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Natural freeze-tolerance in hatchling painted turtles?

Hatchlings of the North American painted turtle (Family Emydidae: Chrysemys picta) typically spend their first winter of life inside a shallow, subterranean hibernaculum (the natal nest) where life-threatening conditions of ice and cold commonly occur. Although a popular opinion holds that neonates exploit a tolerance for freezing to survive the rigors of winter, hatchlings are more likely to withstand exposure to ice and cold by avoiding freezing altogether-and to do so without the benefit of an antifreeze. In the interval between hatching by turtles in late summer and the onset of wintery weather in November or December, the integument of the animals becomes highly resistant to the penetration of ice into body compartments from surrounding soil, and the turtles also purge their bodies of catalysts for the formation of ice. These two adjustments, taken together, enable the animals to supercool to temperatures below those that they routinely experience in nature. However, cardiac function in hatchlings is diminished at subzero temperatures, thereby compromising the delivery of oxygen to peripheral tissues and eliciting an increase in reliance by those tissues on anaerobic metabolism for the provision of ATP. The resulting increase in production of lactic acid may disrupt acid/base balance and lead to death even in animals that remain unfrozen. Although an ability to undergo supercooling may be key to survival by overwintering turtles in northerly populations, a similar capacity to resist inoculation and undergo supercooling characterizes animals from a population near the southern limit of distribution, where winters are relatively benign. Thus, the suite of characters enabling hatchlings to withstand exposure to ice and cold may have been acquired prior to the northward dispersal of the species at the end of the Pleistocene, and the characters may not have originated as adaptations specifically to the challenges of winter.

Acclimatization↗

Restriction in the repertoire of the immunoglobulin light chain subgroup in pathological cold agglutinins with anti-Pr specificity.

BACKGROUND AND OBJECTIVES: In cold agglutinin disease, monoclonal red blood cell autoantibodies, termed cold agglutinins, induce haemolysis in patients exposed to the cold. Commonly, these autoantibodies are directed against the developmentally regulated I/i blood groups. A second blood group system, the Pr system (located on glycophorins), is involved less frequently. Anti-Pr cold agglutinins recognize either alpha 2,3- or alpha 2,6-linked N-acetylneuraminic acid as the immunodominant group. Cold agglutinins of anti-I/i specificity show a remarkable restriction in their genomic repertoire of the immunoglobulin heavy and light-chain immunoglobulin-variable domain (i.e. exclusive use of VH4-34 in heavy chains). For anti-Pr cold agglutinins, preliminary data on the repertoire of the light-chain variable domain indicate a preference for the subgroup Vkappa IV. To elucidate restrictions in the light-chain variable-domain subgroup repertoire of anti-Pr cold agglutinins systematically, and to discuss these results in the context of their anti-Pr(1-3) subclassification and immunodominant sialic acid, light chains in 13 anti-Pr cold agglutinins were investigated. MATERIALS AND METHODS: The anti-Pr light chains were isolated using temperature-dependent absorption/elution techniques. Subsequently, they were subjected to N-terminal Edman degradation, and the light chain Vkappa subgroup was affiliated using the Kabat database. RESULTS: Five of 13 (38%) light chains belonged to Vkappa IV, five of 13 (38%) to Vkappa I and three of 13 (23%) to Vkappa III. Anti-Pr with Vkappa IV subgroup light chains exclusively recognized alpha 2,3-linked N-acetylneuraminic acid. CONCLUSIONS: Including data from the literature, the repertoire of the light-chain variable domain in pathological anti-Pr cold agglutinins exhibits a clear bias towards the use of the single germline gene-derived subgroup, Vkappa IV (eight of 17 or 47%). The association of Vkappa IV subgroup light chain-containing anti-Pr cold agglutinins with binding to alpha 2,3-, but not alpha 2,6-linked N-acetyneuraminic acid raises speculations about a possible role of subgroup-derived determinants in anti-Pr binding.

Adult↗

Nasal obstruction in the pediatric patient.

