimes leads to control of cough. In a proportion of patients, cough may be idiopathic and remain uncontrolled. Currently-available antitussives such as dextromethorphan or codeine are modestly successful in controlling cough. New antitussives may be developed that act on the sensory receptors or prevent their sensitisation.

Asthma↗
PubMed2005

Quality improvement in anesthetic practice--incidence of sore throat after using small tracheal tube.

BACKGROUND AND OBJECTIVE: Sore throat following surgery is common and is due to multitude of factors. The highest incidence of sore throat tends to occur in patients who have undergone tracheal intubation. Between 14.4% to 50% of intubated patients complain of sore throat and hoarseness in the immediate postoperative period, 3% of them are still hoarse after a week. This contributes to higher incidence of postoperative morbidity and patient dissatisfaction of the service. A prospective study was conducted to demonstrate the incidence of hoarseness and sore throat following the use of small tracheal tubes. METHODS: Adult patients, 16 years old and above, presented for tonsillectomy, nasal surgery and/or for functional endoscopic sinus surgery (FESS) were included in the study. Patients who had signs of, common cold were excluded from the study. Size 7-7.5 mm cuffed tracheal tube was used in males and size 6-6.5 mm in females. Patients were asked during 24 hours postoperatively about the presence of hoarseness of voice and of their satisfaction of the service. RESULTS: There were 1618 patients 883 males and 735 females, ages: 16-62 yrs included in the study between February 2000 and end of May 2003. 189 (11.7%) developed postoperative hoarseness of voice and 1429 (88.3%) did not have hoarseness or sore throat (P = 0.0001). Patient satisfaction was 95%. CONCLUSIONS: The use of small tube in intubating the trachea, together with other measures such as lubricating the tube with water soluble jelly, careful airway instrumentation, intubation only when patient was fully relaxed, careful suctioning technique, and extubation when the tracheal tube cuff was fully deflated, have dramatic effects on minimizing the incidence of postoperative hoarseness and sore throat. Accordingly, patient satisfaction has been reported to be high.

Adolescent↗
PubMed2005

[Reported practices of antimicrobial use for upper respiratory tract infections].

AIM: To determine the reported antibiotic prescribing practices for upper respiratory tract infections in children among pediatricians and family physicians. METHODS: Regional survey of practicing pediatricians and family physicians and comparison of the survey responses of 81 physicians with the recently published recommendations of the Centers for Disease Control and Prevention. RESULTS: Whereas almost all the physicians agreed that a diagnosis of acute otitis media required documentation of middle ear effusion and acute illness, 28% of family physicians and 12% of pediatricians reported that they routinely prescribed antibiotics for children with bronchitis, even though this is not recommended. In this survey 39% of pediatricians and 47% of family physicians reported that they omitted laboratory testing for the diagnosis of group A streptococcal pharyngitis, and of those who submitted samples for testing, most reported that they prescribed antibiotics immediately without waiting for the results. Even though these recommendations state that sinus tenderness is rare in young children with sinusitis, more than 48% of the physicians believed that both this and the presence of purulent rhinitis were essential to confirm this diagnosis. While none of the pediatricians reported prescribing antibiotics for the common cold, 17% of the family physicians did so (p = 0.006). CONCLUSIONS: The reported prescribing practices of the physicians in this survey are not in line with the recommendations. Effective intervention is needed to encourage the judicious use of antibiotics in Israel.

Anti-Bacterial Agents↗
PubMed2005

Video-assisted thoracic surgery for Ewing's sarcoma of the mediastinum in a 3-year-old girl.

We report of the experience of video-assisted thoracic surgery (VATS) for a Ewing's sarcoma at the posterior mediastinum in a 3 year old girl. The patient developed common cold like symptoms and developed rapid lower limb paraplegia. A chest computed tomography (CT) showed a solid mass adjacent to the vertebrae. This was diagnosed as a Ewing's sarcoma histopathologically by CT-guided needle biopsy (CT-NB). The mass was pressing on a nerve root in the vicinity of a vertebral foramen. As the tumor reduced after induction chemotherapy, with improvement of paraplegia, the patient underwent thoracoscopic examination followed by complete removal of the tumor by VATS. After surgery, the patient underwent postoperative chemo-radiotherapy. Five years has passed after operation without tumor recurrence. VATS could be an option as combined therapy for Ewing's sarcoma when well controlled and localized under induction therapy.

