Rhinitis Ebook

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Susceptibility Of Children To Severe Respiratory Illness

Disorders of the respiratory tract are the commonest illnesses of childhood. They are the most frequent reason for children to be seen by their general practitioner and they account for 30-40 of acute medical admissions to hospital in children. Despite advances in the management of respiratory illnesses, they still result in almost 300 deaths in children between the ages of 4 weeks and 14 years in England and Wales each year approximately half of these deaths are in children less than 12 months old (ONS 1998). Most respiratory illnesses are self-limiting minor infections, but a few present as potentially life-threatening emergencies. In these, accurate diagnosis and prompt initiation of appropriate treatment are essential if unnecessary morbidity and mortality are to be avoided. The pattern of severe respiratory illness in children is different from that in adults. These variations reflect important differences in the immune status, and the structure and function of the lungs and...

Mammalian orthoreovirus 1Lang MRV

1) A serotype of Mammalian orthoreovirus in the genus Orthoreovirus. The type strain is Lang. Recovered from a number of mammalian species including humans, dogs, cattle, macaque monkeys and cercop-ithecine monkeys. Antibodies have been detected in sera from a wide range of mammalian species. Experimental infection of mice, hamsters, ferrets and rats causes obstructive hydrocephalus, and in pregnant mice fetal resorption, intra-uterine death, malformation or neonatal death occurs. In humans infection is usually symptomless, or associated with mild upper respiratory disease (common cold). Rarely, reovirus type 1 has been isolated from fatal encephalitis cases in children.

Human respiratory syncytial virus S2 A

Human rhinovirus A (HRV-A) A species in the genus Rhinovirus containing 18 serotypes that all use ICAM-1 as a receptor. The cause of most human 'colds' and some other respiratory tract infections. Do not hemagglutinate. Strains which replicate in rhesus monkey kidney cell cultures are called M strains the majority, which multiply only in human cells, are called H strains. Some strains can only be isolated in organ cultures of respiratory epithelium. Optimal conditions for propagation are sodium bicarbonate concentration of not more than 0.35g l, temperature 33 C, slow rotation of culture, islands of cells rather than confluent sheet and minimal concentration of serum compatible with maintenance of cells. Best cells for isolation are primary human kidney or lung or diploid human cell lines. CPE may not be seen for 10 days or only on passage. No vaccine available but experiments suggest immunity to an individual strain can be produced. A drug (Pleconaril) is under development....

Coxsackie virus A21 CAV21 A probable

Strain or serotype of Human enterovirus C. Serologically identical to Coe virus, associated with infantile diarrhea and common colds. coxsackie virus B1-6 (CBV1-6) Species in the genus Human enterovirus B. Associated with a number of human diseases including pleurodynia (Bamble or Bornholm disease), meningitis, respiratory illness and especially cardiopathy. The virus may affect the myocardium, endocardium or pericardium or all three, and evidence of infection is usually seen at autopsy. Experimentally, cardiac disease can be induced in monkeys with CBV 4, and virulence is associated with a single site in the 5' non-translated region of the genome. The possible association of coxsackie B viruses with type 1 insulin-dependent juvenile diabetes remains conjectural, although a similar coxsackie viruses Species in the genus Enterovirus. Named after a small town in New York State from where the first virus was isolated. They are divided on biological characters, especially...

Controlled Randomized Clinical Trials

You get the flu. You get a headache or the runs. You have a series of colds that blend one into the other until you can't remember the last time you were well. So you blame your silicon implants. Or you resolve to stop eating so much sugar. Or, if you're part of a clinical trial, you stop taking the drug. It's then that as the sponsor of the trials you're grateful you included controls. Because when you examine the data you learn that as many of the control patients came down with the flu as those who were on the active drug. And those women without implants had exactly the same incidence of colds and headaches as those who had them.

