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PubMed2000

[Acute rhinosinusitis and sinusitis].

During the common cold in the adult, involvement of the sinusal mucosa, confirmed by CT scan, is virtually constant and justifies the term "rhinosinusitis" that is now applied. The presence of bacterial superinfection can only be demonstrated by positive laboratory results on a sample, which is never performed in usual practice; thus the practitioner must rely on presumptive factors. Among them, an essential element is the unilateral nature of painful symptoms and purulent rhinorrhoea. When symptoms are bilateral, antibiotics should not be prescribed except when the condition has not been resolved by symptomatic treatment during several days. In such cases, other important discriminating factors are also examination showing pus originating from below the middle meatus or sinusal X-ray showing a liquid level or a total opacity. On the other hand, clinical suspicion of localisation of infection in the frontal or sphenoid sinuses unquestionably requires rapid antibiotic treatment. Presently the choice of antibiotic tends toward products active on both Haemophilus producing beta-lactamase and on pneumococci with reduced sensitivity to penicillin having only a low level of resistance.

Acute Disease↗
PubMed2000

Retrospective audit of blood donation at a hospital-based blood centre. Implications for blood product supply and safety.

An audit of blood donation at the University Hospital of the West Indies (UHWI) was performed between January 1995 and December 1998. During these four years, 21,733 persons attended the blood collection centre and 6711 (30.8%) were rejected as donors. Females accounted for 3,054 (45.6%) of rejected donors while 3,647 (54.4%) were males. Females were rejected primarily because of low haemoglobin levels, while rejection of males was most frequently attributed to symptoms of the common cold and recent drug use. One hundred and two rejected donors (1.5%) admitted to recent treatment for a sexually transmitted disease, and 138 (2.0%) presented within 16 weeks of a prior donation. Of 15,022 units donated, altruistic voluntary donations accounted for 307 (2%) and 53 (0.3%) were autologous donations. Seven hundred and four units (4.6%) were discarded because of positivity on initial testing for a marker of transmissible infection. Overall prevalence for markers of infection was 2.5% for HTLV-1, 0.9% for Hepatitis B and 0.4% for HIV I/II. Donations at the University Hospital of the West Indies (UHWI) collection centre contributed 15.8% of the national blood supply for the period under study.

Adult↗
PubMed2000

[Symptoms and clinical and radiological signs predicting the bacterial origin of acute rhinosinusitis].

A minority of patients with common cold and upper respiratory tract infections have a bacterial infection and may benefit from antibiotic therapy. The present analysis set out to determine whether there were clinical symptoms or signs which could help the clinician to identify a subset of patients with moderate forms of acute rhinosinusitis who are infected with pathogenic bacteria. Detailed clinical history and medical examination were obtained from 265 patients (mean age 35 years, 138 females and 127 males) presenting symptoms of upper respiratory tract infections but no fever above 38 degrees C. The presence of three pathogenic bacteria (S. pneumoniae, H. influenzae or M. catarrhalis) was determined in all patients by culture of nasopharyngeal secretions. Aggravating factors for severity of rhinosinusitis, such as severe nasal obstruction, inferior and/or middle turbinate hypertrophy, oedema of the middle meatus mucosa and septal defects, were not associated with the presence of bacteria. Pathogenic bacteria were found in 77 patients (29%). The clinical signs and symptoms which were significantly associated in a multivariate model with the presence of bacteria included facial pain (p < 0.003), coloured nasal discharge (p < 0.003) and radiological maxillary sinusitis (complete opacity, air-fluid level or mucosal thickening greater than 10 mm) (p < 0.002). This, the best predictive model, had a sensitivity of 69% and a specificity of 64% and therefore could not be used either as a screening tool or as a diagnostic criterion for bacterial rhinosinusitis. We conclude that signs and symptoms of acute rhinosinusitis in patients with a mild to moderate clinical presentation are poor predictors of the presence of bacteria. In agreement with previous studies, culture of nasopharyngeal secretions may identify patients who would benefit from antibiotic treatment. Thus, antibiotic therapy should not be prescribed in the absence of bacteriological evidence.

Adolescent↗
PubMed2000

AG-7088 Pfizer.