Early signals of pathologic causes of nasal obstruction in childhood may pass unnoticed by the unsuspecting physician because these signals mimic innocuous problems such as the common cold, sinusitis, and allergic rhinitis. The hope for early recognition of the more serious causes of nasal obstruction in children depends upon a high degree of suspicion. Some of the common and uncommon causes of nasal obstruction are enumerated by categorizing the possible etiologies into congenital, traumatic, iatrogenic, inflammatory, and neoplastic classifications. With a systematic approach that utilizes history, physical examination, and special diagnostic studies, misdiagnosis can be avoided and treatment initiated more rapidly and effectively.

Airway Obstruction↗

Antibacterial use in community practice: assessing quantity, indications and appropriateness, and relationship to the development of antibacterial resistance.

Most use of antibacterials occurs in community practice; however, despite the widespread belief of inappropriate use and the resultant increase in antibacterial resistance, little data exist describing antibacterial use in this setting. A MEDLINE search of English-language articles was conducted for epidemiological studies assessing quantity, indication and appropriateness of antibacterial use in community practice. A 1983 study of international antibacterial use described considerable disparities in quantity of use between countries. Subsequent longitudinal studies from the US, Canada, Australia and the UK described changing patterns of antibacterial use. No increase in the total rate of antibacterial use was reported by any of the 4 countries; however, all countries reported increased use of newer and/or broad-spectrum agents (e.g. fluoroquinolones, amoxicillin-clavulanic acid, cephalosporins and new macrolides] coupled with decreased use of older and/or narrow-spectrum agents [e.g. phenoxymethylpenicillin (penicillin V), erythromycin, ampicillin and tetracycline). Most (approximately three-quarters) use of antibacterials was in the treatment of respiratory tract infections. Prescribing rates for respiratory tract infections of presumed viral aetiology (e.g. the common cold) ranged from 17 to 60% in the UK and US, respectively. Among indications for which antibacterials were indicated, the appropriateness of antibacterial use received little study. Correspondingly, the rates of antibacterial resistance among common respiratory pathogens (Streptococcus pneumoniae and Haemophilus influenzae) have increased significantly in the past decade, although disparities exist between countries. Antibacterial use is considered a major factor in the development of antibacterial resistance, although the relationship between community antibacterial use and resistance has been poorly described. Further study of antibacterial usage patterns and associated resistance patterns is fundamental to the development of methods to reduce unnecessary and inappropriate use, thereby slowing the development of antibacterial resistance in the community.

Anti-Bacterial Agents↗

The effects of zinc on the olfactory neuroepithelium and olfactory bulbs of the Sprague-Dawley rat after oral administration of zinc-gluconate trihydrate.

BACKGROUND: The most frequent causes of upper respiratory infections are human rhinoviruses. The nasopharyngeal area, which includes the respiratory epithelium, mucosa, and the olfactory neuroepithelium (ONe), is a first-line of defense against airborne viruses and allergens, some of which manage to penetrate the nasal mucosa and invade the tissues of the nasal respiratory epithelium. Biochemical evidence from several studies suggests that zinc is an effective cold treatment and that over-the-counter (OTC) zinc-gluconate compounds may provide the high pharmacologic doses of zinc needed to act as an effective means of treating and reducing the duration and severity of symptoms of the common cold. METHODS: A series of male Sprague-Dawley rats were fed an oral preparation of zinc-gluconate trihydrate or received the equivalent through drinking water to investigate the potential cytotoxic and/or neurotoxic insult to the olfactory receptor cells and other tissue in the ONe and afferent neuronal pathways. RESULTS: Coronal sections of the rat ONe and corresponding olfactory bulbs showed consistent cellular and tissue damage of increasing severity that correlated with the duration of treatment with the zinc compound when compared with the control group animals. CONCLUSION: The results of this analysis indicate that the repeated oral administration of such zinc-containing compounds have neurotoxic effects on the ONe and to the mitral cells in the olfactory bulbs of treated rats. These findings point toward the need for increased investigation into the potential deleterious effects of zinc-containing compounds to humans as well.

Administration, Oral↗

Zinc.