Human parvovirus See B19 virus

May occur repeatedly, although serious disease is associated with the first or second infection. Causes 'colds' in captive chimpanzees. Causes no symptoms in ferrets and can be serially passaged in them. Freezing of specimens for virus isolation reduces the chance of success. Diagnosis is by immunofluorescence using exfoliated cells, or by ELISA test of respiratory secretions. Replicates in human cell lines such as HeLa and Hep-2 and less readily in monkey kidney cell cultures. Small syncytia appear and within 1-4 days the whole cell sheet is involved. No demonstrable hemadsorp-tion. No replication in eggs. Virion 90-120nm in diameter and variable in size. Matures at the cell surface by budding in polarized epithelial cells budding is from the apical surface. There is a helical nucleocapsid 12-15nm in diameter containing negative-sense single-stranded RNA, 15222 nucleotides in length, encoding 10 genes. The virion RNA gene order is 3'-NS1-NS2-N-P-M-SH-G-F-M2-L-5'. The 3' end has a...

Synergistic Antimicrobial Combinations

Some of the combinations that showed synergy are used routinely for the therapy of mixed aerobic-anaerobic infections. These include the combination of clindamycin or metro-nidazole plus an aminoglycoside used for the therapy of intra-abdominal and pelvic infections, and the combination of metronidazole and a macrolide for the therapy of upper respiratory tract infections. The synergistic effect against some anaerobic strains noticed by the above studies (Table 8) is a valuable additional asset.

Moderate to Severe Disease

The newest addition to our therapy options for patients with CD is antitumor necrosis factor therapy, infliximab (Sandborn and Targan, 2002). In patients with moderately to severely active CD, a single infusion of 5 mg kg of inflix-imab (Remicade) results in response and remission rates of 81 and 48 , respectively, at 4 weeks (Hanauer et al, 2001). The efficacy does not appear to be influenced by the disease location. The onset of action is rapid, with response within 2 weeks of therapy and lasting approximately 8 to 12 weeks. An induction regimen with 3 infusions at weeks 0, 2, and 6 is recommended because of its superior efficacy and lower immunogenicity compared with single infusions (Hanauer et al, 2002). Most patients tolerate infliximab therapy well. Common side effects include headache, myalgia, upper respiratory tract infections, fatigue, nausea, abdominal pain, and diarrhea. Acute infusion reactions occur in approximately 6 to 16 of patients, and may present with flushing,...

Reticuloendotheliosis virus strain TA

Some 40 of cases have an association with various drugs or chemicals, especially aspirin and related salicylates. There are often symptoms and signs of upper respiratory tract infection, and an association with various viruses has been suggested, but the evidence is not very strong and environmental or constitutional factors may be important. The addition of warning notices on aspirin bottles in the USA has helped to reduce the number of cases. Synonym Reye-Johnson syndrome.

Evaluation of Ad Replication in Hamster Lungs

The natural site of Ad5 replication in humans is the lung, where it causes a mild respiratory illness in young children. In order to evaluate the replication of an oncolytic Ad vector in the lungs and thus the cancer-specificity of your vector, inoculate the hamster by endotracheal instillation of the vector, harvest the lungs, and determine the total virus yield from the lungs.

Otitis Media With Effusion

OME is a common cause of mild hearing loss in children, most often between the ages of two and seven years. The middle ear contains fluid that varies from a thin transudate to a very thick consistency (glue ear). Eustachian tube obstruction is usually caused by primary congenital tube dysfunction. Other possible contributing factors are allergic rhinitis, adenoidal hyperplasia, supine feeding position, or a submucous cleft. Middle-ear effusion was found to persist for at least one month in up to 40 of children who had suffered from AOM, and for at least three months in 10 of afflicted children (27).

Clinical Signs and Diagnosis

Acute adenoiditis may occur alone or in association with rhinitis or tonsillitis. It produces pain behind the nose and postnasal catarrh, lack of resonance of the voice, nasal obstruction, and feeding difficulties in infants, and it is often accompanied by cervical adenitis. Chronic adenoiditis may result from repeated acute attacks or from infection in small adenoid remnants. The main symptom is postnasal drip. This secretion is seen to hang down behind the soft palate as tenacious mucopus. Mouth breathing and persistent rhinitis are characteristic symptoms. With severe adenoid hypertrophy, the mouth is kept open during the day as well as during sleep, and the mucous membranes of the mouth and lips are dry. Chronic nasopharyngitis may be constantly present or recur frequently. The voice is altered, with a nasal, muffled quality. The breath is foul smelling and frequently offensive, and taste and smell are impaired. A harassing cough may be present, especially at night, resulting from...

