BACKGROUND Acute lower respiratory tract illness in previously well adults is usually labelled as acute bronchitis and treated with antibiotics without establishing the aetiology. Viral infection is ...thought to be the cause in most cases. We have investigated the incidence, aetiology, and outcome of this condition. METHODS Previously well adults from a stable suburban population consulting over one year with a lower respiratory tract illness were studied. For the first six months detailed investigations identified predetermined direct and indirect markers of infection. Evidence of infection was assessed in relation to presenting clinical features, indirect markers of infection, antibiotic use, and outcome. RESULTS Consultations were very common, particularly in younger women (70/1000 per year in previously well women aged 16–39 years), mainly in the winter months; 638 patients consulted, of whom 316 were investigated. Pathogens were identified in 173 (55%) cases: bacteria in 82 (Streptococcus pneumoniae 54,Haemophilus influenzae 31,Moraxella catarrhalis 7), atypical organisms in 75 (Chlamydia pneumoniae 55,Mycoplasma pneumoniae 23), and viruses in 61 (influenza 23). Seventy nine (24%) had indirect evidence of infection. Bacterial and atypical infection correlated with changes in the chest radiograph and high levels of C reactive protein but not with (a) the GP's clinical assessment of whether infection was present, (b) clinical features other than focal chest signs, and (c) outcome, whether or not appropriate antibiotics were prescribed. CONCLUSIONS Over 50% of patients have direct and/or indirect evidence of infection, most commonly bacterial and atypical pathogens, but the outcome is unrelated to the identified pathogens. Many patients improve without antibiotics and investigations do not help in the management of these patients. GPs can reassure patients of the causes and usual outcome of this self-limiting condition.
Background: We analysed data from three clinical trials in Parkinson’s disease (PD) patients with wearing‐off to determine whether early enhancement of levodopa therapy with entacapone can lead to ...better long‐term outcomes than delayed entacapone treatment.
Methods: Post‐hoc analysis of pooled data from three randomized, double‐blind, placebo‐controlled studies and their long‐term, open‐label extension phases. In all three studies, patients on levodopa/dopa‐decarboxylase inhibitor (DDCI) were first randomized to entacapone (‘early‐start’ group) or placebo (‘delayed‐start’ group) for the initial 6‐month double‐blind phase, after which all patients received open‐label levodopa/DDCI and entacapone treatment for up to 5 years.
Results: A total of 488 PD patients with wearing‐off were included in the analysis. A statistically significant benefit of early initiation of levodopa/DDCI and entacapone was found, with an improvement in Unified Parkinson’s Disease Rating Scale Part III (motor) score of −1.66 (95% confidence intervals −3.01, −0.31) points compared with the delayed‐start treatment group (P < 0.05). Levodopa/DDCI and entacapone therapy was well tolerated. There was no excess of dyskinesia in the early‐start group.
Conclusions: These data suggest that early rather than delayed addition of entacapone to levodopa/DDCI in PD patients with wearing‐off provides a modest clinical benefit over levodopa/DDCI that is maintained for up to 5 years.
The antibody prevalence data indicate that C. pneumoniae infections are common worldwide and more frequently occur in middle-aged and elderly males than in females. C. pneumoniae infections are first ...acquired in childhood in heavily populated areas, whereas in northern countries, first infections are generally at teenage and in Scandinavia, typically at the time of military service. All chlamydial species tend to cause chronic infections, with severe sequelae developing 10 to 50 years after the primary infections. If C. pneumoniae resides in alveolar macrophages or in vascular endothelial cells in chronic infections the bacteria and their structural components, such as lipopolysaccharides have an easy access to circulation. The continuous induction of cytokines by C. pneumoniae may lead to chronic inflammation of vascular endothelium.
The effect of superheat on grain sedimentation and macrosegregation has been investigated using experimental castings of a low-alloyed steel grade. With a high superheat of ∼ 40 °C, the central ...equiaxed parts of the slabs consisted of randomly oriented fine dendrites but with a low superheat of ∼ 10 °C, coarse globular structures formed. The mean carbon content measured with optical emission spectroscopy was of the order of 15% smaller with coarse globular structures than in fine equiaxed dendritic structures. Electron probe microanalysis of other alloying elements indicates that the negative segregation in the slab central zones is caused by sedimentation of globulites. With superheat in the range ∼ 20 - 40 °C, the equiaxed zone is bordered by a columnar to equiaxed transition (CET) zone. In this region a positive macrosegregation of carbon and other alloying elements was observed. These phenomena are important when considering the through-thickness properties of the slabs and final products.