Child, Preschool↗
PubMed2004

Clinical study on the use of nozovent in a tertiary care setting.

OBJECTIVE: To assess the effectiveness of the Nozovent device in Pakistani subjects at Aga Khan University Hospital, Karachi and Sir Ganga Ram Hospital, Lahore from 15 January 2001 to 15 January 2002. METHODS: Sixty males and 40 females were selected by non probability purposive sampling, from OPD of ENT Department, complaining of nasal obstruction due to various reasons, e.g. vasomotor rhinitis, allergic rhinitis, congestion during pregnancy and menstruation, common cold, traumatic nose and nasal valve problem. RESULTS: All patients benefited subjectively but the degree of relief varied in individuals. CONCLUSION: The Nozovent provides a unique method to relieve nasal obstruction with no side effects.

Adolescent↗
PubMed2005

[Case of paroxysmal nocturnal hemoglobinuria complicated with IgA nephropathy who developed acute renal failure induced by hemolytic crisis].

A 60-year-old man, who had been diagnosed as having paroxysmal nocturnal hemoglobinuria(PNH) in 1994, was admitted to our hospital with general fatigue, and dark urine after a common-cold in January 2001. In the peripheral blood, the red blood cell count was 136 x 10(4)/microl, hemoglobin 4.0 g/dl and hematocrit 12.4%. The serum creatinine level was 9.9 mg/dl. Kidney biopsy revealed focal and segmental proliferation of mesangial cells, mesangial matrix expansion, acute tubular necrosis, interstitial fibrosis and hemosiderine deposits in the tubular epithelial cells confirmed by Berlin-blue staining. Immunofluorescence microscopy showed IgA and C3 deposition in the mesangium. Electron microscopy revealed electron dense deposits in the mesangial area and heavy electron-dense hemosiderin pigments in proximal tubular epithelial cells. After the transfusion of six units of washed red blood cells and two sessions of hemodialysis, the renal function returned to the levels before admission.

Acute Kidney Injury↗
PubMedDate not supplied

[Antimicrobial use in acute upper respiratory infections in family medicine].

Acute upper respiratory infections are one of the main causes of office visits in family practice worldwide. If antimicrobial drugs were used judiciously, it is estimated that 50 million of these prescriptions could be avoided. The vast majority of acute rhinopharyngitis (common cold) and acute sinusitis cases are resolved without using antibiotics. Acute otitis media must be distinguished from otitis media with effusion: the former may be successfully treated, in many cases, without prescribing antibiotics, while the latter does not improve with antimicrobial drug use unless its evolution was > 3 months. Acute pharyngitis is better treated if considered as an odynophagia syndrome, employing clinical criteria to distinguish cases that need antimicrobial drug prescription. Acute bronchitis does not improve significantly by utilizing antimicrobial drugs. Drugs from the quinolones group are not a choice for treating acute upper respiratory infections.

Acute Disease↗
PubMed2005

[Study on the effectiveness and cost-benefit of influenza vaccine on elderly population in Beijing city].

OBJECTIVE: To estimate the effectiveness of inactivated influenza vaccine in elderly population. METHODS: An quasi-experimental study was used. 590 elderly people who volunteered to receive the influenza vaccine were served as vaccine group, while 602 persons who did not want to receive the inoculation but could match the vaccine group were served as controls. One baseline and three follow-up surveys were carried out. RESULTS: The protective rates of influenza like ill (ILI) as 52.38%, 36.84% and 37.89% with the decreasing rates of visits to ILI clinic as 45.16%, 50.54% and 50.54% were found after 1 month, 3 month and 6 month of inoculation of influenza vaccine; The protective rates of common cold, other respiratory tract or chronic disease were 49.54%, 64.54%, and 38.82%, respectively. The benefit-cost ratio was 4.98:1 in elderly population. CONCLUSION: Influenza vaccination could decrease ILI incidence and recurrence rates of related chronic diseases on elderly population to provide better economic benefits for the elderly.

