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PubMedDate not supplied

Use of folk remedies among patients in Karachi Pakistan.

BACKGROUND: The concept that food is medicine is being practiced in certain parts of the world, with positive outcomes on health of the population. We have such practice in Pakistan but it needs to be brought in line with the available scientific evidence. METHODS: The study was conducted on 270 patients, visiting the Family Practice Center, the Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and the use of folk remedies for medicinal uses. RESULTS: Substantial use of folk remedies for different medical conditions has been documented. The remedies included cinnamon, ginger, cloves, cordimon, sesame oil, poppy seeds, honey, lemon, table salt, eggs and curd. The medical conditions in which folk remedies are used in respondents' view, include conditions such as common cold, cough and flu to more serious conditions such as asthma, jaundice and heat stroke. CONCLUSIONS: We have found a substantial use of folk remedies for treatment of medical conditions. There is a need to organize their use on scientific lines.

Adult↗
PubMed2003

Oxymetazoline nasal spray three times daily for four weeks in normal subjects is not associated with rebound congestion or tachyphylaxis.

Topical decongestants are available over the counter and provide rapid relief of nasal obstruction for conditions of short duration, for example the common cold. Manufacturers' recommendations are that topical decongestants should not be used regularly for more than 1 week in view of the risk of rebound mucosal hyperaemia with persistent nasal obstruction and refractoriness to further effects of decongestants. For this reason we performed a randomised double-blind placebo-controlled trial in 30 normal adult subjects with 0.05% oxymetazoline nasal spray 2 sprays (0.1 ml/spray) to each nostril 3 times daily over an extended period of 4 weeks. Degree of nasal blockage was assessed before and after 4 weeks treatment and for 2 weeks following discontinuation of treatment. Outcome measures included diary symptom scores and measurements of nasal peak inspiratory flow, airway resistance (using posterior active rhinomanometry) and volume (using acoustic rhinometry). Nasal patency was assessed at baseline and 15 minutes after oxymetazoline challenge at each clinic visit. Results demonstrated no significant increases in subjective nasal blockage throughout the 6 weeks study period in either oxymetazoline- or placebo-treated subjects. No significant differences were observed between groups for baseline measurements of nasal peak inspiratory flow, airway resistance or volume at each clinic visit. A highly significant decongestant effect of oxymetazoline was observed at each clinic visit with changes in all 3 measurements for both treatment groups, again with no significant differences between groups. In summary, in normal subjects, we identified no significant nasal blockage or impaired decongestant response to oxymetazoline following 4 weeks treatment with oxymetazoline compared to matched placebo nasal spray.

Administration, Intranasal↗
PubMed2003

Outbreak of aseptic meningitis among adults in southern Taiwan.

A total of 38 adult cases of aseptic meningitis were diagnosed based on clinical manifestations as well as examination of cerebrospinal fluid at Kaohsiung Veterans General Hospital in 2001. The majority (31 cases, 82%) of cases occurred between June and August, and most (33 cases, 87%) of them aged from 18 to 35 years (median age, 25 years). The male-to-female ratio was 2.16:1. Common clinical presentations included headache, fever, nausea or vomiting, and symptoms of common cold. On initial cerebrospinal fluid examination, white cell counts were above 500 cells/mm3 in 7 (18%) cases, and neutrophils predominated in 10 (28%) of 36 cases. The cerebrospinal fluid protein concentration was below 100 mg/dL in 29 (77%) of 38 cases, and hypoglycorrhachia (cerebrospinal fluid/serum glucose ratio <0.5) was seen in 9 (24%) cases. Enterovirus as a definite etiology was confirmed by isolation from cerebrospinal fluid in 17 (45%) of 38 cases and was the presumptive etiology by isolation from the stool or throat swab in 2 (5%) cases. Of the 19 cases with positive viral isolation, echovirus serotype 30 accounted for the majority (15 cases, 79%), followed by echovirus serotype 6 (3 cases, 16%), with one (5%) case undetermined. The viral isolation rate from cerebrospinal fluid correlated to the day of cerebrospinal fluid sampling after disease onset (chi2 = 12.05, p = 0.007). All patients were discharged uneventfully without receiving antibiotic therapy.