Pfizer (formerly Agouron) is developing AG-7088, a peptide aldehyde that targets the human rhinovirus (HRV) 3C proteinase enzyme and has potential for the treatment of the common cold. A phase II efficacy study has been completed in healthy patients infected with the virus [318668] and in November 1999, Agouron initiated a large, double-blind, placebo-controlled trial in the US, in individuals within 36 h of experiencing cold symptoms [346362]. AG-7088 is derived from AG-6084, the development of which has been discontinued. In order to develop human rhinovirus 3C protease inhibitors with improved pharmacological properties, Agouron replaced the backbone amide moiety of the series which yielded AG-6084, with a ketomethylene isostere. Such compounds displayed slightly reduced anti-3CP inhibitory activity, but improved antiviral properties, due to increased cell membrane permeability [324627]. Compounds in which P1 lactam moieties were incorporated in lieu of an L-glutamine residue displayed significantly increased 3CP inhibition activity and improved antirhinoviral properties relative to the corresponding molecules. Of this series, AG-7088 was the most potent inhibitor [324635]. In May 2000, Merrill Lynch predicted that phase III trials would begin in the first half of 2000 and that US filing would take place in the second half of 2001 [375962].

Antiviral Agents↗
PubMed2000

[A case of anti-GQ1b-positive atypical Fisher syndrome with internal ophthalmoplegia but without external ophthalmoplegia].

We report a 21-year-old man who developed an atypical form of Fisher syndrome. One week after having a common cold, he was admitted to our hospital because of a gait disturbance. Neurological examination revealed a somnolent state, cerebellar ataxia, areflexia, limb muscle weakness, and numbness in a glove and stocking like distribution. The patient had internal ophthalmoplegia but did not have external ophthalmoplegia. Brain MRI showed no abnormality in the orbital and the pretegmental brain regions. The protein level in the cerebrospinal fluid was 57 mg/dl and the cell count was 5 mononuclear cells/mm3. His serum titer of anti-GQ1b IgG antibody was markedly elevated. There have been only two previous reports of isolated internal ophthalmoplegia with elevated anti-GQ1b antibody. The present case suggests that anti-GQ1b antibody play an important role in the pathogenesis of patients who present with internal ophthalmoplegia but without external ophthalmoplegia.

Adult↗
PubMed2000

Rational use of antibiotics for upper respiratory infections: an evidence-based approach.

Despite the lack of evidence of efficacy of antibiotic agents for treating upper respiratory tract infection (URI) symptoms (i.e., acute cough, sore throat, purulent nasal discharge, bronchitis, and the common cold), primary care providers frequently prescribe antibiotic agents for patients presenting with such symptoms. Far from being a harmless practice, prescribing antibiotics for conditions for which there is no proven benefit of such therapy contributes to a number of adverse consequences, including the development of antimicrobial resistance and an unnecessary expense to patients and the healthcare system as a whole. An evidence-based approach to practice can guide nurse practitioners in making the best clinical management decisions for patients presenting with URI symptoms.

Anti-Bacterial Agents↗
PubMed2000

[Immunoadsorption therapy with TR-350 (tryptophan column) for Guillain-Barré syndrome: investigation including serum antiganglioside antibody assay].

Immunoadsorption therapy (IAT) using TR-350 was performed for 14 patients with Guillain-Barré syndrome (GBS). Presence of serum antiganglioside antibodies (AGA) was investigated in all the patients in the acute phase. In 14 patients studied, 6 men and 8 women, ages from 24 to 74 years(mean, 42.5 years), 7 patients had suffered from common cold and 3 from diarrhea before neurological onset. Ophthalmoplegia was seen in 6 patients, facial palsy in 6, bulbar palsy in 3 and cerebellar sign in 2. Functional grade scores (FGS) by Hughes et al. of the patients were from 5 to 1 (mean, 3.3). In 4 patients, whose FGS were 1 or 2, IAT were performed, because of worsting of bulbar palsy, bilateral facial palsy and limb weakness. Relapse occurred in one patient. IAT was started from 2 to 18 days (mean, 8.4) after neurological onset and performed 3 to 14 times (mean, 7.5) for each patient. Mean FGS improved from 3.3 to 2.1 after IAT. The mean time to improve 1 grade was 10.3 days and mean time to improve 2 grades was 39.0 days. The mean FGS after 1 month was 1.4 and that after 3 months was 0.4. Some of 14 patients had elevated titers of AGA in sera in the acute phase. Four patients had anti-GQ1b IgG antibody and showed external ophthalmoplegia. One patient with anti-GD1b IgG antibody had cerebellar signs as well as peripheral neuropathy. Those AGAs decreased after IAT in parallel with improvement. IAT is an effective treatment in acute phase of GBS.

