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Saliva collection technique for cytologic, microbiologic and viral evaluation in pediatric HIV infection.

Acquisition of saliva for biologic, immunologic and chemical analyses has been extremely difficult in infants and young children due to lack of cooperation and motor skills necessary for expectorating adequately. The purpose of this study was to investigate a technique for obtaining satisfactory quantities of whole, unstimulated saliva in the typical dental operatory setting for cytologic, microbiologic and viral evaluation, while requiring minimal cooperation and motor skills from pediatric patients. A low vacuum-assisted aspiration device was utilized to obtain samples from infants and children who were at risk for vertically acquired HIV-infection (age-range 6 mos to 8 yrs). Adequate saliva samples were collected in 175 of 196 (89 percent) attempts in 88 of 89 (99 percent) children (2.3 samples/child). Saliva was not obtained in twenty-one attempts primarily due to xerostomia (62.5 percent). Saliva sample volume obtained was variable, ranging from 1.2 to 3.6 mls with a collection time of approximately three to five minutes. Cell block preparations were made from the saliva, which allowed for cytologic evaluation of sloughed superficial squamous cells, evaluation of oral flora, and detection of yeast and hyphal fungal forms. Adequate volumes of supernate were also available for microbiologic and viral cultures, immunologic studies and PCR study for various viral agents shed in the saliva. Use of a vacuum-assisted collection device for whole unstimulated saliva in infants and young children in the dental operatory setting provides adequate saliva for multiple analyses, which may provide information regarding HIV disease status and early diagnosis of opportunistic infections.

AIDS-Related Opportunistic Infections↗

PubMed1998

[Pulmonary crytosporidium in a patient with AIDS].

Compared to digestive disorders, respiratory disease linked to cryptosporidium has not been very well documented in AIDS. We report a case of a patient suffering from AIDS who presented with chronic bronchial symptoms which became more and more incapacitating. Different respiratory specimens (broncho-alveolar lavage, expectoration and bronchial biopsy) revealed the presence of cryptosporidium species. The patient died in a few weeks from respiratory insufficiency without the parasite being eradicated from the bronchi. Although the autopsy confirmed the presence of cryptosporidium species, it was difficult to confirm its responsibility due to the fact that other pathogens were present in the bronchial tree.

AIDS-Related Opportunistic Infections↗

PubMed1998

[Perihilar interstitial bleeding due to thoracic endometriosis].

A 47-year-old woman was admitted to our hospital for evaluation of an abnormal shadow in the left hilar region. A CT scan showed a non-enhancing mass between the lingula and left basal bronchus. On the twelfth hospital day, when her menstruation began, she suddenly expectorated a large amount of blood, and her chest X-ray film showed enlargement of the mass in the left hilum and an infiltrative shadow in the left lung field. We suspected pulmonary endometriosis because the hemoptysis was synchronized with the menstruation and because of her history of operations for polyps in the uterine cervix. Six days after the episode of hemoptysis, magnetic resonance (MR) imaging demonstrated a fluid-fluid level in the mass on T 2-weighted images. The abnormal signals spread along the interstitium into the lung parenchyma, therefore we made a diagnosis of hemorrhage in the perihilar interstitium due to endometriosis. MR images obtained 20 days and 48 days after the episode of hemoptysis showed changes of intensity in the mass similar to those of intracranial bleeding. This was a rare case of endometriosis in the perihilar interstitium and it shows the usefulness of MR imaging in making the diagnosis.

Endometriosis↗

PubMed1997

[A prospective study on respiratory symptoms and functions in new employees exposed to cotton dust].

Sixty new employees in a cotton textile mill were followed up for five years to study their occurrence of byssinosis and its natural history. Results showed that the workers complained more cough, expectoration and other respiratory irritation symptoms at their early exposure to cotton dust, and the frequency of chest tightness in them reached the peak one year after exposure and remained at higher level later. Stratified analysis showed that all the respiratory symptoms did not correlate with their smoking habits, specific body constitution, etc. Forced expiratory volume at one second (FEV1) after shift declined with length of exposure and appeared a tendency to exacerbate gradually, especially in workers with a positive skin test of cotton antigen. Smoking had no influence on it. It suggests that exposure to cotton dust and idiosyncracy of the workers play important roles in damage to lung function.

Adolescent↗

PubMed1998

[Tuberculosis in respiratory system--tracheo-bronchial tuberculosis, pulmonary tuberculosis, tuberculous pleurisy and thoracic empyema].