Chronic Bacterial Sinusitis Antiinflammatories

Long-term, low dose macrolide therapy represents one attempt at controlling the inflammation associated with chronic sinusitis (80). Medicines that have anti-inflammatory properties and are well tolerated are sought to help ease the reliance on systemic corticosteroids that affect both the number and function of inflammatory cells. When used in a topical form, nasal steroid sprays have been shown to be safe and effective in reducing the symptoms of alleric rhinitis (81). Their use in patients with chronic sinusitis can decrease the size of nasal polyps, and diminish sinomucosal edema (82). There are no set guidelines for the duration of use, and the expected side effects from long-term use are not yet known. Experience in using oral steroids for the treatment of chronic sinusitis is only anectodal. The extended use of oral steroid may result in serious side effects that include muscle wasting and osteoporosis. Because of the side effects, steroids are tapered and given in short...

Preoperative abnormalities

Asthma, hypereosinophilia ( 1.5 X 109l-1), necrotising vasculitis, extravascular granulomas, and allergic rhinitis.The vasculitis involves two or more extrapulmonary organs.The combination of late onset asthma with severe, recurrent sinusitis that requires surgery, particularly if there are abnormal paranasal sinus X-rays, may give a clue to the presence of the disease (D'Cruz et al 1999).

Early DP antagonists and their related analogs

BW A868C (2) is one of the early DP antagonists reported in the literature. It binds the DP receptor with a Kd value of 1.45 nM (Kd was determined using human platelets) 28 . S-5751 (3) was the first DP antagonist reported to be under evaluation in clinical trials for rhinitis and asthma 29 . S-5751 demonstrated binding IC50 value of 1.9 nM in 3H -PGD2 binding assays using human platelet membranes. It also inhibited PGD2-induced cAMP formation in human platelets with an IC50 of 0.9 nM 30 . Several other DP antagonists, structurally similar to 3, were described in the literature. Compound 4 had a binding IC50 value of 130 nM and an IC50 value of 70 nM in a functional assay 31 .

Equine abortion herpesvirus Synonym for

Equine arteritis virus (EAV) The type species in the genus Arterivirus. Horses are the only susceptible species. Causes epizootics and is highly contagious, infecting mainly young animals via the respiratory tract. Causes fever, conjunctivitis, rhinitis, edema of the legs and trunk, enteritis and colitis. In pregnant mares the fetus may become infected and abortion occurs. Bronchopneumonia and pleural effusions occur in fatal cases. There is medial necrosis of small arteries and when the intima is involved, thrombosis. The virion is 50-70nm in diameter with a core 20-30nm in diameter, enveloped, inactivated by lipid solvents and low pH. Replicates in horse kidney cell cultures with CPE. Virus becomes attenuated on passage in tissue culture and can be used as a vaccine. Synonyms epizootic cellulitis virus equine infectious arteritis virus equine influenza virus fievre typhoide du cheval virus infectious arteritis of horses virus pferdestaupe virus pink eye virus.

Subacute myeloopticoneuropathy virus

Suid herpesvirus 2 (SuHV-2) An unas-signed species in the family Herpesviridae. Causes rhinitis and destruction of the turbinates, with distortion of the snout, epistaxis and sneezing, notably in 2-week-old piglets, when death is common. Transmission is possible in piglets but not in adult pigs. Disease occurs in outbreaks and inclusions are present in the cells of many organs. Can be cultivated in primary pig cell cultures, replicating better in epithelial than in fibroblastic cells. Synonyms inclusion-body rhinitis virus swine cytomegalovirus.