Acute-Phase Reaction↗
PubMed2001

Translating the message.

The "one gene = one protein" model for understanding the genome is well-known. But, as with most biological "rules", it has its exceptions. The viral family that brings polio, the common cold and foot-and-mouth disease translates its entire genome into one long "polyprotein". The study of this translation strategy is bringing to light new targets for fighting disease and new techniques for the biotech industry.

Humans↗
PubMed2001

Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods.

The need to decrease excess antibiotic use in ambulatory practice has been fueled by the epidemic increase in antibiotic-resistant Streptococcus pneumoniae. The majority of antibiotics prescribed to adults in ambulatory practice in the United States are for acute sinusitis, acute pharyngitis, acute bronchitis, and nonspecific upper respiratory tract infections (including the common cold). For each of these conditions--especially colds, nonspecific upper respiratory tract infections, and acute bronchitis (for which routine antibiotic treatment is not recommended)--a large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients. Because decreasing community use of antibiotics is an important strategy for combating the increase in community-acquired antibiotic-resistant infections, the Centers for Disease Control and Prevention convened a panel of physicians representing the disciplines of internal medicine, family medicine, emergency medicine, and infectious diseases to develop a series of "Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults." These principles provide evidence-based recommendations for evaluation and treatment of adults with acute respiratory illnesses.This paper describes the background and specific aims of and methods used to develop these principles. The goal of the principles is to provide clinicians with practical strategies for limiting antibiotic use to the patients who are most likely to benefit from it. These principles should be used in conjunction with effective patient educational campaigns and enhancements to the health care delivery system that facilitate nonantibiotic treatment of the conditions in question.

Acute Disease↗
PubMed2001

[Atypical Fisher syndrome with optic nerve involvement].

We report a 38-year-old woman who developed what appeared to be Fisher syndrome associated with optic nerve involvement. One week after a common cold, she developed double vision and left facial palsy. Four days after the onset, she developed bilateral blurred vision, painful total ophthalmoplegia, and ataxic gait. Brain CT and MRI findings were normal. Her vision worsened but the optic fundi were normal. Serum anti-GQ 1 b antibody was elevated. She received steroid therapy at another hospital, and her vision, facial palsy and ocular pain improved. She was transferred to our hospital and we treated her by plasma exchange. She showed near complete recovery. Human optic and ocular nerves contain high amount of GQ 1 b. This may be a underlying mechanism for optic nerve involvement in Fisher syndrome. We thought that she had an atypical Fisher syndrome associated with optic nerve involvement.

Adult↗
PubMed2001

[A case of pneumonectomy for lung cancer associated with scleroderma].

A 60-year-old female, diagnosed as scleroderma, was referred to our hospital because of symptoms of common cold and abnormal findings on a chest X-ray. The chest X-ray and CT scan revealed a mass in the left upper field, suspected to invade left anterior chest wall. Moreover, fibrotic changes were observed in the lung field. Cytology by bronchofiberscopy showed squamous cell carcinoma. Evaluation of pulmonary function, including unilateral pulmonary artery occlusion test (UPAO), revealed possibility of lung resection. Subsequently, pneumonectomy with combined resection of left 1st rib was performed. Postoperative course was uneventful and she was discharged. She was admitted again four months after the operation with appetite loss and body weight loss. Further examinations revealed arrhythmia, renal failure, pancreatitis and liver metastasis. Her general conditions grew worse and she died five months after the operation. In conclusion, UPAO was a useful method to determine the functional lung resectability for the case with scleroderma. However, effects of surgical stress for the development of scleroderma remain to be elucidated.

