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Controlled trial of enviroxime against natural rhinovirus infections in a community.

The therapeutic effect of intranasally administered enviroxime was tested against naturally occurring common colds. The double-blind evaluation was carried out in Tecumseh, Mich., during a period when rhinoviruses are usually the principal pathogen. Rhinovirus transmission followed the typical pattern during this period of study. Although there were trends indicating greater therapeutic effectiveness for enviroxime when certain nasal symptoms were considered, there were no consistent statistically significant differences between treated and untreated groups. Results were unchanged when illnesses in different periods or associated with rhinovirus isolation were examined. It was concluded that no therapeutic effect of enviroxime was demonstrated.

Adolescent↗

Sudden death in a 35-year-old man with occult malformation of the brain and aseptic meningitis.

A 35-year-old man was found dead by his wife. He was reported to have had symptoms of a common cold the week preceding his death. The medicolegal autopsy yielded signs of central dysregulation (ectasia of the urinary bladder and rectum, dystelectasis of the lungs) together with marked brain edema and fresh bite marks on the tongue. The cause of death was presumed to be lethal epileptic seizure. Neuropathologic examination revealed neuronal nodular heterotopia as well as discrete lymphocytic meningitis (aseptic meningitis). The death was most probably caused by the combination of the meningitis with the occult malformation, leading to a lowered seizure threshold and subsequent lethal seizure. The morphologic findings of this case are presented, and the probable mechanisms of death are discussed.

Adult↗

Respiratory symptoms or signs on the day of the study alter pulmonary function in teenagers.

Pulmonary function variables (forced expiratory flows and vital capacity, static lung volume, alveolar N2 slope, closing volume and closing capacity) were compared in a group of 10-16 year old children with (n = 65) and without (n = 440) symptoms or signs of mild acute respiratory infection ('common cold'). Symptomatic children had a significant impairment of forced expiratory vital capacity and flows, with no change in static volumes, alveolar N2 slopes and closing volumes. The effect was present only in boys (in whom RV/TLC and phase III slope were borderline abnormal), was more evident in older children (13 to 16 years) and was independent of the smoking habits or the presence of chronic respiratory symptoms. The results are in favour of a predominant involvement of upper airways, but signs of lower airways dysfunction are present in boys and in children 13 to 16 years old.

Acute Disease↗

Respiratory and cough mechanics in antitussive trials. Responsivity of objective indices to the treatment of acute upper respiratory tract infections.

The relative responsitivy of nine expirographic and airway indices to antitussive therapy was studied in a randomized double-blind trial in which 60 adults without bronchopulmonary disorders, but suffering from common colds, were given oral doses of five drug formulations or placebo during their initial 48 h of symptoms. Thoracic gas volume (Vtg), nasal (Rn), lower (Ra), total t[Rn + Ra]) and specific (sRa) airway resistances were determined plethysmographically; forced vital capacity (FVC), forced expiratory volume for the first second (FEV1.0) and maximal mid-expiratory flow rate (MMEFR) were recorded spirometrically. Cough pressure at peak flow furnished an index of cough (CI). The measurements were made at baseline and for 4 h after drug; medication was continued for two additional doses and the indices determined again the following morning. Abnormal control means were noted for Rn and [Rn + Ra] (90.8%), cough resistance (83.3%), MMEFR (58.3%), Ra and sRa (30.0%), but less ofter for FEV1.0, Vtg and FVC (6.6, 5.1 and 0.0%, respectively). Nasal and total airways flow resistance means were as sensitive to active therapy and in discriminating the relative worth of medication as direct CI values, Ra and sRa were less reliable, and the three spirometric functions were the lease responsive. This ranking was consistent with the common central airways location of subepithelial receptors responsible for cough and the associated reflex bronchoconstriction. The greatest changes in cough resistance followed treatment with the most significant activity in the nasal, as well as the lower tract, component of total airway resistance.

Adolescent↗

Coronavirus 229E-related pneumonia in immunocompromised patients.

Coronaviruses strains 229E and OC43 have been associated with various respiratory illnesses ranging from the self-resolving common cold to severe pneumonia. Although chronic underlying conditions are major determinants of severe respiratory virus infections, few data about coronavirus-related pneumonia in immunocompromised patients are available. Here we report 2 well-documented cases of pneumonia related to coronavirus 229E, each with a different clinical presentation. Diagnosis was made on the basis of viral culture and electron microscopy findings that exhibited typical crown-like particles and through amplification of the viral genome by reverse transcriptase-polymerase chain reaction. On the basis of this report, coronaviruses should be considered as potential causative microorganisms of pneumonia in immunocompromised patients.