Far East Russian encephalitis virus

Feline calicivirus (FCV) A species in the genus Vesivirus. Several serotypes are described. Most strains have been isolated from the respiratory tract but some may be associated with the gastrointestinal tract. Experimental exposure to aerosol of virus caused rhinitis, conjunctivitis, oral ulceration and pneumonia. Infection most often seen in catteries, may be mild or severe, even fatal. Replicates in cultures of feline cells more readily than rhi-novirus. An attenuated strain is used as a vaccine, given intranasally or i.m. Synonyms cat flu virus.

Callitrichine herpesvirus 2 CalHV2 An

Canid herpesvirus 1 (CaHV-1) A species in the genus Varicellovirus. There is only one serotype, which has worldwide distribution. A natural infection in dogs, often silent but may cause necrotizing rhinitis and pneumonia, frequently fatal in newborn puppies. The necropsy findings are predominantly disseminated focal necroses and hemorrhages in kidneys, liver, lungs, spleen, thymus and brain. May cause tracheobronchitis (kennel cough) in older animals but this condition can also be caused by an adenovirus. Replicates in primary dog kidney cell cultures and all canine cell lines that have been tested with CPE. No CPE in human, bovine or porcine cell cultures. Synonyms canine herpesvirus canine tra-cheobronchitis virus kennel cough virus.

ARCAs for Prostate Cancer CV706 and CV787

Members of the human Adenoviridae family were first cultured from the tonsils and adenoids of children in 1953 29 . They represent 51 different serotypes which are distinguishable by antibody reactivity to epitopes on the virion surface. Each serotype is assigned to one of five subgroups (A-E). Adenovirus type 5 (Ad5), a member of Subgroup C, is associated with a self-limiting, febrile respiratory illness and ocular disease in humans infectious virus can be recovered from the throat, sputum, urine, and rectum. Ad5 is also associated with renal impairment, hepatic necrosis, and gastric erosions in immunosuppressed individuals 30, 31 . Ad5 and the other Subgroup C viruses have little or no oncogenic potential in mammals 32 .

Cladosporium Herbarum Nasal Problems Mexico

September 20) but also during the time of year Alternaria spore counts are high (July through October) (Reed, 1985). Cladosporium herbarum has been shown to be a potential cause of allergic asthma and rhinitis (Malling, 1990). Curvularia lunata was found to be a cause of allergic bronchopulmonary disease (Halwig et al., 1985). Epicoccum nigrum was reported to be able to colonize nasal sinuses and cause allergic fungal sinusitis (Noble et al., 1997). Sooty molds caused allergies ranging from rhinitis to asthma in the eastern United States (Santilli et al., 1985). Basidiospores of Agaricus campestris, Coprinus micaceus, Lycoper-don perlatum, Scleroderma lycoperdoides, and Ustilago maydis caused allergies ranging from rhinitis to asthma in the eastern United States (Santilli et al., 1985). Basidiospores are antigenic and can elicit immediate skin reactivity in sensitive patients. Mushrooms and basi-diospores are considered most likely to be of outdoor origin, although mycelia and conidia...

Bovine hemadsorbing enteric virus

Bovine herpesvirus 1 (BoHV-1) A species in the genus Varicellovirus. A natural worldwide infection in cattle, but antibodies can also be found in mule deer, Odocoileus hemionus, and ferrets are susceptible to disease in the USA. Wild ruminants in Africa are probably the original host. The virus has also been isolated from soft-shelled ticks, Ornithodorus coriaceus, collected from mule deer in western USA, but it is not clear whether ticks are a reservoir host. May cause a silent, mild infection, or acute disease of the whole respiratory tract. Mortality can be as high as 75 . In Europe it has been known to cause conjunctivitis and, notably, disease of the genital tract when lesions appear on the external genitalia. There is no evidence of antigenic difference between the respiratory and genital strains. Young goats infected experimentally develop fever in rabbits there is meningoencephalitis with paralysis of the hind legs. Transmission of the virus is by contact, especially under...