Carcinoma, Squamous Cell↗
PubMed2001

Nasal inflammation and anti-inflammatory treatment. Semantics or clinical reality.

In recent years there has been a tremendous development in molecular biology and with that an improved understanding of the immunological and inflammatory background for rhinitis. However, this progress has not yet had any influence on diagnosis or choice of treatment. Today it is emphasized that allergic rhinitis is an inflammatory disease. However, the majority of allergic rhinitis symptoms are caused by histamine, which can be released from a non-inflamed mucous membrane. Thus, the role of inflammation may be overestimated as a cause of rhinitis symptoms. It is often claimed that the 2nd generation antihistamines have non-H1 mediated anti-inflammatory effects of clinical significance. However, the large majority of published clinical data speaks against this hypothesis. Corticosteroids do not, as often believed have a general anti-inflammatory effect in the nose. They are highly effective in a disease associated with eosinophil-dominated inflammation (e.g. allergic rhinitis), but not in a disease associated with neutrophil-dominated inflammation (e.g. the common cold). It is recommended that drugs are used merely based on a thorough cost-risk-benefit-patient-compliance analysis in the single patient and disease entity with little attention being paid to the assumed mode of action of the drug, which may or may not be of clinical relevance.

Adrenal Cortex Hormones↗
PubMed2001

Medical care perceptions in elderly patients with musculoskeletal complaints.

BACKGROUND: Musculoskeletal complaints represent the second most common reason for visits to a physician, second only to the common cold. The limited capability of medical treatment for musculoskeletal disease requires modification of communication with patients by attending to their perception of the disease. OBJECTIVES: To assess patients' satisfaction with care provided by their primary physicians, and the relationship of patients' satisfaction to their expectations of that care, perceptions of physician performance, and perceived severity of musculoskeletal disease. METHODS: Questionnaires were administered to 90 community-dwelling elderly patients (mean age 76 +/- 8 years) presenting for follow-up appointments with their primary care physicians. Patients were asked to report on their satisfaction with the medical care provided by the primary physicians for musculoskeletal symptoms, their expectations of that care, their perceptions of their primary physicians' interaction (regarding competence, performance, and communication), and their perceptions of disease severity (based on the number of areas involved, pain frequency and intensity, and impact on daily activity). The effects on the degree of satisfaction were assessed with regard to demographic variables, co-morbidity, site involved, and response to recommended treatment. RESULTS: Most patients (> 85%) expressed overall satisfaction with their doctor's interpersonal skills. Fewer (76.9%) were satisfied with the amount of effort their doctors spend evaluating their musculoskeletal symptoms, the information received regarding their musculoskeletal symptoms (75%), the degree of pain relief (75%), and the degree of functional improvement (61.8%). Level of education and response to recommended treatment for musculoskeletal disease were the only parameters associated with degree of satisfaction (higher education P = 0.005, lower education P = 0.059, medication P = 0.008, rehabilitation P = 0.076). A high level of expectations (regarding physician's care and musculoskeletal disease treatment) was noted. CONCLUSIONS: The high level of patient satisfaction with their primary physicians' care for musculoskeletal symptoms may reflect the overall tendency of the elderly population to be satisfied with its primary care physicians. However, their high level of expectations (related to perceived efficacy of medical treatment) and their unrealistic perceptions of disease may lead to disappointment and non-compliance with their doctor's recommendations. Management of musculoskeletal disease in the elderly should address the patients' disease perceptions, as well as their therapeutic and functional needs.

Aged↗
PubMedDate not supplied

[Data analysis of daily reports in general medicine].

Health priorities in a sample of 1,425 subjects of a defined urban population were studied from data collected routinely in general practice. Analysis of prevalence has shown 1/5 of circulatory diseases, 1/7 of respiratory diseases, 1/8 of musculoskeletal diseases, and 1/10 of mental disorders. According to incidence for the first medical examination, the leading diagnostic categories were diseases of the respiratory, circulatory, musculoskeletal, digestive, and genitourinary system. Both prevalence and incidence have shown that health priorities in the studied population were diseases of circulatory system, with hypertension, and diseases of the respiratory system, with common cold, of the highest prevalence.