Tuberculosis in respiratory system is most common in mycobacterial infections. Eighty percent of the patients with pulmonary tuberculosis visit hospital because of the respiratory symptoms, and only 10% of them were discovered by chest X-ray mass screening. In order to confirm respiratory tuberculosis, various methods to obtain specimens for mycobacterial examination have been carried out; hypertonic saline nebulizing for sputum expectoration, trans-bronchoscopic biopsy, percutaneous needle aspiration, and so on. The recent development of imaging modalities including CT, MRI, and ultrasonogram have been much contributed to the improvement of diagnosis of pleural tuberculosis. Basically, the main treatment for respiratory tuberculosis is chemotherapy except chronic tuberculous thoracic empyema. The initial chemotherapy regimen should be chosen among the three arms; [INH + RFP + PZA + EB (or SM)] x 2-->[INH + RFP] x 6, [INH + RFP + EB (or SM)] x 6-->[INH + RFP] x 3-6, and [INH + RFP] x 6-9. The sputum positive patient is recommended to have the chemotherapy regimen including PZA. In the patients with tracheo-bronchial tuberculosis an attention should be paid for the airway narrowing or obstruction during and after the scheduled chemotherapy. For a part of patients with tuberculous pleurisy and thoracic empyema, a surgical treatment must be indicated.

Empyema, Tuberculous↗

PubMed1998

[The utilization of anti-infective agents in primary care in La Rioja].

OBJECTIVE: To analyse the use of drugs to combat infection, prescribed in primary care in the La Rioja area during 1996. DESIGN: A retrospective observational study. SETTING: Primary care. PARTICIPANTS: All the anti-infectious drug prescriptions in primary care during 1996 in our province (450078 units). They are covered by the following therapeutic groups: JO1 (systemic antibiotics), JO3 (systemic chemotherapeutic drugs), JO4A (anti-tubercular), JO5A (antiviral), GO4A (antiseptic and for urinary infections) and RO5C1 (expectorants combining mucolytics and anti-infectious drugs). MEASUREMENTS AND MAIN RESULTS: All the prescriptions for anti-infectious drugs billed in the National Health Service in La Rioja during 1996 were processed. The defined daily dose (DDD) was used as the technical unit of measurement. The DDD per 1000 inhabitants per day (DID) was used as comparative indicator. The DID for the various therapeutic groups was compared with the overall consumption of antibiotics in 1996 in La Rioja. CONCLUSIONS: Non-hospital consumption of anti-infectious drugs during 1996 in La Rioja reached 20.97 DID, which is slightly higher than in other areas. The five therapeutic groups with most prescriptions were: penicillin (8.78 DID), macrolides (4.86 DID), cephalosporins (2.48 DID), quinolones (1.25 DID), antiseptic and urinary anti-infectious drugs (1.11 DID). The new macrolides were used a lot, as were quinolones and third-generation cephalosporins. These last two groups are not first-choice drugs in the empirical treatment of pathologies common in primary care.

Anti-Infective Agents↗

PubMed1998

[Clinico-biochemical effectiveness of emoxpine in patients with bacterial bronchial asthma].

AIM: To determine effectiveness of a synthetic antioxidant drug emoxipine in combined treatment of bacterial bronchial asthma (BBA). MATERIALS AND METHODS: A total of 59 BBA patients were treated who had the disease for 1-14 years. The previous treatment consisted of bronchodilating, mucolytic and expectorant drugs. 19 of them received i.m. adjuvant emoxipine for 10 days in daily dose 0.3 mg/kg as a 1% aqueous solution. Metabolic activity of alveolar macrophages (AM) was measured. RESULTS: Emoxipine-treated patients had reduced content of primary lipid peroxidation products and schiff bases in AM, catalase level in them returned to normal, blood levels of alpha-tocopherol went up. CONCLUSION: Emoxipine is beneficial for AM antioxidant defence system in BBA patients.

Antioxidants↗

PubMed2000

Deoxyribonuclease for cystic fibrosis.