Adolescent↗

A possible case of drug-induced familial pemphigus.

Two sisters developed pemphigus vulgaris and pemphigus erythematosus within 3 years. The diagnosis was confirmed by clinical, histologic and immunofluorescent antibody studies. One of the sisters experienced a common cold before the pemphigus developed and displayed a positive macrophage migration inhibition (MIF) test to a combination drug compounded of paracetamol, caffeine, chlorpheniramine maleate and phenylephrine HCl, which she had received 2 weeks prior to the appearance of the cutaneous lesions. It is suggested that her pemphigus was triggered by the drug. Although the patient had a strong genetic and familial predisposition to pemphigus, her clinical symptoms did not become evident until they were activated through an exogenous factor, namely, the causative drug. This case offers an example of a possible interaction between endogenous, genetic factors, and exogenous, triggering factors in the development of full-blown disease.

Acetaminophen↗

Life-style related factors and idiopathic dilated cardiomyopathy--a case-control study using pooled controls.

A case-control study was conducted to investigate how basic habits of life including dietary habit, physical activity, cigarette smoking, and drinking, are involved in the development of idiopathic dilated cardiomyopathy (DCM). Collection of cases was entrusted to the clinical research group of DCM, and national pooled controls established by sex and age category by the epidemiological research group of intractable diseases were used to ensure representativeness of the controls. Fifty-eight cases of DCM which developed in and after January 1991 were collected, and 5,912 controls matched with the cases by residential area, sex, and age were selected. Analysis of the results of the study showed that items in the questionnaire suggestive of viral infection, such as "susceptibility to common cold" and "susceptibility to diarrhea", items concerning dietary habit, including "taking no breakfast", "ingestion of salty food", and "ingestion of fatty food", and such items as "cigarette smoking" and "lack of sleep" tended to be observed in the case group at significantly higher frequencies. Since viral infection has been suspected as a causative factor of DCM, further research of this area is thought to be of particular importance for determining the etiology of DCM.

Adult↗

Anosmia after intranasal zinc gluconate use.

BACKGROUND: Zinc is an essential mineral. Beneficial zinc absorption takes place via enteral, parenteral, or cutaneous routes. However, direct application to the olfactory epithelium has been reported to cause loss of smell. Recently, intranasal zinc gluconate has been recommended as a treatment for the common cold. Severe posttreatment hyposmia and anosmia have been observed. METHODS: The case report of a typical patient is presented and analyzed in detail, followed by a series of patients with severe hyposmia or anosmia after the use of intranasal zinc gluconate. RESULTS: Although interindividual variation in drug response and drug effect is apparent, the severe hyposmia or anosmia appears to be long lasting or permanent in some cases. The mechanism of olfactory loss is thought to be the direct action of the divalent zinc ion on the olfactory receptor cell. CONCLUSIONS: Zinc ions are toxic to olfactory epithelium. Reports of severe hyposmia with parosmia or anosmia have occurred after intranasal use of zinc gluconate.

Administration, Intranasal↗

Upper airway infections in preschool children--frequency and risk factors.

OBJECTIVE: To estimate the frequency of upper respiratory tract infections (URTI) over a three month period and possible risk factors in the social surroundings, daily routines and health history. DESIGN: A retrospective epidemiological survey by means of questionnaires. SETTING: Gardabaer, a small town, ten km south of Reykjavík, Iceland. PARTICIPANTS: All children in Gardabaer, six months to six years old (n = 555). MAIN OUTCOME MEASURE: Number of URTI and possible risk factors. RESULTS: The response rate was 81.8%. The most common infections were common cold (n = 345), acute otitis media (n = 82), sore throat (n = 75), and bronchitis (n = 13). The mean frequency of URTI during the previous three months was 2.2 in boys and 1.7 in girls (p < 0.01). Log-linear regression analysis showed that the predicted number of URTI was 1.9 higher if the child was attending day care, and that the number of URTI increased by 1.015 with each month until the age of 24 months, but decreased after that by 0.985. CONCLUSIONS: The major factors which affect the frequency of URTI are: age, sex, family history of frequent URTI, asthma, allergy, and the form of day care. Measures to reduce URTI could involve prospective intervention studies on the form of day care.

Bronchitis↗

Middle-ear pressure and eustachian tube function.