Adolescent↗
PubMed2003

[Successfully treated case with microscopic polyangiitis complicated severe varicella zoster virus infection including encephalitis and disseminated varicella zoster].

We report a case with microscopic polyangiitis (MPA) complicated by varicella zoster encephalitis. A 60-year-old woman caught a common cold and had acute otitis media in April 1998. Proteinuria and hematuria with hyaline cast were noted at the routine medical check in May, and she was referred to our hospital because of high fever and chest pain. MPA was diagnosed with acute progressive renal failure, pleuritis and elevated anti-neutrophil cytoplasmic myeloperoxidase antibody (MPO-ANCA). Corticosteroid therapy was administered under hemodialysis but MPA was flared several times with various symptoms including interstitial pneumonitis, alveolar hemorrhage and erythema multiforme exudativum. During the course of the disease she developed disseminated varicella zoster and encephalitis. Positive polymerase chain reaction to varicella zoster in cerebrospinal fluid helped to differentiate her encephalitis from central nervous system symptoms due to microscopic angiitis and herpes simplex encephalitis. Combination of corticosteroid and acyclovir therapies for MPA and varicella zoster encephalitis under hemodialysis were successful. The diagnostic process and therapies to these complicated contexts were thought to be very important.

Acute Kidney Injury↗
PubMed2003

[An outbreak of SARS in Dongcheng District, Beijing during March to June 2003].

OBJECTIVE: To describe epidemiological characteristics of an outbreak of severe acute respiratory syndrome (SRAS) in Dongcheng District, Beijing during March to June 2003. METHODS: Data of SARS cases notified from Dongcheng District Center for Disease Control and Prevention (CDC) and supplemented by other channels were collected. All data were input into dataset files by Microsoft Excel-2000 software and analyzed with SPSS version 10.0 software. RESULTS: Totally, 572 cases notified were collected during this period in Dongcheng District, Beijing, and 99 of them were excluded from SARS, because of diagnosis of common cold, pneumonia, measles, or rubella, etc. Actually, 473 SARS cases were analyzed. Attack rate of SARS in permanent residents of Dongcheng was 28.3 per 100,000. Forty-one of them died, with a case-fatality ratio of 8.7%. Outbreak of SARS in Dongcheng District started on March 14, with a peak during mid- and late April, and dropped from May 5, 2003. Persons were all susceptible to SARS, with the highest proportion at ages of 20-50 years, which accounted for 68.7% of the total cases. Average age of the patients at their onset was 40.7 years. No gender difference in SARS cases was found. Number of SARS cases in health care workers (HCWs) accounted for 18.0% and that in the retired persons accounted for 15.4% of the total cases. Cases occurred in all 10 sub-districts of Dongcheng. Totally, 230 of the 572 notified cases (40.2%) hospitalized at local hospitals under the jurisdiction of Dongcheng District. Eighteen of 85 cases of SARS occurred in health care workers of local hospitals, accounting for 4.5% of the total number of health care workers working at the wards caring for SARS patients or at fever clinics. There were 34.7% of SARS cases without any contact histories before their onset. Familial aggregation phenomena were observed in 41.8% of the cases and 18.1% of households. And, 7.4% (attack rate) in those exposed to SARS cases suffered the illness during the periods of quarantine. CONCLUSIONS: SARS appeared outbreak in Dongcheng District, Beijing during March to June 2003. People were all susceptible to SARS, which mainly threatened the young adults and the middle-aged, as well as health care workers and the retired workers. Main mode of transmission was exposure to SARS patients in a near distance at hospitals or families. Prevention and control of SARS should be focused on early isolation of patients and quarantine for the contacts. Current available measures to prevent and control SARS proved effective.

Adolescent↗
PubMed2003

Do delayed prescriptions reduce antibiotic use in respiratory tract infections? A systematic review.