BACKGROUND: Recombinant human deoxyribonuclease is currently used to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis. OBJECTIVES: To determine whether the use of recombinant human deoxyribonuclease in cystic fibrosis is associated with improved mortality and morbidity as compared to placebo and to identify any adverse events associated with its use. To compare the efficacy of recombinant human deoxyribonuclease with other mucolytics. SEARCH STRATEGY: The Cochrane Cystic Fibrosis and Genetic Disorders Group specialist trials register which comprises references identified from comprehensive electronic database searches, hand searching relevant journals and abstracts from conferences. The company producing recombinant human deoxyribonuclease was also contacted. Date of the most recent search of the Group's specialised register: November 1999. SELECTION CRITERIA: All randomised and quasi-randomised trials where recombinant human deoxyribonuclease was compared to either placebo, standard therapy or another mucolytic for any duration, dose regimen and age of patient with cystic fibrosis of any disease severity. DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion criteria, methodological quality and data extraction by the two reviewers. Comparisons were between recombinant human deoxyribonuclease and placebo and recombinant human deoxyribonuclease and other mucolytics. The following outcomes were recorded: Mean % change from baseline in forced vital capacity (FVC), forced expiratory voloume at one second (FEV1) and weight, mean number of respiratory tract exacerbations, days intravenous and oral antibiotics used, mean number of days as inpatient, number of deaths, adverse events and the cost of therapy. MAIN RESULTS: Seven primary clinical trials were identified, totalling 1710 patients. Two further studies examined the health care cost of patients from one of the clinical trials. No eligible studies compared recombinant human deoxyribonuclease to another mucolytic. Five trials presented outcomes at up to one month, one at three months and one at six months. No reduction in mortality for treated patients was identified (Relative Risk (RR) at six month 1.01, 95%Confidence Interval (CI) 0.09, 11.11). Lung function improved to a greater extent in the treated groups (at six months Weighted Mean Difference (WMD) FEV1 5.7, 95%CI 4.18, 7.23, at three months 7.3, 95%CI 4.04, 10.65). Pooled data from the five trials of up to one month gave WMD 9.2 95%CI 0.93, 17. 6 although there was significant heterogeneity). Recombinant human deoxyribonuclease was well tolerated with no excess of serious adverse events (RR haemoptysis 0.89, 95%CI 0.54, 1.45, pneumothorax 0.97 95%CI 0.19, 4.96). Voice alteration was, however, reported more frequently in the treated groups (RR 2.33 95%CI 1.38, 3.93). No study analysed our pre-defined outcome measure for respiratory exacerbations and insufficient data was available to analyse differences in antibiotic treatment, inpatient stay and quality of life. REVIEWER'S CONCLUSIONS: Studies are of insufficient duration to identify a reduction in mortality or number of respiratory exacerbations. Further trials are required to answer these important questions. Recombinant human deoxyribonuclease therapy is associated with an improvement in lung function after six months treatment, but it is not possible to assess whether this effect on lung function is sustained in the long-term. No studies were identified that compared recombinant human deoxyribonuclease to another mucolytic.

Cystic Fibrosis↗

PubMed2000

Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease.

BACKGROUND: Individuals with chronic bronchitis or chronic obstructive pulmonary disease (COPD) may suffer recurrent exacerbations with an increase in volume and/or purulence of sputum and any therapy that reduced the number of exacerbations would be useful. There is a marked difference between countries in terms of the prescribing of mucolytics depending on whether or not they are perceived to be effective. OBJECTIVES: To assess the effects of oral mucolytics in adults with stable chronic bronchitis or COPD. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and reference lists of articles. SELECTION CRITERIA: Randomised trials that compared oral mucolytic therapy with placebo for at least two months in adults with chronic bronchitis or COPD. Studies of people with asthma and cystic fibrosis were excluded. DATA COLLECTION AND ANALYSIS: One reviewer extracted data. Study authors and drug companies were contacted for missing information. MAIN RESULTS: Twenty two trials were included. Compared with placebo, there was a significant reduction in the number of exacerbations per patient with oral mucolytics (weighted mean difference (WMD) -0.067 per month, 95% confidence interval -0.079, -0.055, p<0.001) which is a 29% reduction. The annualised rate of exacerbations in the control patients was 2.7 per year. The number of days of disability also fell on mucolytic therapy (WMD -0.56, 95% confidence interval -0.77, -0.35, p<0.001). The number of patients who remained exacerbation-free was greater in the mucolytic group thanin the placebo group (OR 2.22, 95% confidence interval 1.93, 2.54, p<0.001). There was no difference in lung function or in adverse effects reported between treatments. REVIEWER'S CONCLUSIONS: In subjects with chronic bronchitis or COPD, treatment with mucolytics was associated with a small reduction in acute exacerbations and a somewhat greater reduction in total number of days of disability.

Adult↗

PubMed1963