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Occurrence of epistaxis in habitual nose-bleeders and analysis of some etiological factors.

The occurrence of epistaxis in 121 habitual nose-bleeders has been analysed together with the importance of different etiological factors. Heredity for recurrent nose-bleeds was noted by 42% of the bleeders, which was significantly more than in the control group (p less than 0.001). The start of the nose-bleeds was mostly spontaneous. Both common cold and stress or tiredness were frequently experienced before the occurrence of the nose-bleeds. The blood pressure distribution of the habitual nose-bleeders did not differ from that of the population samples used for comparison. Diseases reported by the habitual bleeders were few, and the blood routine tests revealed only few diseases that could be related to the recurrent nose-bleeds.

Adolescent↗

A prospective epidemiological study of secretory otitis media in young children related to the indoor environment.

To assess the influence of housing upon the middle ear status in young children in the form of secretory otitis media (SOM), 210 children not looked after in kindergarten or municipal day-care were investigated. Tympanometry was performed 6 times at 2-week intervals, and the parents filled in a questionnaire concerning housing conditions. In addition to the number of times the children had suffered from SOM, we evaluated long-lasting cases, and the frequency of common colds. Age affected all 3 parameters and sex 1, the boys having a larger number of long-lasting episodes. As to housing factors, the type of housing was of importance, children living in flats being most apt to get SOM, and children on farms least, but this difference disappeared after a regression analysis. Both major and minor airing resulted in fewer cases of SOM than did average airing. Children with a history of allergy (but not of allergic rhinitis) caught colds more often than others.

Acoustic Impedance Tests↗

Role of nasal interleukin-8 in neutrophil recruitment and activation in children with virus-induced asthma.

Neutrophil infiltration is a major feature in the pathogenesis of the common cold, and respiratory viral infection is the major cause of asthma exacerbations. The factors regulating the neutrophil influx are unknown. Interleukin-8 (IL-8) is a potent neutrophil chemoattractant, which has been implicated in several inflammatory diseases. In this study, we investigated the presence of IL-8 chemokine in the nasal aspirates of asthmatic children (n = 12) in whom asthma was precipitated by proven viral infection. There were increased IL-8 levels in nasal aspirates from children during the virus-induced asthma exacerbations compared with samples from the same children when they had been asymptomatic for 2 wk (medians 863 and < 20 pg/ml, respectively, p < 0.01). Biological relevance was shown in that IL-8 levels correlate with increased nasal aspirate neutrophil myeloperoxidase levels and there was also a correlation between myeloperoxidase levels and upper respiratory symptom severity. Furthermore, we purified IL-8 from these samples, and demonstrated biological neutrophil chemotactic activity. These are the first in vivo data to suggest an important role for IL-8 in neutrophil influx in proven upper respiratory viral infection associated with asthma exacerbations. We suggest that IL-8 might provide a target for therapeutic intervention in virus-induced respiratory diseases.

Asthma↗

Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease.

Although exacerbations of chronic obstructive pulmonary disease (COPD) are associated with symptomatic and physiological deterioration, little is known of the time course and duration of these changes. We have studied symptoms and lung function changes associated with COPD exacerbations to determine factors affecting recovery from exacerbation. A cohort of 101 patients with moderate to severe COPD (mean FEV(1) 41.9% predicted) were studied over a period of 2.5 yr and regularly followed when stable and during 504 exacerbations. Patients recorded daily morning peak expiratory flow rate (PEFR) and changes in respiratory symptoms on diary cards. A subgroup of 34 patients also recorded daily spirometry. Exacerbations were defined by major symptoms (increased dyspnea, increased sputum purulence, increased sputum volume) and minor symptoms. Before onset of exacerbation there was deterioration in the symptoms of dyspnea, sore throat, cough, and symptoms of a common cold (all p < 0.05), but not lung function. Larger falls in PEFR were associated with symptoms of increased dyspnea (p = 0.014), colds (p = 0.047), or increased wheeze (p = 0.009) at exacerbation. Median recovery times were 6 (interquartile range [IQR] 1 to 14) d for PEFR and 7 (IQR 4 to 14) d for daily total symptom score. Recovery of PEFR to baseline values was complete in only 75.2% of exacerbations at 35 d, whereas in 7.1% of exacerbations at 91 d PEFR recovery had not occurred. In the 404 exacerbations where recovery of PEFR to baseline values was complete at 91 d, increased dyspnea and colds at onset of exacerbation were associated with prolonged recovery times (p < 0.001 in both cases). Symptom changes during exacerbation do not closely reflect those of lung function, but their increase may predict exacerbation, with dyspnea or colds characterizing the more severe. Recovery is incomplete in a significant proportion of COPD exacerbations.