In 92 healthy persons with the common cold, 184 ears were examined and 786 coincidental sonotubometric and tympanometric measurements were taken. There was a good tubal function when the middle-ear pressure was 0 to -25 mm H2O, with 91% of the tubes opening during swallowing. A systematically reduced tubal opening was noted as the middle ear pressure decreased from 0 to -200 mm H2O. The present study discloses that a negative middle-ear pressure evaluated by tympanometry does not always denote a closed tube, nor does a flat tympanogram necessarily indicate a middle-ear effusion. No definite limits could be ascertained for the normal middle-ear pressure; the middle ear is extremely dynamic, and middle-ear pressure can change for many reasons.

Acoustic Impedance Tests↗

Risk factors for IgA nephropathy: a case-control study with incident cases in Japan.

BACKGROUND/AIM: Our previous study with prevalent cases suggested that some genetic, immunological and lifestyle-related factors increased the risk of immunoglobulin A nephropathy (IgAN). To confirm this hypothesis, we conducted another case-control study. METHODS: The study included 116 incident cases and 276 sex-, age- and residence-matched controls in central Japan. Information on family and individual history and on lifestyle was collected using a self-administered questionnaire. The strength of association between IgAN and a potential risk factor was assessed by calculating an odds ratio. RESULTS: A family history of chronic glomerulonephritis, susceptibility to the common cold, episodes of tonsillitis in the preceding year, preference for salty foods and a high intake of rice and n-6 polyunsaturated fatty acids (PUFA) were associated with an increased risk of IgAN. Coffee consumption and dietary calcium intake were somewhat negatively related to the risk. A significance of alcohol drinking, use of vitamin supplements, consumption of raw eggs and intake of nutrients other than n-6 PUFA and calcium, though previously suggested, was not shown in the present study. CONCLUSION: Our findings imply that some genetic factors, immune response to infections in the upper respiratory tract and nutritional imbalance would promote the development of IgAN.

Adult↗

Comparing two crossing hazard rates by Cox proportional hazards modelling.

Motivated by a clinical trial of zinc nasal spray for the treatment of the common cold, we consider the problem of comparing two crossing hazard rates. A comprehensive review of the existing methods for dealing with the crossing hazard rates problem is provided. A new method, based on modelling the crossing hazard rates, is proposed and implemented under the Cox proportional hazards framework. The main advantage of the proposed method is the utilization of the Box-Cox transformation which covers a wide range of hazard crossing patterns. Simulation studies are conducted for comparing the performance of the existing methods and the proposed one, which show that the proposed method outperforms some of its peers in certain cases. Applications to a kidney dialysis patients data and the zinc nasal spray clinical trial data are discussed.

Administration, Intranasal↗

Function and structure of the nasal mucosa after 6 weeks' use of nose-drops.

The nasal mucosa of 20 healthy subjects were examined before, during and after 6 weeks of regular use of xylometazoline nose-drops (1 mg/ml) 0.15 ml three times daily. The subjects, except those affected by common colds, did not suffer any diminished mucociliar function during or after the trial. The surface structures were not found to have changed when examined with scanning electron microscopy. No morphological changes were observed in the intercellular space, basal membrane or tunica propria when using transmission electron microscopy. During the test period 5 of the subjects developed upper respiratory infections which temporarily prolonged the mucociliar transport time tested with small particles of saccharin. In some of these subjects a reduction in the number of ciliated cells was observed as well as an inflammatory reaction close to the epithelial cells. It is concluded that the use of xylometazoline over a 6-week period does not provoke any major functional or structural changes in a normal nasal mucosa.

Adult↗

[A case of eosinophilic pneumonia induced by Pelex granule].

We report a case of eosinophilic pneumonia induced by Pelex granule. A 31-year-old male patient had been treated with Pelex granule and other drugs for common-cold symptoms such as cough and fever. Since these symptoms were persistent, he was admitted to our hospital for further examination. His laboratory findings showed eosinophilia and a mild elevation of serum IgE. Chest radiography revealed a reticular shadow and patchy shadows in both lung fields. Analysis of the bronchoalveolar lavage fluid (BALF) showed an increased percentage of eosinophils. The histological findings of the specimen obtained by transbronchial lung biopsy showed infiltration of eosniophils into the alveolar walls and spaces. After withdrawal of all drugs, the patient's clinical findings-symptoms, laboratory data, and chest radiographic findings-soon improved. A lymphocyte stimulation test (LST) for Pelex granule was positive. Taken together, the case was diagnosed as eosinophilic pneumonia induced by Pelex granule.

Acetaminophen↗

A double-blind, placebo-controlled clinical trial of the effect of chlorpheniramine on the response of the nasal airway, middle ear and eustachian tube to provocative rhinovirus challenge.