The use of zinc in metal alloys and medicinal lotions dates back before the time of Christ. Currently, most of the commercial production of zinc involves the galvanizing of iron and the manufacture of brass. Some studies support the use of zinc gluconate lozenges to treat the common cold, but there are insufficient data at this time to recommend the routine use of these lozenges. Zinc is an essential co-factor in a variety of cellular processes including DNA synthesis, behavioral responses, reproduction, bone formation, growth, and wound healing. Zinc is a relatively common metal with an average concentration of 50 mg/kg soil and a range of 10-300 mg/kg soil. Meat, seafood, dairy products, nuts, legumes, and whole grains contain relatively high concentrations of zinc. The mobility of zinc in anaerobic environments is poor and therefore severe zinc contamination occurs primarily near points sources of zinc release. The recommended daily allowance for adults is 15 mg zinc. The ingestion of 1-2 g zinc sulfate produces emesis. Zinc compounds can produce irritation and corrosion of the gastrointestinal tract, along with acute renal tubular necrosis and interstitial nephritis. Inhalation of high concentrations of zinc chloride from smoke bombs detonated in closed spaces may cause chemical pneumonitis and adult respiratory distress syndrome. In the occupational setting inhalation of fumes from zinc oxide is the most common cause of metal fume fever (fatigue, chills, fever, myalgias, cough, dyspnea, leukocytosis, thirst, metallic taste, salivation). Zinc compounds are not suspected carcinogens. Treatment of zinc toxicity is supportive. Calcium disodium ethylenediaminetetraacetate (CaNa2EDTA) is the chelator of choice based on case reports that demonstrate normalization of zinc concentrations, but there are few clinical data to confirm the efficacy of this agent.

Animals↗

[Beliefs on vitamin and consumption of vitamin supplements among university students in the city of São Paulo].

A survey was conducted in a sample of 894 students entering a private university in São Paulo to examine the vitamin beliefs and to verify the relation between vitamin beliefs and vitamin supplements consumption. Nineteen statements about the relation between vitamins and health were developed to assess the beliefs; the respondents answered by means of a 5-point agreement scale. Cronbach's alpha coefficient of internal consistency was determined for the total scale. 94.5% of students believe that vitamin C prevents and cures the common cold and 72.5% consider vitamins as an energy source. Many students recognize the possibility of health risks associated to excessive vitamin consumption. Vitamin supplement users had a belief score higher than non-users (p < 0.001). The results indicate that several misconceptions about vitamin benefits are common among the students and suggest a relation between vitamin beliefs and supplements consumption.

Adolescent↗

[Self medication in general pediatrics].

OBJECTIVE: Description and quantification of self medication in a general paediatric office. DESIGN: Descriptive and prospective study. SITE. Cervantes Health Centre (Guadalajara). PATIENTS: 387 cases of both sexes until 8 that attended to on demand consultation during the period of two months. MEASUREMENTS AND MAIN RESULTS: 36% of the patients were given drugs before attending to consultation and in 18.7% of these cases, the actuation was incorrect. Parents were, mainly the responsible of incorrect treatment. The most often registered pathology was common cold. We did not found relation between self medication and the next variables: child's age or sex, parents' age or studies, number of children in the family, number of consultation for the same pathologic event and mother working outside home. CONCLUSIONS: Self medication is a common practice. Parents should be instructed about management of the commonest pathologies and when they should ask the doctor.

Adult↗

Exploring patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in primary care.