Aged↗

Natural and experimental rhinovirus infections of the lower respiratory tract.

Rhinoviruses are the cause of the majority of common colds, but their role in lower respiratory disorders is less clear. Recent studies using the polymerase chain reaction to detect rhinoviruses have established respiratory viral infections as major factors in the induction of acute exacerbations of asthma in both adults and children, both in mild exacerbations and in more severe exacerbations leading to hospital admission. Rhinoviruses were the major virus type detected in these studies, accounting for two-thirds of viruses detected. It is not known whether rhinoviruses produce their effects by directly invading the lower airway or by indirect means. Previous clinical studies provide some evidence that rhinoviruses are capable of infecting the lower airway. However, the immunologic response, both in the upper and lower airways, remains poorly defined. Recent studies have provided evidence of increased cellular activation in peripheral blood and in bronchial biopsies in atopic subjects compared with normal subjects during experimental rhinovirus infections. The reasons for these different cellular responses are unclear. Rhinoviruses as well as other respiratory viruses have been shown to increase levels of a variety of cytokines from respiratory epithelium, monocytes, or macrophages. Prominent among these cytokines is interleukin (IL)-8. We have detected increased levels of IL-8 in nasal secretions from subjects with wild-type rhinovirus infections. We studied the mechanisms of rhinovirus-induced IL-8 production and and found protein release from both pulmonary epithelial and peripheral blood mononuclear cells. This protein production was accompanied by increased mRNA expression and evidence of infection of both pulmonary epithelial and monocyte cell lines.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Interleukin-10 gene expression in acute virus-induced asthma.

RATIONALE: Virus-induced asthma is characterized by marked neutrophil influx and eosinophil degranulation, suggesting a mode of immunopathogenesis different from that of allergen-induced asthma. OBJECTIVES: This study compared induced sputum cytokine responses in subjects with severe asthma exacerbation and respiratory virus infection with those of patients with stable asthma, healthy control subjects, and virus-infected nonasthmatic subjects. METHODS: Subject infection status and pulmonary history were established on the basis of common cold and asthma questionnaires, and lung function and atopy tests were performed. Respiratory virus infection was diagnosed by cell culture and direct polymerase chain reaction, using induced sputum. The induced sputum cellular profile was examined and cytokine gene expression was assessed by quantitative real-time polymerase chain reaction. RESULTS: A respiratory virus was detected in 78% of subjects with acute asthma. Specific viruses detected were rhinovirus (83%), influenza (15%), enterovirus (4%), and respiratory syncytial virus (2%). Virus-infected subjects with acute asthma or no asthma had increased RANTES (regulated on activation, normal T cell expressed and secreted) and macrophage inflammatory protein-1alpha messenger RNAs compared with other groups. Interleukin (IL)-10 mRNA was significantly increased in virus-infected acute asthma and reduced on recovery from acute asthma. IL-5, eotaxin, and IL-8 mRNA transcripts were similar across groups. CONCLUSIONS: Asthma exacerbation triggered by respiratory virus infection is characterized by increased IL-10 gene expression that may explain the suppressed eosinophil influx in acute asthma. Airway neutrophilia due to respiratory virus infection is associated with chemokine gene expression involving RANTES and macrophage inflammatory protein-1alpha.

Acute Disease↗

Rhinovirus induces airway epithelial gene expression through double-stranded RNA and IFN-dependent pathways.