Aged↗
PubMedDate not supplied

Safety and efficacy of alefacept in elderly patients and other special populations.

BACKGROUND: The safety of biologic agents for psoriasis treatment is of particular importance in patient groups at higher risk for adverse events. We assessed the safety and efficacy of alefacept in elderly, obese, and diabetic patients with moderate to severe chronic plaque psoriasis by integrating data from phase 2 and 3 clinical studies and their extensions. OBSERVATIONS: Ninety-nine elderly, 652 obese, and 122 diabetic patients received at least 1 course of alefacept. In each cohort, accidental injury, headache, and pharyngitis were among the most common adverse events; infections were primarily common colds; and malignancies were mostly skin carcinomas. No opportunistic infections were reported. Safety was maintained over repeated courses. The safety profile of alefacept in each cohort was consistent with that of the overall population; however, additional data are needed to confirm our findings in the elderly and diabetic subgroups in the later courses due to the limited sample sizes. In course 1, 24% to 33% of patients achieved 75% or greater improvement in Psoriasis Area and Severity Index (PASI) at any time, with further enhancement of benefit with subsequent courses (eg, course 3, 41% to 58%). CONCLUSIONS: Alefacept was well-tolerated and effective in elderly, obese, and diabetic patients with psoriasis.

Age Factors↗
PubMedDate not supplied

[Measurement of transport in mucous membrane in the human nose with Cr-51-labeled resin beads].

The mucociliary transport of the human nasal mucosa was studied by using very small resin beads tagged with 51Cr. Several modifications of previous methods were introduced, e.g. kind of nuclide, particle size, pH, mode of application, measuring technique and reduction of local irradiation. Finally arrangements implying exact measurements of transport not only horizontally but also vertically or obliquely were obtained. No mucociliary transport was demonstrated in five of nine subjects with a common cold 10 days before or one week after the investigation. Xylometazolin as a nasal spray diminished the mucociliary transport significantly. In addition, the effects on mucociliary transport caused by homolateral or contralateral experimental nasal obstruction as well as by tobacco smoking were studied in healthy subjects. Finally, patients with various diseases: pollen allergy in free intervals, chronic rhinitis, septal deviation or perforation, and condition after laryngectomy were also investigated.

Adult↗
PubMed2005

Predictors of antibiotic prescription in respiratory tract infections by ambulatory care practitioners.

The use of antibiotics in viral respiratory infections (common cold, acute rhinosinusitis and acute bronchitis) promotes the emergence and spread of resistant bacteria. Studies have found that antibiotics are prescribed for 50-70% of respiratory tract infections, despite the fact that most of them have a viral etiology. The objective of the study was to determine predictors of antibiotic use in acute respiratory infections. It was conducted as a cross-sectional study on physicians' practices for antibiotic use. The subjects were internists and otolaryngologists of adult patients in an ambulatory setting in Buenos Aires. The instrument was a questionnaire with 20 clinical vignettes that included relevant variables for making decisions regarding antibiotic use in acute respiratory infections. The vignettes were constructed with a fractional factorial design with nine clinical variables. The absolute and relative weight of each clinical variable that predicted antibiotic use were calculated for each individual practitioner using multiple linear regression. The predictors with the greatest absolute weight in the decision to prescribe antibiotics were nasal discharge and cough (24% and 21% of total weight). The correlation between predictors and individual physician answers was high (r2 = 0.73). The mean probability and the rate of antibiotic prescription were both about 50%. Predictors of antibiotic use for acute respiratory infections among ambulatory physicians in this sample differ from internationally accepted guidelines. The likelihood of prescribing antibiotics for these illnesses is high. Wider implementation of management guidelines for acute respiratory infections could improve cost effective antibiotic use and decrease the development of antibiotic resistance.