This paper presents the results of a randomized, double-blind, placebo-controlled study of the efficacy of chlorpheniramine in relieving the symptoms and attenuating the pathophysiologic correlates of a rhinovirus "common cold." Forty healthy, adult, nonatopic subjects were randomly assigned to one of two treatment groups: active drug and placebo. On study Day 0, all subjects were challenged intranasally with rhinovirus type 39 (dose = 100 TCID50). Subjects were cloistered from Day 2 to Day 7, at which time they were treated with either chlorpheniramine or placebo. From 3 days before challenge to study Day 19, subjects had nasal patency assessed by rhinomanometry, eustachian tube function assessed by the 9-step test and sonotubometry, middle ear pressure assessed by tympanometry and nasal clearance assessed by the dyed-saccharin technique. Symptom diaries were maintained throughout the period of follow-up. During cloister, symptoms also were scored by interview, nasal secretions were quantified and nasal washings were performed for viral culture. Results showed that 19 (95%) subjects in the active-treatment group and 18 (90%) subjects in the placebo-treatment group shed virus. Symptomatic colds were observed in 63% of the active-treated and 83% of the placebo-treated subjects. Symptoms increased on Day 1 and peaked at Days 4 to 5. Detrimental changes in other measured functions consistent with those previously reported were observed. During the period of treatment, significant differences in the average symptom scores favoring the active-treatment group were observed for sneezing. Also, weight of expelled secretions was greater and mucociliary clearance rate less on some cloister days for the placebo-treated group. No significant differences between treatment groups in the objective measures of nasal congestion or the response of the middle ear and eustachian tube were documented.

Acoustic Impedance Tests↗

Large scale studies with vitamin C.

The combination of a regular daily supplement of vitamin C with extra dosage at the time of illness has been shown to reduce the disability due to common colds and other winter illness, but we have seen little effect on frequency of infections, sense of (well-being), or levels of serum cholesterol. The variable results that have been obtained from some other trials of vitamin C may be due in part to variation in the initial nutritional state of the subjects, with the greatest effects to be expected where there is most room for improvement. Because of the great variation in individual susceptibility to infection large numbers of subjects are required in these trials and they must be strictly double-blind. Although we have seen no clear evidence of harmful side-effects, occasional sensitivity to large doses of vitamin C cannot be ruled out, and the withdrawal depression of blood levels could conceivably interfere with a patient's ability to handle stress.

Ascorbic Acid↗

Immunological barriers in the nose and paranasal sinuses.

This review deals mainly with lymphocyte subsets in the human nasal mucosa, and with the common cold. Lymphocytes have recently been characterized in biopsy specimens by an immuno-histochemical method (the avidin-biotin, monoclonal antibody peroxidase technique). In summary, the overall T:B cell ratio was 3:1 and that of T helper cells to T suppressor was 2.5:1; topographical differences within the nasal mucosa were identified. Non-specific defence systems, such as interferon, provide some protection against rhinovirus infection, but most important is the presence of specific antibodies against a given antigenic type of virus. Recent results have suggested that a rhinovirus infection does not cause a marked destruction of the epithelial lining, that it is spotty in the nasal mucosa, and that it is most prominent in the nasopharynx. Increased knowledge about the site of infection and how symptoms are produced is essential for a rational approach to the development of anti-viral therapy.

Common Cold↗

Sesame oil use in ameliorating cough in children: a randomised controlled trial.

OBJECTIVES: To examine the role of sesame oil (SO) in reducing the frequency and severity of acute cough in children 2-12 years of age. DESIGN: Double blind, placebo controlled randomised trial. SETTING: Seven primary health care centres/clinics in Lebanon. A total of 107 children between the age of 2 and 12 years with cough secondary to common cold were enrolled. INTERVENTION: Five milliliters of SO or placebo by mouth at bed time. OUTCOME MEASURES: Cough strength and frequency as judged by parents on a four points Likert scale after giving three syrup doses over three consecutive nights. Analysis was performed on an intention to treat basis. RESULTS: At day 1, the effect size for cough frequency and cough strength were +0.26 (95%CI -0.64,+0.12) and +0.15 (95%CI -0.53, +0.23), respectively. SO decreased cough symptoms more than placebo but these were not statistically significant. The effect size decreased from days 1 to 3. Cough symptoms improved over the 3 days both in SO and placebo group. No evidence of undesirable effects were noted to SO. CONCLUSION: Like other over the counter antitussives, SO did not result in marked improvement in cough symptoms.

Child↗