Rhinovirus (RV) infection is the major cause of common colds and of asthma exacerbations. Because the epithelial cell layer is the primary target of RV infection, we hypothesize that RV-induced airway disease is associated with the perturbation of airway epithelial gene expression. In this study, well differentiated primary human airway epithelial cells were infected with either RV16 (major group) or RV1B (minor group). Transcriptional gene profiles from RV-infected and mock-infected control cells were analyzed by Affymetrix Genechip, and changes of the gene expression were confirmed by real-time RT-PCR analysis. At 24 h after infection, 48 genes induced by both viruses were identified. Most of these genes are related to the IFN pathway, and have been documented to have antiviral functions. Indeed, a significant stimulation of IFN-beta secretion was detected after RV16 infection. Neutralizing antibody specific to IFN-beta and a specific inhibitor of the Janus kinase pathway both significantly blocked the induction of RV-inducible genes. Further studies demonstrated that 2-aminopurine, a specific inhibitor double-stranded RNA-dependent protein kinase, could block both IFN-beta production and RV-induced gene expression. Thus, IFN-beta-dependent pathway is a part of the double-stranded RNA-initiated pathway that is responsible for RV-induced gene expression. Consistent with its indispensable role in the induction of antiviral genes, deactivation of this signaling pathway significantly enhanced viral production. Because increase of viral yield is associated with the severity of RV-induced airway illness, the discovery of an epithelial antiviral signaling pathway in this study will contribute to our understanding of the pathogenesis of RV-induced colds and asthma exacerbations.

2-Aminopurine↗

Human major group rhinoviruses downmodulate the accessory function of monocytes by inducing IL-10.

Human rhinoviruses (HRVs) are the predominant cause of the common cold. Although this disease is per se rather harmless, HRV infection is considered to set the stage for more dangerous pathogens in vivo. Here we demonstrate that HRV-14, a member of the major group HRV family, can efficiently inhibit antigen-induced T-cell proliferation and T-cell responses to allogeneic monocytes. HRV-14 triggered a significant downregulation of MHC class II molecules on monocytes. Moreover, supernatants from monocytes cultured in the presence of HRV-14 strongly reduced the allogeneic T-cell stimulatory property of untreated monocytes and monocyte-derived dendritic cells (md-DCs), whereas Epstein Barr virus-transformed B-lymphoblastoid cells were not sensitive. Analysis of the supernatant revealed that HRV-14 induced the production of significant amounts of the immunosuppressive cytokine IL-10. The important T-cell stimulatory cytokine IL-12 or the proinflammatory cytokines IL-1beta or TNF-alpha were not detected or were only minimally detected. Finally, monocytes pretreated with HRV-14 were greatly inhibited in their production of IL-12 upon stimulation with IFN-gamma/LPS. These observations suggest that altered cytokine production in mononuclear phagocytes upon interaction with HRV downmodulates appropriate immune responses during the viral infection.

Antigens, CD↗

Parents' worries about children compared to actual risks.

To investigate the concerns of parents, questionnaires were given to the "first 100" parents waiting for their child's pediatric appointment in four different medical settings. They were asked to rate whether they worry "frequently," "occasionally," or "not at all" about 17 physical health issues, 16 psychosocial problems, 7 possible injuries, 4 instances of victimization, and 4 questions about parents' ability to provide discipline, affection, values and financial support. The response rate was 94%; 89% were completed adequately for analysis. Parental concerns were compared to data from the National Center for Health Statistics about the statistical likelihood of the risks occurring. Ear infections (65%) were the most common health concern, followed by reaction to immunization (57%), common colds (51%), and cancer (50%). The greatest psychosocial concern was about children watching too much television (53%), followed by concerns about the quality of day care (50%). Three-quarters of parents worry about car accidents and 72% worry about abduction of their children. Parents worry significantly about their own contribution to their child's welfare: appropriate discipline (73%), affection (56%), values and being a role model (55%), and financial support (66%). Parents who had not completed high school worried more than parents who had more than a high school education (P less than 0.03).

Adolescent↗

Schizonepeta tenuifolia: chemistry, pharmacology, and clinical applications.