BACKGROUND: There is concern about the increasing resistance of antibiotics to common bacteria. Delayed prescribing for respiratory tract infections is a strategy that may reduce the use of antibiotics. AIM: To systematically review controlled trials of delayed prescriptions to establish their capacity to reduce antibiotic intake. DESIGN OF STUDY: A systematic review of the literature. SETTING: Four studies were conducted in the United Kingdom and one in New Zealand. METHODS: We searched MEDLINE from 1966 to April 2003, EMBASE, and the Cochrane Controlled Trials Register using the following terms: 'delayed', 'antibiotics', 'prescriptions', and 'back-up' (as in back-up prescription). We included controlled trials of studies in which the intervention was a delayed prescription compared to an immediate prescription for patients with upper respiratory tract infections. The studies were selected independently and the results compared. Disagreements were resolved by discussion. The data and quality of the studies were extracted and assessed independently by two of the authors. RESULTS: Four randomised controlled trials and one before-after controlled trial contributed to the review. The relative risk in the randomised trials for lower antibiotic usage when a delayed prescription was given ranged from 0.54 for the common cold to 0.25 for otitis media. CONCLUSION: The consistent reduction in antibiotic usage in the five controlled trials included in this review suggests that delayed prescription is an effective means of reducing antibiotic usage for acute respiratory infections. The duration of delay for prescriptions ranged widely, from 1 to 7 days.

Anti-Bacterial Agents↗
PubMed1992

[A 5-year-old patient with allergic diseases responsive to stellate ganglion block].

We examined a 5-year-old boy with allergic rhinitis, chronic sinusitis, atopic dermatitis, and tendency to suffer common cold, who responded to stellate ganglion block (SGB). SGB therapy was extremely effective for this patient. The result suggests that SGB therapy should be performed on patients with allergic diseases resistant to drug and diet therapy. Furthermore, the indication for nerve block therapy, such as SGB, may be extended even to pediatric patients.

Autonomic Nerve Block↗
PubMed2003

Epidemiological characteristics of an outbreak of severe acute respiratory syndrome in Dongcheng District of Beijing from March to May 2003.

OBJECTIVE: To describe epidemiologic features of an outbreak of severe acute respiratory syndrome (SARS) in Dongcheng District, Beijing occurred in a period between March and May 2003. METHODS: Data of SARS cases notified from Dongcheng District Center for Disease Control and Prevention(CDC)and supplemented by other channels were collected. Clinicians and officials of local hospitals were interviewed in groups and medical records of fatal cases of SARS were reviewed to verify the diagnosis. Stored serum specimens of the patients were detected for IgG antibody against SARS Co-V by enzyme-linked immunosorbent assay (ELISA). All the data were input into dataset files by Microsoft Excel-2000 software and analyzed with SPSS version 10.0 software. RESULTS: Outbreak of SARS in Dongcheng District started on March 14, 2003 with a peak in mid- and late April, and dropped in early May. A total of 572 reported cases were collected during this period in Dongcheng District, Beijing, and 99 of them were excluded from SARS, because of diagnosis of common cold, regular pneumonia, measles and rubella, etc. Actually, 473 SARS cases, which included 390 (82.5%) probable cases and 83 (17.5%) suspect cases, were analyzed. About 90% of the probable cases were positive for IgG antibody. Attack rate of SARS in permanent residents of Dongcheng District was 28.3 per 100 000. Forty-one of them died, with a case-fatality rate of 8.7%. Persons were all susceptible to infection of SARS Co-V, with the highest proportion at ages of 20-50 years, which accounted for 68.7% of the total cases. Average age of the patients at their onset was 40.7 years. No gender difference in SARS cases was found. Number of SARS cases in health-care workers (HCWs) accounted for 18.0% and that in retired workers accounted for 15.4% of the total cases. Cases occurred in all 10 sub-districts of Dongcheng, with the highest in Beixinqiao and Andingmen Sub-districts. Totally, 230 of the 572 notified cases (40.2%) were hospitalized at local hospitals under the jurisdiction of Dongcheng District. Eighteen of 85 cases of SARS occurred in HCWs of local hospitals, accounting for 4.5% of the total number of HCWs working at wards caring for SARS patients or fever clinics. There were 34.7% of SARS cases without any histories of contact before the onset of the disease. Familial aggregation phenomena were observed in 41.8% of the cases and 18.1% of households. And 7.4% (attack rate) of those exposed to SARS cases suffered from the illness during the periods of quarantine. CONCLUSIONS: SARS appeared to be infectious in origin and caused outbreak in Dongcheng District, Beijing introduced by an imported case traveling from Hong Kong in a period between March and May 2003. People are all susceptible to infection of SARS Co-V, which mainly threatens the young adults and the middle-aged, as well as HCWs and the retired workers. The main mode of transmission is direct exposure to SARS patients in a near distance at hospitals or families via droplets spread. Prevention and control of SARS should be focused on early isolation of patients and quarantine for close contacts. Current available measures to prevent and control SARS are proved to be effective.