OBJECTIVE: To assess patient- and doctor-related variables leading physicians to prescribe antibiotics or parenteral antibiotics for acute respiratory infections (ARIs) and to describe the variability as well as the appropriateness of antibiotic use and its predictive factors in general practice. METHODS: We conducted a cross-sectional study among patients aged 15-85 years with a diagnosis of ARIs, using information from 469 GPs from the Health Search Database. Diagnoses were linked with antibiotic prescriptions and other patients and doctor-related variables. Available scientific evidence was used to establish the appropriateness of first-choice antibiotic treatment. Frequency analyses and logistic regressions were used to identify variables associated with antibiotic use and appropriateness. RESULTS: On 67,761 cases of ARIs, antibiotics were prescribed in 63.2%, varying from 80.9% for acute bronchitis to 43.9% for croup, influenza and common cold. Significant associations with antibiotic use were found for geographic location and number of patients under care. The use of diagnostic tests significantly lowered the risk. Geographic location and living in an urban area were associated with parenteral antibiotic use. Amoxicillin (16.7%) and amoxicillin-clavulanate (17.9%) were the most common antibiotics prescribed. Appropriateness was reported in 39.0% of cases, with geographic location, physician's gender and diagnostic tests being the factors more predictive of appropriate antibiotic use. CONCLUSIONS: There is still excessive antibiotic use for ARIs. Its overuse is influenced by the physicians' characteristics and by the environment in which they practice, whilst diagnostic tests might reduce inappropriateness. Therefore, effective strategies for changing diagnostic and therapeutic behaviour are needed.

Acute Disease↗

Use and perceptions of antibiotics for upper respiratory infections among college students.

BACKGROUND: Upper respiratory infections (URIs) are mainly viral in nature, rendering antibiotics ineffective. Little is known about what college students believe concerning the effectiveness of antibiotics as a treatment for URIs. METHODS: Students (n=425) on 3 college campuses were surveyed using a survey describing 3 variations in presentation of an uncomplicated URI. Participants were questioned about their likelihood of using a variety of treatments for the URI and about their likelihood of seeking a physician's care. RESULTS: The percentage of students endorsing antibiotic use differed significantly by symptom complex. Likelihood of seeking medical care also differed significantly across symptom groups, with greater endorsement in the discolored nasal discharge and low-grade fever scenarios. Stepwise multiple regression analysis revealed that belief in antibiotic effectiveness for cold symptoms decreased with tic and Therapeutic increasing years of higher education. Likelihood of antibiotic use across different scenarios increased with age. Likelihood of seeking care across different scenarios was related to type of health insurance and belief in antibiotic effectiveness. CONCLUSIONS: Undergraduate college students show poor recognition of typical presentations of the common cold and have misconceptions about effective treatment. Although increasing years of college correlated with decreasing belief in antibiotics' effectiveness for a cold, more health education at the college level is recommended.

Adolescent↗

Effects of the nasal decongestant oxymetazoline on human olfactory and intranasal trigeminal function in acute rhinitis.

OBJECTIVE: The placebo-controlled, randomized, double-blind study was performed to investigate dose-related effects of oxymetazoline on olfactory function during the course of the spontaneously occurring cold. METHODS: Drug effects were assessed using olfactory/ trigeminal event-related potentials (ERPs) and psychophysical measures (intensity ratings, odor discrimination, butanol threshold); nasal volume was monitored by means of acoustic rhinometry. The investigation was performed in 36 subjects (mean age 24.6 years). The subjects were assigned to treatment groups A, B or C (three groups with 12 subjects each; six women and six men per group). All the subjects received placebo on the left side; on the right side, group A subjects received placebo and group B and C subjects received 0.25 mg x ml(-1) and 0.5 mg x ml(-1) oxymetazoline, respectively. After onset of the rhinitis (day 0) measurements were performed on days 2, 4, 6 and 35. RESULTS: Oxymetazoline clearly produced an increase in nasal volume. However, during the 2-h observation period, effects produced by the two dosages were not significantly different. Despite the increase in nasal volume, oxymetazoline produced only an increase of the overall intensity of H2S stimuli; it had no systematic effect on other measures of olfactory or trigeminal function. In addition, after all the subjects had recovered from the cold, oxymetazoline had no significant main effect on olfactory/trigeminally mediated sensations. CONCLUSIONS: Oxymetazoline appeared to have neither negative nor major positive effects on intranasal chemosensory function. It is hypothesized that oxymetazoline needs to be applied locally to the area of the olfactory cleft in order to significantly improve olfaction during the course of the common cold.

Acute Disease↗

Chlamydia pneumoniae infection in children with lower respiratory tract infections.