Acute Disease↗
PubMed1975

Antigenic relationships of common rhinovirus types from disabling upper respiratory illnesses.

The frequency of the common cold has been though to be due to the existence of more than 89 different serologic types of rhinoviruses. However, in the civilian and military population studied in this area from 1962 through 1970, types 1A, 1B, 2, 23, 29, 30 and 31 accounted for 81 percent of 487 rhinoviruses isolated from individuals with respiratory illnesses. Antigenic relationships between these types and others have been demonstrated by neutralization in WI-38 cell cultures and by immunodiffusion. Types 1A and 1b, 2 and 49, 23 and 30, 29 and 44 and others are related. With specific animal antisera, heterotypic antibody titers are minimal. However, following natural infection in man with one of these related types, antibody responses to the other was almost equal to the homotype and could predictably provide cross-protection. Even with inactive T13 rhinovirus vaccine in man, protective levels of neutralizing antibody to T41 were produced. It is clear that the rates of rhinovirus colds would be greatly increased if more than 89 immunologic distinct types actually existed. An effective vaccine could be easily prepared by selection of a few appropriate types, such as 1A, 2, 23, 29 and 31.

Adolescent↗
PubMed2006

[Callosal disconnection syndrome due to acute disseminated enchephalomyelitis].

We have reported a very rare case of a patient with callosal disconnection syndrome due to acute disseminated enchephalomyelitis (ADEM). A 54-year-old right-handed woman developed sudden consciousness disturbance and fever after 2 weeks when she had common cold. She did not have a history of stuttering. On admission, the neurological finding showed consciousness disturbance, and exaggerated muscle stretch reflex in four extremities without meningeal irritation. The cerebrospinal fluid examination revealed the cell counts of 273/mm3, the protein of 348 mg/dl and the myelin basic protein 18.3 pg/ml. The brain MRI demonstrated a focal high signal intensity in the right cerebellar peduncle, right temporal lobe, left occipital lobe and corpus callosum on the T2-weighted and FLAIR images. The lesion of corpus callosum was the trunk and splenium, sparing the dorsal side of splenium. Her diagnosis was ADEM. The steroid pulse therapy (metylpredinisolone 1 g/day for 3 days) improved the consciousness disturbance. After 6 weeks from the onset, the neuropsycological examination was performed. The remarkable findings included pure alexia without color naming defects, the acquired stuttering and one-way disturbance of somesthetic transfer from the left hand to the right. This patient may contribute to the study of functional localization of the corpus callosum.

Apraxias↗
PubMed1991

[Acrocallosal syndrome--an autopsy case report and literature review].

This is an autopsy report of a female neonate with acrocallosal syndrome, which shows developmental retardation, callosal dysgenesis and preaxial hemimelia of the upper limbs. Either dysgenesis or corpus callosum or congenital absence of radius is rare; their combination are even rarer and only eleven cases of acrocallosal syndrome have been reported in the English literature. Our case appears to be the first report in Taiwan. The family history and pregnant course were unremarkable except that her mother had taken Chinese herb medicine for common cold in the 4th pregnant month. Prenatal obstetric sonography showed "ventriculomegaly" at the 31st week. We reviewed the literature and discussed the incidence, embryology, pathogenesis, symptoms as well as etiology concerning this rare syndrome.

Abnormalities, Multiple↗
PubMed2006

Dietary fat and meat intake and idiopathic pulmonary fibrosis: a case-control study in Japan.