The role of
Streptococcus pneumoniae
in the etiology of respiratory tract infections has been studied serologically using microbe-specific antibody and immune complex assays. Serological methods are ...sensitive in the bacteremic pneumococcal pneumonia of adults. In children, however, pneumococcal pneumonia is seldom bacteremic, and, thus, in the absence of a gold standard for the detection of pneumococcal infection, serological methods are still insufficiently validated. We report here indirect evidence for the sensitivity and specificity of pneumococcal serology in children. Serological evidence of pneumococcal infection has been found in 27% to 38% of children with radiologically confirmed pneumonia, in 7% to 8% of children with viral wheezy bronchitis, and in <1% to 5% of children and young adults with viral upper respiratory infection. Serological findings for pneumococcal infection have been dependent on the study venue, whether in hospital or ambulatory subjects, and on the test panel used. Where both antibody and immune complex assays have been available, the proportion of children with pneumococcal infection has been 32% to 37% in inpatients and 27% to 28% in outpatients. The respective rates have been 10% to 18% by antibody assays alone. Pneumococcal acute otitis media, when present with pneumonia, may confound findings in pneumococcal serology, but pure nasopharyngeal carriage of
S. pneumoniae
has little effect. In contrast, carriage acquisition of a new serotype may induce significant antibody production. Thus, understandably, significant rises between paired sera in antibodies to pneumococcal capsular polysaccharides and pneumococcal pneumolysin have been found in <1% to 3% of non-symptomatic children and young adults. Findings from the last 20 years indirectly suggest that pneumococcal antibody and immune complex assays are sensitive and specific enough for the detection of pneumococcal infection in children. However, the methods are too complex for routine clinical practice, and, so far, serological methods for
S. pneumoniae
infections have only been used for research purposes.
Polyorchid Dog Tamminen, TM; Leinonen, MR; Käck, H ...
Reproduction in domestic animals,
April 2012, Letnik:
47, Številka:
2
Journal Article
Recenzirano
The case of a polyorchid Irish Setter is presented here. Castration and intra‐abdominal testis removal were performed one year of age when one scrotal and one cryptorchid testis near the right ...inguinal canal were removed. Later it became apparent that there was still testosterone production. A third testis, abdominal cryptorchid, was found on the right side cranially and right to the bladder. The third testis had a strong cranial suspensory ligament and the tail of the epididymis was elongated. The ductus deferens did not enter the prostate but followed the gubernaculum to the inguinal canal near the stump of the previous operation on the caudal right testis. This suggests that two right cryptorchid testes had common ductus deferens.
Bacterial coinfections occur in respiratory viral infections, but the attack rates and the clinical profile are not clear. The aim of this study was to determine bacterial coinfections in children ...hospitalized for acute expiratory wheezing with defined viral etiology. A total of 220 children aged 3 months to 16 years were investigated. The viral etiology of wheezing was confirmed by viral culture, antigen detection, serologic investigation, and/or PCR. Specific antibodies to common respiratory bacteria were measured from acute and convalescent serum samples. All children were examined clinically for acute otitis media, and subgroups of children were examined radiologically for sinusitis and pneumonia. Rhinovirus (32%), respiratory syncytial virus (31%), and enteroviruses (31%) were the most common causative viruses. Serologic evidence of bacterial coinfection was found in 18% of the children. Streptococcus pneumoniae (8%) and Mycoplasma pneumoniae (5%) were the most common causative bacteria. Acute otitis media was diagnosed in 44% of the children. Chest radiographs showed alveolar infiltrates in 10%, and paranasal radiographs and clinical signs showed sinusitis in 17% of the older children studied. Leukocyte counts and serum C-reactive protein levels were low in a great majority of patients. Viral lower respiratory tract infection in children is often associated with bacterial-type upper respiratory tract infections. However, coexisting bacterial lower respiratory tract infections that induce systemic inflammatory response are seldom detected.
Chlamydial infections are very common worldwide. All chlamydial species have a tendency to cause persistent infections, which have been associated to several chronic diseases including blinding ...trachoma, infertility and coronary heart disease (CHD). At present, no efficient treatment for the eradication of chronic chlamydial infections exists and, thus, new antichlamydial compounds are urgently needed. This study was designed to screen antichlamydial activity of natural flavonoids and other natural and structurally similar synthetic compounds against
Chlamydia pneumoniae in human cell line (HL).
HL cells were infected with
C. pneumoniae and incubated 72
h with studied compounds. Reduction in the number of inclusions was determined with immunofluorescence staining. In vitro minimum inhibitory concentration was also determined for some of the most active compounds. Thirty seven percentage of the studied compounds (57 in total) were highly active against
C. pneumoniae and all the studied compounds were non-toxic to the host cells at studied concentrations.
Our study revealed direct antichlamydial effect for selected polyphenolic compounds against
C. pneumoniae, in vitro. We also demonstrated the ability of some of the investigated compounds to accumulate inside cells or into cell membranes and cause inhibition, even when present only prior to infection.
PDF
