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PubMed1997

The end of antibiotic treatment in adults with acute sinusitis-like complaints in general practice? A placebo-controlled double-blind randomized doxycycline trial.

BACKGROUND: Acute sinusitis-like complaints are very common and are usually treated with antibiotics in spite of the lack of evidence for the effectiveness of antibiotic therapy and the increasing number of resistant strains. AIM: To assess the effectiveness of doxycycline in adults with acute sinusitis-like complaints in general practice. METHOD: The effects of doxycycline in a placebo-controlled, double-blind, randomized trial were assessed in adults consulting their general practitioner (GP) with complaints after a common cold or influenza, pain in the head when bending forward, purulent nasal discharge, predominantly unilateral maxillary pain, toothache, or pain when chewing. Primary outcome events were the resolution of facial pain and the resumption of daily activities. Treatment differences were assessed by means of Kaplan-Meier curves and hazard ratios. The follow-up period was 42 days. RESULTS: No significant difference was found in time to recover between the doxycycline-treated group and the placebo-treated group. However, the adjusted hazard ratio for the group receiving doxycycline was 1.17 (95% CI = 0.87-1.57) for the resolution of pain and 1.31 (95% CI = 0.96-1.78) for the resumption of daily activities. After 10 days, 85% of all patients reported improvement and 60% were completely cured. Side effects were reported by 17% of the doxycycline-treated group, with two patients withdrawing because of side effects. CONCLUSIONS: Data from this study indicate that doxycycline does not add to the effectiveness of decongestive nose drops and steam inhalation in treating acute sinusitis-like complaints in general practice adults.

Acute Disease↗

PubMed1994

A pilot study of periodontal disease awareness amongst Nigerians.

Two hundred and seventy-five Nigerian subjects were seen to assess their periodontal disease awareness and to correlate it with their periodontal status, using a screening index--Community Periodontal Index of Treatment Needs (C.P.I.T.N.). More than half of the subjects had visited the dental clinics in the past. The major reason for their visits was for relief of toothache and/or extraction. Although a high percentage claimed not to have gum disease, various stages of periodontal disease were observed in this group of subjects. The author advocates: (1) The introduction and use of periodontal index e.g. C.P.I.T.N. for easier examination of patients. (2) Refresher courses for dental personnel in periodontics, and (3) Use of the mass media such as electronic media to promote periodontal health awareness.

Adolescent↗

PubMed1998

NSAIDs associated nephropathy.

Renal biopsy of 32 patients who developed renal complications after treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) were studied. The treatment with NSAIDs in these cases was used for many reasons such as: headaches, toothaches, dysmenorrea, osteochondrosis, polyarthritis and acute respiratory infections. The renal function of these patients, before the treatment with NSAIDs was normal. The renal biopsies were studied by light, electron and immunofluorescence microscopy. In 32 cases treated with NSAIDs renal changes were shown. There types of morphological changes were found: focal glomerulonephritis with crescents (FGN)(5 cases), acute tubulo-interstitial diseases (ATID)(8 cases) and lipoid nephrosis with tubulo-interstitial nephritis (LN)(19 cases). FGN and ATID possibly represent a hypersensitive reaction of predominantly humoral (FGN) or cellular (ATID) mechanisms. These types of reaction are also seen to occur with the use of various drugs (most commonly with penicillin type antibiotics). LN on the other hand is rarely, if ever, seen with any drugs but NSAIDs and therefore seems to be a characteristic change for NSAIDs and possibly related to the inhibition of renal prostaglandin synthesis by NSAIDs. NSAIDs-associated renal dysfunction is mainly observed in patients of an increased use of NSAIDs with ineffective circulatory plasma volume (advanced age, cardiovascular disease, overweight and hypovolemia of various causes).

Adolescent↗

PubMed1998

Acute sinusitis: a cost-effective approach to diagnosis and treatment.

Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance and overproduction of secretions. The diagnosis is based on the patient's history of a biphasic illness ("double sickening"), purulent rhinorrhea, maxillary toothache, pain on leaning forward, pain with a unilateral prominence and a poor response to decongestant therapy. Radiographs and computed tomographic scans of the sinuses generally are not useful in making the initial diagnosis. Since sinusitis is self-limited in 40 to 50 percent of patients, the expensive, newer-generation antibiotics should not be used as first-line therapy. First-line antibiotics such as amoxicillin or trimethoprim-sulfamethoxazole are as effective in the treatment of sinusitis as the more expensive antibiotics. Little evidence supports the use of adjunctive treatments such as nasal corticosteroids and systemic decongestants. Patients with recurrent or chronic sinusitis require referral to an otolaryngologist for consideration of functional endoscopic sinus surgery.

Acute Disease↗

PubMed1997

Tooth pulp neurons in the caudal medulla oblongata of the cat.

The medulla oblongata caudal to the obex was explored for neurons responsive to tooth pulp (TP) stimulation in cats. Four different subclasses of TP neurons were found. The latter included TP specific (TPS) neurons, trigeminal wide dynamic range (trigeminal WDR) neurons with TP input, trigeminal subnucleus reticularis ventralis (trigeminal SRV) neurons with TP input and convergent reticular formation (convergent RF) neurons with TP input. TPS neurons were located in the dorsal marginal rim of the trigeminal subnucleus caudalis, i.e., in the marginal layer or the outer zone of substantia gelatinosa. WDR neurons with TP input were found in the neck region of medullary dorsal horn which corresponds to the lateral part of subnucleus reticularis dorsalis (SRD). Trigeminal SRV neurons with TP input were located in the lateral part of SRV. Convergent RF neurons with TP input were found in the middle third of the caudal bulbar RF consisting of SRD and SRV. Both TPS neurons and WDR neurons with TP input included trigeminothalamic neurons as evidenced by the antidromic activation from the nucleus ventralis posteromedialis of the contralateral thalamus. A significant proportion of both trigeminal SRV and convergent RF neurons with TP input were antidromically activated by stimulation of the nucleus centralis lateralis of the contralateral thalamus. The former two subclasses may subserve the sensory-discriminative aspect of toothache, while the latter two subclasses, the emotional-motivational aspect.

Animals↗

PubMed1965