SETTING: There is sparse epidemiologic information regarding the role of dietary factors in the development of idiopathic pulmonary fibrosis (IPF). OBJECTIVE: To examine the relationship between specific types of fatty acids and selected foods high in fat and IPF in Japan. DESIGN: Included were 104 cases aged > or = 40 years who had been diagnosed in the last 2 years in accordance with the most recent criteria. Controls aged > or = 40 years consisted of 56 hospitalised patients diagnosed as having acute bacterial pneumonia and four out-patients with common cold. RESULTS: Intake of saturated fatty acids, mono-unsaturated fatty acids, n-6 polyunsaturated fatty acids and meat was independently associated with an increased risk of IPF. Specifically, the multivariate OR for comparison of the highest with the lowest quartile of intake of saturated fatty acids was 6.26 (95%CI 1.79-24.96, P for trend = 0.01) and for meat it was 7.19 (95%CI 2.15-27.07, P for trend = 0.02). Intake of cholesterol, n-3 polyunsaturated fatty acids, fish, eggs and dairy products was not related to the risk. CONCLUSION: These findings suggest that consumption of saturated fatty acids and meat may increase the risk of IPF.

Adult↗
PubMed2006

Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia.

INTRODUCTION: A study was carried out in a primary healthcare clinic in the Hulu Langat district of Malaysia to assess the parental knowledge, attitudes and antibiotic use for common childhood acute upper respiratory tract infection (URTI). METHODS: A cross-sectional study involving 421 parents, who were surveyed by using an interviewer-administered questionnaire, from April to June 2001. RESULTS: Approximately 59 percent of parents from this study believed that weather was the main cause of acute URTI of their children, 13 percent thought it was due to food, and only about 27 percent said it was caused by germs. Nearly 68 percent, 69 percent and 76 percent of them believed that antibiotics was helpful in treating the common cold, cough and fever, respectively. 29 percent of parents who thought that their child with acute URTI needed antibiotics were not prescribed with any. On the other hand, 17 percent believed that antibiotics were unnecessary when prescribed. 28 percent of parents had requested for antibiotics, and 93 percent received what they requested for their child with acute URTI. About 31 percent of parents who did not request any antibiotics claimed that private general practitioners habitually prescribed antibiotics. The antibiotic compliance was poor with only 74 percent completing the entire course, with 85 percent of them stopping once they improved symptomatically. 15 percent of parents gave "leftover" antibiotics, 24 percent gave "shared" antibiotics, and 5.5 percent bought antibiotics for their child with acute URTI without consulting a doctor. CONCLUSION: This study shows that parents often have inadequate knowledge and misconceptions on antibiotic use for acute URTI in children. Improved parental education may reduce unnecessary antibiotic prescription and antimicrobial resistance in the community.

Acute Disease↗
PubMed1991

[Proptosis and optic nerve compression caused by unilateral ethmoidal pyocele: a case report].

This paper presents the case of a 29 year-old male with a left ethmoidal pyocele with orbital and intracranial extensions causing proptosis and a temporal visual field defect of the left eye. The patient had a history of nasal injury as a result of traffic accident eleven years ago, and was well until four months prior to his first visit at which time he had an onset of left eye pain, proptosis, and blurring of vision developed following a URI episode. Since then, fluctuation of symptoms was noted with exacerbation when contracting a common cold. The left ethmoidal pyocele was diagnosed via clinical features and roentgenographic findings. The patient received a Caldwell Luc Operation with endonasal ethmoidectomy and the postoperative condition was good except for constriction of the entire visual field and the depression of temporal internal isopters of the left eye.

Adult↗
PubMed2006

[Clinical case of the month. Fatal pertussis infection in a 2 month old infant].

The incidence of B pertussis has increased by 50% from the 1980s to the 1990s, primarily among those aged 4 months and younger. Worldwide, pertussis is a significant cause of infectious mortality with 40 million cases and 400.000 deaths. Most of these cases and deaths occur in infancy. Symptoms vary from common cold in adults to respiratory distress in infants. Non immune babies with respiratory disease and significant lymphocytosis should be considered to have pertussis until proven otherwise. The onset of severe pulmonary hypertension during B pertussis pneumonia is frequenly rapid and relentless. Exchange-transfusion can be life-saving by reducing the leucocyte mass. Classic vaccination or boosters given to adults and adolescents would reduce the spread from parents tho infants, but a new vaccination schedule is under investigation at Vanderbilt Children's Hospital to give baby's first pertussis vaccination at birth?

Dyspnea↗

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