This article presents an up-to-date review of the plant Schizonepeta tenuifolia (Jingjie), of family Labiatae, with respect to its traditional uses, chemical constituents, various pharmacological activities, and clinical effects. Nonetheless, its mechanism of actions, adverse effects, drug interactions, and contraindications remain unclear. With the global growth on the use of herbal products, Jingjie has been commonly marketed for the treatment of common cold and fever in Chinese proprietary medicines. Hence, further studies will be warranted to show its efficacy and safety.

Animals↗

Therapeutic approach to sinusitis: antiinfectious therapy as the baseline of management.

Although acute sinusitis is an infectious disease in which several bacterial species play a major etiologic role, there is an important interaction between the respiratory viruses (common cold viruses) and the bacteria in the pathogenesis of acute community-acquired sinusitis. The relative inaccessibility of the sinus cavities makes special techniques of sampling necessary to acquire specimens that accurately reflect disease conditions in the sinuses. Bacterial etiology of sinus infection has therefore been determined by sinus puncture studies, chiefly of the maxillary sinus, several of which are reviewed here. Because the bacteria causing acute sinusitis have not changed in many years, puncture is not often necessary for clinical diagnosis. Patients with acute, community-acquired sinusitis can usually be treated empirically, on the basis of previous studies, unless complications are suspected. In that case, and in other patients with hospital-acquired sinusitis, puncture of the involved sinus and aspiration of sinus fluid for Gram's staining and quantitative microbial cultures and sensitivities are required for appropriate antimicrobial management.

Acute Disease↗

T-Cell response profiling to biological threat agents including the SARS coronavirus.

The emergence of pathogens such as SARS and the increased threat of bioterrorism has stimulated the development of novel diagnostic assays for differential diagnosis. Rather than focusing on the detection of an individual pathogen component, we have developed a T cell profiling system to monitor responses to the pathogens in an array format. Using a matrix of antigens specific for different pathogens, a specific T cell profile was generated for each individual by monitoring the intracellular production of interferon-gamma by flow cytometry. This assay allows for the testing of multiple proteins or peptides at a single time and provides a quantitative and phenotypic assessment of CD4(+) and CD8(+) responding cells. We present profiling examples for several positive individuals, including those vaccinated with the smallpox and anthrax vaccines. We also show antigen optimization for the SARS-hCoV, as studies revealed that these proteins contain peptides which cross-react with more common coronaviruses, a cause of the common cold. The T cell array is an early and sensitive multiplex measure of active infection, exposure to a pathogen, or effective, recent vaccination.

Antigens, Viral↗

The effect of Mentha spicata Labiatae on uterine tissue in rats.

The plant Mentha spicata, or peppermint, is commonly used in the treatment of loss of appetite, common cold, bronchitis, sinusitis, fever, nausea and vomiting, and indigestion as a herbal agent. In this study, we aimed to investigate the biochemical and histological effects of M. spicata Labiatae, growing on the Anamas high plateau of Yenisarbademli town, on rat uterine tissue. Twenty female Wistar albino rats weighing 160+/-10 g were used for this study. Rats were divided into two groups of ten animals: group I received no herbal tea (control group) and group II received 20 g/L M. spicata tea. Control group rats were given commercial drinking water (Hayat DANONESA water). Herbal tea was prepared daily and provided at all times to the rats over 30 days as drinking water. Plasma malondialdehyde (MDA) levels were determined. In addition, uterine tissues were submitted for histopathologic examination. MDA levels were increased in group II when compared with the control group. The difference between group II and the control group was statistically significant (P<0.01). In the M. spicata Labiatae-treated group, histopathological changes like apoptosis and diffuse eosinophil leucocyte infiltration in surface and stromal glandular epithelium were observed in both endometrium and endocervix. It was concluded that lipid peroxidation and uterine damage occurs after M. spicata administration in rat uterus. Despite the beneficial effects of M. spicata Labiatae in indigestion, we should also be aware of the toxic effects when it is not used in the recommended fashion, at the recommended dose.

Animals↗

Work and lifestyle factors associated with morbidity of electronic women workers in Selangor, Malaysia.