Adolescent↗
PubMed2004

[Secondary bronchiolitis obliterans organizing pneumonia with primary Sjögren's syndrome, resulting in acute respiratory distress syndrome: a case report].

A 71-year-old female who was taking 10 mg/day of prednisolone for Sjögren's syndrome was admitted because of fever and dyspnea with multiple infiltrative shadows on chest radiography and computed tomography (CT), although she had been discharged only 4 days before. On the 1st and 2nd admissions, a BOOP pattern had been suspected, and she was treated by tapering the prednisolone dose from 40 mg/day to 10 mg/day, which resulted in the disappearance of the infiltrative lung shadows. This time we confirmed the BOOP pattern with Sjögren's syndrome, because bronchoalveolar lavage showed an increase of total cells, with a high lymphocyte fraction, and a transbronchial lung biopsy revealed loose fibroblastic plugs in some alveolar ducts and alveoli. Also, there were intra-alveolar accumulations of foamy macrophages. Furthermore, we noticed migration of pulmonary opacity. Although the clinical symptoms of the patient improved, the response to the prednisolone therapy appeared to be poor. At 35 mg of prednisolone (which had been initiated at 40 mg/day), the disease became rapidly exacerbated by a common cold, and developed into ARDS on the 30th hospital day. In spite of intensive care, the patient died. Here we report a rare case in which the BOOP pattern based on Sjögren's syndrome resulted in ARDS. In general, prednisolone is effective against the BOOP pattern, but we need to be aware of the possibility of a poor response to this BOOP pattern in Sjögren's syndrome.

Aged↗
PubMed1992

[Inhibitory effect of amlexanox on asthmatic attacks in an aspirin sensitive asthmatic].

The anti-allergic action of amlexanox is reported to be associated with inhibition of the release of LTC4, LTD4 and histamine, and with antagonistic activity on leukotrienes. The patient was a 18-year-old female who had suffered from bronchial asthma since the age of fifteen. We diagnosed the case as aspirin sensitive asthma because of development of a severe asthmatic attack with syncope after oral administration of an analgesic for treatment of a common cold at the age of seventeen. She also had sensitivity to toothpaste. Three-minute aerosol inhalation challenge with 0.1, 1 and 10% solution of sulpyrine was performed as a stepwise increment at 20 minutes intervals. This inhalation test was positive and it evoked simultaneous increases of LTC4, LTD4 and histamine in the peripheral blood. Since the commencement of oral administration of 150 mg per day of amlexanox, the patient has had no attacks for about 8 months. In the second inhalation test, premedication with amlexanox elevated the threshold of sulpyrine and inhibited the release of LTC4, LTD4 and histamine. We report that amlexanox was of use to control asthmatic attacks in this aspirin-sensitive asthmatic patient.

Adolescent↗
PubMed2004

[The practice guideline 'Acute cough' from the Dutch College of General Practitioners; a response from the perspective of pulmonology].

Coughing is one of the most prevalent symptoms for which patients seek medical attention. Acute cough is defined as a symptom that lasts less than 3 weeks, is mostly transient and with minor consequences. Upper airway infections, and especially the common cold, are the main cause of acute cough. Acute cough is only occasionally due to life-threatening causes like severe pneumonia or pulmonary embolism. The Dutch College of General Practitioners has issued a comprehensive, practical guideline for diagnosis and treatment of acute cough. As viral infections are the most prevalent cause of acute cough, the guideline emphasises the need to be as cautious as possible with the prescription of antibiotics. Unfortunately, a paragraph on the causes of reduced cough effectiveness, which may lead to a more complicated course of illness, is missing from this guideline. Hopefully, this guideline will lead to a more standardized approach to patients presenting with acute cough.

Acute Disease↗
PubMed2004

Outpatient drug expenditures and prescription policies for diseases with high cost to the National Health Insurance system in Taiwan.