Equine morbillivirus EMV See Hendra virus

Equine rhinitis A virus (ERAV) A species in the genus Aphthovirus. Causes upper respiratory tract infections of horses whereas all other members of the genus cause foot-and-mouth disease. Included in the genus because of similarities in genome organization and structure to Foot-and-mouth disease virus. Synonym equine rhinovirus 1. Equine rhinitis B virus (ERBV) An unas-signed species in the family Picornaviridae. Causes upper respiratory tract infections of horses. equine rhinovirus 1 Former name for Equine rhinitis A virus. equine rhinovirus 2 Former name for Equine rhinitis B virus. equine rhinovirus 3 (ERV3) An unassigned virus in the family Picornaviridae. Replicates with CPE in cell cultures of horse, monkey, humans and rabbit tissue. Does not require low temperature or low bicarbonate. Worldwide infection causing rhinitis and pharyngitis, often with fever. Incubation period 3-7 days. Rabbits, guinea pigs, monkeys and humans can be infected. Spreads readily in stables virus may...

Human astrovirus 18 HAstV1 to

Human coronaviruses 229E and OC43 (HCV-229E and HCV-OC43) Species in the genus Coronavirus. Cause acute respiratory disease (common colds) in humans mainly from January to March. 229E virus was isolated in 1966 in human embryonic kidney cells from a medical student with a cold. OC43 virus was isolated in 1967 in organ culture from a patient with respiratory infection. Not always easy to isolate human tracheal organ cultures are probably the best method for primary isolations. The corona-like virus particles seen in feces and associated with diarrhea are difficult to isolate even in organ cultures. Strains have a common CF antigen but differences in antigenic structure can be demonstrated by neutralization tests and they belong to different coronavirus anti-genic groups. OC43 is antigenically related to mouse hepatitis virus and 229E is related to coronaviruses of pigs (TGEV) and cats (FECV). Some strains of OC43 virus agglutinate human and monkey erythrocytes at 4 C, and chicken, rat...

APCs In Initiation Of Mucosal Immune Responses

Antigens can be taken up across the epithelial linings of various mucosal tissues, and many of these tissues then generate robust sIgA responses. Most of our knowledge about this response has been gained from studies of gut-associated lymphoid tissue in rodents and of human tonsils. The major inductive sites of the mucosal immune system are follicles and organized aggregates of follicles, exemplified by Peyer's patches in the intestine and referred to generically as mucosa-associated lymphoid tissue (MALT). Antigens are often efficiently absorbed by specialized cells in the epithelium overlaying the MALT, the morphologically distinct M cells (37,38). In some cases dendritic cells extend processes between neighboring epithelial cells to sample antigens in the external milieu (39). Despite the well-developed conjunctival lymphoid follicles, however, most of the IgA+ plasma cells that populate the lacrimal glands appear to be generated in the gut or upper respiratory system, rather than...

Mixed Infections Involving Anaerobic BLPB

BLPB were found in 262 (51 ) of 514 patients with upper respiratory tract infections 72 URTI had aerobic BLPB and 57 had anaerobic. The infections in which these organisms were most frequently recovered were adenoiditis (83 of patients), tonsillitis in adults (82 ) and children (74 ), and retropharyngeal abscess (71 ). The predominant BLPB were S. aureus (49 of patients with BLPB), pigmented Prevotella and Porphyromonas (28 ) and the B. fragilis group (20 ).

Japanese hemagglutinating virus

JC polyomavirus (JCPyV) A species in the genus Polyomavirus. Antigenically distinguishable from BK virus and SV40 virus. Agglutinates human group O erythrocytes. Originally isolated from the brain of a patient with progressive multifocal leukoencephalopathy (PML) by inoculation of homogenized brain tissue into primary human fetal glial cell cultures. Has been clearly identified as the cause of PML, as well as renal disease and upper respiratory tract infections. Can be