The incidence of antibody and the clinical features of Chlamydia pneumoniae (C.pneumoniae) infection have not been studied in children in Japan. We investigated the incidence of C.pneumoniae antibody in sera from 580 healthy children (including 30 umbilical cord blood samples) during the 2-year period between June 1992 and June 1994. The antibody titer was determined by a microimmunofluorescence (MIF) test by using the elementary body of C.pneumoniae TW-183 as the antigen. Umbilical cord blood samples were positive for the antibody in 50% of newborns tested at birth. The incidence of positivity decreased to 0% in 1-year-old children. It was still low in children up to 5 years of age and then increased rapidly in children 6 years of age or older. The positivity reached increased rapidly in children 6 years of age or older. The positivity reached 55% in 7-year-old children and remained at this level in children older than 7 years of age. High antibody titer (IgG > or = 512), indicating recent infection, was observed in 13 (2.2%) of the 580 children, two of whom showed no symptoms. We detected the pathogen in throat swabs by culture and capillary polymerase chain reaction (PCR), and determined IgM and IgG serum titers to C.pneumoniae in 130 children with lower respiratory tract infection (91 with pneumonia and 39 with bronchitis) between December 1993 and December 1994. The infection due to C.pneumoniae was confirmed in 10 (7.7%). Of these, 7 were boys and 3 were girls, ranging in age from 9 months to 12 years. The clinical manifestations of the infection were mild symptoms like in common cold; post-nasal discharge, hoarseness and prolonged cough were relatively characteristic. There was no significant difference in the incidence of serum positivity between the healthy children group and the patients group. The present study suggests that primary-schoolers show antibodies for C.pneumoniae with nearly the same frequency as adults. Mild clinical symptoms are very common in C.pneumoniae infections in children as in adults.

Adolescent↗

Tolerance of one-month intranasal interferon.

Under double-blind conditions, groups of volunteers (68 in total) were allocated at random to take intranasal solutions of placebo or one of three doses of highly purified leucocyte interferon by intranasal spray twice a day for 28 days. The highest dose would have been expected to protect against experimental colds. Treatment was discontinued because of upper respiratory symptoms as often in each of the interferon groups as in the placebo group. However, it was possible to distinguish clinically between "colds" on placebo and low-dose interferon and "reactions to treatment" on high-dose interferon. The features of the reactions to treatment were a protracted build-up of local symptoms and minor epistaxis. None of the volunteers on the high-dose interferon were thought to have a definite cold, but viruses were isolated from four out of six volunteers on low-dose interferon who had definite colds. Previous experiments had also shown this dose to be insufficient to protect against experimental rhinovirus challenge. The dose of interferon that appeared to protect against virus infection caused significant unwanted effects. It is essential to find interferon preparations with less inflammatory activity before interferon can be considered for use as a long-term prophylactic against the common cold.

Administration, Intranasal↗

Frostbite: incidence and predisposing factors in mountaineers.

BACKGROUND: Frostbite, the most common cold injury, occurs in mountaineers, a major group at risk, more often than in the general population. OBJECTIVES: To describe the incidence of frostbite and the situations associated with it in mountaineering, emphasising factors that can be modified to decrease its frequency and severity. METHODS: In this cross sectional, questionnaire based study, 637 mountaineers were asked if they had suffered any frostbite injuries during the preceding two years and to provide the personal and circumstantial details. RESULTS: The mean incidence was 366/1000 population per year. Grade 1 injury (83.0%) and hands (26.4%) and feet (24.1%) involvement were most common. There was a significant relation between lack of proper equipment (odds ratio 14.3) or guide (p<0.001) and the injury. Inappropriate clothing, lack or incorrect use of equipment, and lack of knowledge of how to deal with cold and severe weather were claimed to be the main reasons for the injury. CONCLUSIONS: In high altitude and winter expeditions, mountaineers should wear appropriate clothing, have the necessary equipment such as quality boots and mittens, use a competent guide, and have training on how to tackle cold weather. They should also avoid wet clothing, windy terrains, and should never remain in the same position for long periods to reduce the risk of cold injuries.