BACKGROUND AND PURPOSE: The high cost of drugs, particularly those used to treat upper respiratory tract infections, is an increasingly important problem for the National Health Insurance system in Taiwan. This study proposed a new classification scheme for reimbursing drug cost and estimated its impact on expenditures and health care utilization. METHODS: Data were obtained from the National Health Research Institutes' year 2000 computer file of the National Health Insurance Academic Research Database in Taiwan. Two factors were used to classify medications: 1) urgency of medications required; and 2) patient's self-care ability. RESULTS: Among the 10 diseases with the highest number of outpatient department (OPD) visits, 7 were upper respiratory diseases. Acute upper respiratory infections (URIs) and acute nasopharyngitis were the 2 diseases with the highest number of OPD visits. Drug expenditure for acute URIs is about 6% of total expenditure for drugs. Medications suitable for URIs patients' self-care accounted for 42.8% of the total cost of prescribed drugs for these illnesses, and treatment medications unsuitable for patients' self-care accounted for 48.6%. Other medications used for URIs could not be grouped into these categories. The total expenditure for acute nasopharyngitis was about 1.3% of total expenditure for drugs. Medications suitable for self-care in patients with nasopharyngitis accounted for 51.8% of the total cost of medication prescribed for this illness, and medications unsuitable for patients' self-care accounted for 36.8%. CONCLUSIONS: Reducing the medications suitable for patients' self-care and enforcing different levels of payment rates on medications unsuitable for patients' self-care may reduce the excessive use of OPD drugs, improve the appropriateness of utilization for acute URIs and the common cold, and allow medical resources to be distributed more efficiently.

Adolescent↗
PubMed1992

How do we classify functional status?

The original question "How do we classify functional status?" is rephrased as "How do we order or arrange the limitations of function of primary care patients in classes?". After a review of the functions to be considered, the concept of functional status is presented using empirical data from the research project "Morbidity and Functional Status of the Elderly." The group studied consisted of 5,502 patients older than age 65 and 25 general practitioners in 12 practices. Functional status was assessed using five COOP charts: physical status, psychological status, daily activities, social status, and change. Morbidity was registered using the International Classification of Primary Care (ICPC). At the beginning and end of the study, 30% of the elderly patients assessed their physical functions as seriously limited, whereas 6% to 8% reported psychological problems and limitations in daily activities or social contacts. During the encounters, more serious limitations were recorded: 35% of encounters involved serious physical limitations; 18% involved serious limitations in activities of daily living, and 11% involved constant psychological problems or limitations in social contact. Women reported more physical limitations than men. Older patients reported more physical limitations than younger ones, and people living in nursing homes reported more limitations than patients living independently. From the disease-specific health profiles, we concluded that the greatest limitation of all aspects of function was scored during encounters for cerebrovascular disease, dementia, and cancer of the lung, stomach, intestine, and breast. Hypertension, "no disease," and "common cold" elicited the lowest functional limitations.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2004

[CT perfusion abnormalities in a case of non-herpetic acute limbic encephalitis].

We report a 42-year-old woman of non-herpetic acute limbic encephalitis (NHALE) whose CT perfusion (CTP) images revealed abnormalities of the limbic system at the early stage. The patient had high fever, convulsion and memory disturbance soon after having caught a common cold, and was admitted to a hospital where she developed progressive disturbance of consciousness. She was then transferred to our hospital 7 days after the initial manifestations. Although enhanced CT images of the brain failed to find any lesion, CTP images revealed a focal increase in the cerebral blood flow and shortening of mean transit time in the bilateral hippocampi and amygdalae. MRI of the subsequent day showed high signal intensity lesions on diffusion, T2-weighted and FLAIR images at the same area. Her consciousness improved by intravenous administration of high-dose methylprednisolone together with other combination therapies. Her CTP images apparently improved by 5 weeks after the onset, but she was left with mild memory disturbance, amenorrhea secondary to hypothalamic failure, hyperosmia, and hypogeusia. In conclusion, CTP is sensitive enough to detect the lesions of the limbic system even in the early stage of NHALE.

Acute Disease↗
PubMed2004

[A case of hypersensitivity pneumonitis caused by Lyophyllum karst].