The objective of this study was to identify sociodemographic, work, living arrangement and lifestyle factors associated with morbidity of electronics women workers in selected factories in Selangor, Malaysia. The research design was a cross-sectional questionnaire-based survey. Most of the 401 respondents were young single Malay women. Morbidity was high as 85.5% of the women reported experiencing at least one chronic health problem, and 25.7% said that an illness or injury prevented them from carrying out normal activities within the last two weeks. Major acute illness symptoms were the common cold, backache, and diarrhoea while chronic health problems such as persistent headache, eye problems, menstrual problems, and persistent backache were also reported. After logistic regression, chronic health problems was significantly associated with room sharing; while illness that prevented normal activities within the last two weeks was significantly associated with overtime work and exercise. Further research is recommended to understand the complex inter-relationship between morbidity and working and living conditions.

Adult↗

Rampant caries.

Although dental caries in the pediatric and adolescent population has consistently declined in the United States, it is still the most common childhood disease. Dental problems are the number one reason for missing school next to the common cold. Dental caries are an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, an intraoral biofilm, in the presence of sugar. The etiology of rampant disease is very complex. It is multifactorial and has a close relationship to a number of risk factors. It is important that school nurses identify patients at risk for dental caries early to determine their risk and refer them for disease prevention and control.

Adolescent↗

Prospective trial on captopril-related cough.

OBJECTIVE: Quantify and characterize cough as an adverse reaction secondary to captopril. DESIGN: Cohort analytic study: six-month prospective trial including two-week, placebo, run-in period; five-month, single-blind, active treatment; and two-week, dechallenge period. SETTING: Outpatient clinic. PATIENTS: 199 previously treated or newly diagnosed untreated patients with mild to moderate hypertension. INTERVENTIONS: Captopril 50 mg/d during five months. OUTCOME MEASURES: Self-questionnaires, interviews, dechallenge, and rechallenge periods. Naranjo's algorithm. RESULTS AND CONCLUSIONS: (1) Cumulative incidence of captopril-induced cough over a five-month period was 7.1 percent (95 percent C.I., 6.8-7.4 percent). Incidence of drug withdrawal secondary to severe cough was 1.0 percent; this figure is somewhat similar to first reports about the reaction. (2) Cough was a generally mild to moderate symptom, present day and night in 71.4 percent of patients and resistant to antitussive agents. Cough was not statistically related to sex, age, or smoking habit; however, the female gender and the development of a common cold may be predisposing factors.

Adolescent↗

Educational web-based intervention for high school students to increase knowledge and promote positive attitudes toward organ donation.

A sample of 490 high school students from 81 schools in Michigan participated in an experiment in which they were randomly assigned to either a control or an experimental Web site. The experimental Web site provided exposure to educational material about the process of organ donation and organ transplantation. The control Web site provided educational material on methods to avoid the common cold. The pre-and posttests of knowledge of issues related to organ donation and of attitude toward donation demonstrated statistically significant increases for the experimental group compared with the control group. A structural equation path model suggested that these increases in knowledge and prodonation attitude mediated the effects of the experiment on contacting the Michigan donor registry. The increase in knowledge and in prodonation attitude increased the likelihood of contacting the registry. The potential for this and similar other Web interventions to enhance students' health education is discussed.

Adolescent↗

The layman's medical vocabulary. A study of illness definitions and perceived need for medical care.

A knowledge of the layman's illness concepts is of value both for diagnosis and therapy in the practical application of the medical services. It is also valuable for the estimation of morbidity and of the need for medical assistance. The present article describes an investigation intended to throw light on the import of ten different illness concepts and on the implications these may have for the utilization of the medical services. The study is based on interviews with 100 middle-aged women. Most of the respondents considered that an illness may have many causes--a multifactorial aetiology. Great differences between the illnesses were noted with respect to the opinions as to whether examination by a doctor was necessary for diagnosis. The interpretations as to whether an illness needed treatment--medical attention, medicine, hospital care--seemed however to be more closely related to its duration than to its nature. A long duration was regarded by a surprisingly large number as a sign that hospitalization was required--even in the case of a common cold! Only 8% considered obesity 'serious'. As regards the choice of illness alternatives, earlier experience of illness influenced this only in the case of 'shortness of breath' and 'nervous symptoms'. Social class was not found to affect the type of answer.

Adult↗