Adolescent↗
PubMed2002

Potential therapeutic uses for S-nitrosothiols.

The S-nitrosothiols (RSNOs) are thought to represent a circulating endogenous reservoir of nitric oxide (NO), and may have potential as donors of NO, distinct from currently used agents. They have the general formula RSNO, and naturally occurring examples include S-nitrosocysteine, S-nitrosoglutathione and S-nitrosoalbumin, in which R is an amino acid, polypeptide and protein respectively. RSNOs have anti-platelet properties, a theoretical role in the treatment of asthma and the potential to be used as agents to treat infectious diseases ranging from the common cold to AIDS. RSNOs are relatively unstable, being degraded to release NO and the corresponding disulphide. Their stability is influenced by the properties of the R group, heat, light, the presence of transition metal ions (in particular copper) and the presence of other thiols. RSNOs participate in transnitrosation reactions in which the -NO group is transferred to another thiol to form a more stable RSNO. Thus the stability of RSNOs in vivo is difficult to predict, and this has led to the development of more stable analogues, in which the properties of R are modified. Potential interactions of RSNOs include that with ascorbic acid (vitamin C), which enhances the ability of copper to catalyse their degradation. Transnitrosation reactions with thiol-containing enzymes can influence protein function, and the intracellular thiol glutathione, levels of which are influenced by many disease states, can also influence stability. Thus, although RSNOs have many theoretically useful properties, there are also many aspects of their biochemistry that need to be addressed before their therapeutic potential can be fully realized.

Anti-Asthmatic Agents↗
PubMed2001

[A case with cerebral subcortical hemorrhage following the administration of phenylpropanolamine].

A 21-year-old woman experienced severe headache and nausea one hour after taking pills containing 160 mg of phenylpropanolamine for common cold. She had no previous history of drug abuse or hypertension. Physical examination revealed slight left-sided hemiparesis. Her blood pressure was 100/52 mmHg. Subcortical hemorrhage was noted in the right frontal lobe with a cranial computed tomography. On the seventh hospital day, cerebral angiography demonstrated with segmental narrowing of a branch of the right anterior cerebral artery, indicating the presence of focal angitis. This finding disappeared on the 35th hospital day. In the majority of the reported cases of the intracerebal hemorrhage associated with the ingestion of phenylpropanolamine, focal angitis rather than induced hypertension is considered to be a causative factor for hemorrhage. Thus, we would like to emphasize that the administration of phenylpropanolamine should be avoided, even to the patients without hypertention or past history of intracerebral hemorrhage.

Adult↗
PubMed2001

[A case of bronchiolitis obliterans: auscultation leading to accurate diagnosis].

This is a case of a 31-year-old man with a history of common cold. He had been suffering from productive cough and dyspnea on exertion. Squawks were heard through auscultation, and hyperinflation was also observed in his chest radiograph. Bronchiolitis was first suspected as a result of HRCT and TBLB. He was then treated with CAM for six months, but his symptoms showed little improvement. So we evaluated his squawks objectively by phonopneumograph, performed video assisted thoracoscopic surgery and diagnosed his illness as constrictive bronchiolitis. Based on the examinations, PSL therapy was applied to his case, which contributed improving his condition remarkably. The significance of this case is that proper auscultation led to the accurate diagnosis.

Adult↗
PubMed1998

[A new saikosaponin from Bupleurum Chinese DC].

Bupleurum chinese DC. is a well-known and very important traditional Chinese drug. It is often used to treat common cold with fever, alternating chill and fever, the feeling of fullness and oppression in the chest. A new saikosaponin was isolated from Bupleurum chinese DC. and its structure was identified as 3 beta, 16 beta, 28-trihydroxy-11-alpha-methoxy-olean-12-ene-3-O-beta-D-glucosyl-(1-->3)-beta D-fucoside on the basis of chemical and spectral evidence. In addition, six known saikosaponins were isolated and characterized as saikosaponin a, saikosaponin d, saikosaponin c, saikosaponin f, saikosaponin b3 and saikosaponin b2. All these compounds were isolated from Bupleurum chinese DC. for the first time.

Bupleurum↗