A 52-year-old woman who has worked at factory to check pack Lyophyllum karst for six years consulted another doctor for dry cough as common cold. After a month, low grade fever, dyspnea on effort, and productive cough brought her to our hospital. Her chest radiographs showed multiple small nodular shadows and ground glass opacities in entire lung fields. Histopathological examination of transbronchial lung biopsy specimen revealed granuloma and thickening of alveolar septa with lymphocytes infiltration. She was admitted to our hospital for hypersensitivity pneumonitis and prescribed predonisorone 30 mg/day. Her symptoms and the finding of chest radiograph improved in two weeks. The precipitation antibodies to Lyophyllum karst were positive and the symptoms exacerbated by going to work. Those finding suggests that hypersensitivity pneumonitis in this case. After quitting her job, she has had no relapse by tapering steroids.

Alveolitis, Extrinsic Allergic↗
PubMed2004

[A case of acute autonomic, sensory and motor neuropathy (AASMN)--less favorable response of the autonomic dysfunctions to IVIg treatment].

We report a rare case of acute autonomic, sensory and motor neuropathy (AASMN). The patient, a 26-year-old woman, developed fever and common cold around January 20, 2001 and was admitted because of abdominal pain due to ileus on January 30. After admission, the patient complained of muscle weakness and numbness in the extremities, difficulty in seeing with the right eye, and dysuria. Neurologically, marked orthostatic hypotension, right tonic pupil, distal dominant moderate muscle weakness in extremities, areflexia in both lower limbs, glove and stocking type of paresthesia, and neurogenic atonic bladder were noted. Sensation to pin prick, light touch, temperature, and vibration were markedly impaired in upper limbs and below the level of the 5th thoracic cord. Cerebrospinal fluid examination revealed albumino-cytologic dissociation. Peripheral nerve conduction study revealed lower limb dominant axonal type impairment of sensory conduction and slight impairment of motor conduction velocity. Clinical autonomic testings revealed dysfunction of both sympathetic and parasympathetic systems. As having AASMN, she was given the intravenous high-dose immunoglobulin (IVIg) therapy twice. After IVIg, the sensory and motor symptoms improved remarkably, but pandysautonomia did not. To our knowledge, this is the first report of AASMN treated by IVIg, and the notable clinical feature in this case was the favorable motor and sensory recovery to IVIg, as opposed to poor autonomic outcome.

Acute Disease↗
PubMed2004

Sunlight is an important causative factor of recurrent herpes simplex.

To evaluate the role of exposure to solar UV radiation (UVR) in primary and recurrent herpes simplex virus 1 (HSV-1) infections, we investigated the self-reported cause of infection among diagnosed patients in Hyogo Prefecture, Japan. Among 4295 infected patients, 3678 had HSV-1, and 2656 of those patients (72.2%) had a recurrent flare-up. Fatigue was the most commonly reported cause of a flare-up among all patients, followed by the common cold and sun exposure. Sun-induced HSV-1 flare-up was reported by 10.4% of the total study population. However, this increased to 19.7% among patients diagnosed in July and August, to 28% among patients younger than 30 years diagnosed in July and August, and to 40% among patients younger than 30 years diagnosed in July and August with a recurrent infection. These results suggest the important role of solar UVR in the development of recurrent HSV-1, possibly due to UVR-induced immunosuppression or direct reactivation of HSV-1 in the neural ganglia.

Adolescent↗
PubMed1992

[TWAR infection is a common diagnosis in outpatient clinics].

Infections caused by Chlamydia pneumoniae were first described in 1985. The infection can cause common cold, sore throat, hoarseness, cough, headache, fatigue and sometimes influenza-like illness. Examination can indicate serous otitis media, sinusitis, laryngitis, bronchitis and pneumonia. The course can be long and relapsing. The recommended drugs for treatment are tetracycline or erythromycin for at least two weeks. Five verified cases are described in the article, four of them with symptoms from the upper respiratory tract only. It is concluded that Chlamydia pneumoniae is a not unusual cause of upper airway diseases. Up to now the diagnosis can best be verified by micro immunofluorescence. The authors call for a rapid and reliable test for use in physician's office. It is proposed that infections caused by Chlamydia pneumoniae be termed TWAR.

Adolescent↗