Adolescent↗

Exacerbations of chronic obstructive pulmonary disease.

Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.

Adrenal Cortex Hormones↗

Pathogenesis of herpes simplex labialis: excretion of virus in the oral cavity.

Excretion of herpes simplex virus (HSV) in the oral cavity was studied in eight human subjects with a history of herpes labialis. Serial intraoral specimens were obtained by gargling broth and examined for virus by centrifugal inoculation of primary human amnion cells. Forty-seven of 637 specimens (7.4%) contained HSV. The majority of isolates (62%) were found in clusters, and the rate of excretion was significantly increased during the common cold (21%) and after oral trauma (17%) (P = 0.001 and 0.04, respectively). Oral HSV excretion often occurred in parallel with episodes of herpes labialis but could not be attributed to viral contamination from a labial lesion. Each patient excreted only one strain of HSV type 1 as determined by restriction endonuclease analysis with KpnI and BamHI. Unexpectedly, prodromal symptoms of herpes labialis were commonly not followed by development of a lesion (false prodrome). False prodromes were associated with a high rate of oral HSV excretion (60%). Intraoral ulcers on the gingivae and hard palate were frequently associated with oral HSV excretion (31%) and are the most likely source of HSV in the oral cavity.

Adult↗

A case of granular lymphocyte proliferation with T-cell phenotype.

Immunological studies were conducted on a case of granular lymphocytosis with benign clinical feature. A 60-year-old Japanese woman was found incidentally to have lymphocytosis when she had a common cold. A complete blood count showed 47,200 leukocyte per mm3 with 82% granular lymphocytes, 8% small lymphocytes and others. Hemoglobin was 11.5 g/dl and platelet count was 365 X 10(3)/mm3. Surface marker study revealed erythrocyte-rosettes 94%, Leu-1 59%, Leu-2a 70%, Leu-3a 14%, Leu-4 98%, Leu-7 57%, Leu-11 5%, HLA-DR 92%, BA-2 6%, common ALL antigen 4%, and surface immunoglobulin 2%. These results suggest granular lymphocyte proliferation with T-cell phenotype. Natural killer activity was 4.5%, but it was elevated to 11.4% after interleukin-2 stimulation by 2 days' culture. Human T-cell lymphotropic virus-I antibody was absent. No lymphadenopathy and no hepatosplenomegaly were seen, except for bone marrow infiltration of granular lymphocytes. The patient has been in good health without any acute distress. The leukocyte count has gradually decreased to 12,300/mm3 with 79% lymphocytes in 6 months of follow-up without any therapy. This case is suggestive of benign lymphocytosis, although similar cases have been reported previously as chronic lymphocytic leukemia with T-cell marker and/or natural killer function.

Female↗

Self-medication with antibiotics--does it really happen in Europe?

AIMS AND METHODS: The aim of this study was to determine whether antibiotics are used for self-medication in southern Spain, a region belonging to European Union. The data were collected by a survey in the Costa del Sol region, Spain during 2002 by using a convenience sample of 1000 Finns living permanently in the area (response rate 53%, n=530). RESULTS: Antibiotics were used by 28% of the respondents during the previous 6 months before the query. Of the antibiotic users, 41% had bought their antibiotics without a prescription. Clearly the most common indication for antibiotic use was common cold, with almost half (45%) of the antibiotic users reporting it as purpose of medication, followed by sore throat (17%). The number of courses did not differ between prescription and non-prescription antibiotic users, most (64%) of the users having used one course. Neither did the groups differ according to background variables used, including the frequency of experiencing adverse reactions. CONCLUSIONS: Unnecessary and unrational self-medication with antibiotics seems to be common in southern Spain among Finnish immigrants. This may indicate that Spanish health care system, including community pharmacies are failing their task in enhancing rational use of medicines. It is important that all the member countries within EU will take their responsibility in promoting public health goals in their national policy, e.g., in minimising the antibiotic resistance for expanding.

Adult↗