Indole acetic acid derivatives and related compounds

Tes Organisches Molek

Numerous 1-indole acetic acid derivatives compounds have been reported as CRTH2 antagonists. These include the tetrahydrocarbazole derivative 17, Rama-troban (BAY U3405), which is currently marketed in Japan for allergic rhinitis 51 . Ramatroban was developed as a thromboxane A2 receptor (TP) antagonist later it was also shown to be a CRTH2 antagonist. Ramatroban has been reported to reduce antigen-induced early and late-phase allergic responses in mice, rats and guinea pigs. In humans, Ramatroban has been reported to attenuate PGD2-induced bronchial hyper-responsiveness 52,53 . It has been postulated that the efficacy observed with Ramatroban in humans cannot be fully explained by its action on TP and that Ramatroban's efficacy in humans is due in part to its CRTH2 antagonist activity 23 . The affinities of Ramatroban and its close analogs, 18 and 19, for the CRTH2 receptor were determined using a 3H -PGD2 binding assay (K values for Ramatroban, 18 and 19 were 4.3, 0.5 and 0.6 nM,...

Churg Strauss syndrome

A syndrome of asthma, allergic rhinitis, pulmonary and systemic small-vessel vasculitis and extravascular granulomas. Reid et al (1999) reported organ systems involvement as follows lungs (48 ), heart (44 ), kidney (48 ), nervous system (78 ),skin (48 ),bowel (30 ), joints (57 ), and muscle (57 ).The presence of severe gastrointestinal disease or myocardial involvement is associated with a poor prognosis (Guillevin et al 1999). It has sometimes been associated with the new leukotriene antagonists used for asthma. However, it is thought that the disease is unmasked when these drugs replace corticosteroids for treatment, rather than being the cause of it (Churg & Churg 1998, Stirling & Chung 1999).

Pulmonary Pathophysiology

Asthma And Fibrosis

Bronchitis is an inflammation of the airways resulting in excessive mucus production in the bronchial tree. Bronchitis occurs when the inner walls of the bronchi become inflamed. It often follows a cold or other respiratory infection and happens in virtually all people, just as the common cold. When the bronchitis does not go away quickly but persists, then it is termed chronic bronchitis.

Preoperative Treatment Of Patients With Pheochromocytomas

Sive are also usually treated (carefully) preopera-tively. Phenoxybenzamine (Dibenzyline, 10 mg capsules), an oral nonselective a-blocker, is the most commonly used a-blocker it is given orally in a starting dose of 10 mg daily and increased by 10 mg every 3 to 5 days until the blood pressure is 140 90 mm Hg. Hydration should be encouraged. Patients must be monitored for worsening orthostatic hypotension. Other adverse effects are common, including dry mouth, headache, diplopia, inhibition of ejaculation, and nasal congestion. (Patients are cautioned not to use nasal decongestants if urinary catecholamines or 123I-MIBG scanning is planned, but antihistamines are acceptable.) Phenoxybenza-mine crosses the placenta and can cause hypotension and respiratory depression in the newborn for several days following birth.60 Most patients require 30 to 60 mg day, but the dosage is sometimes escalated to as high as 120 mg day. Excessive alpha-blockade with phenoxybenzamine is undesirable because...

Diagnosis Investigation And Discussion

Diagnosed (laryngoscopy showed glottis oedema and a 1 -2 mm white lesion on the right ventricular band). On the basis of synchronous symptoms we investigated two associations ear involvement with hearing loss and rhinitis with sinusopathy. Rhinitis with sinusopathy was diagnosed based on rhinoscopy showing hyperaemia with no focal lesion and perinasal sinuses CT-scan images compatible with chronic pansinusopathy of ethmoido-maxilar predomination, with destructive characteristics (amputation of the conchae and sept perforation). ENT findings were normal otoscopy positive hearing tests for mixed conductive and sensory hearing loss of light degree on the left side and of moderate degree on the right side. CT scan of the temporal bones showed bilateral middle ear involvement right side occlusion of the oval and round windows by liquid collection no signs of cholesteatoma or of ossicle destruction, compatible with bilateral medial chronic otitis, particularly on the right ear. It is known...

Background information on asthma and bronchiolitis

Upper respiratory tract infections are the commonest precipitant of symptoms of asthma in the preschool child. Ninety per cent of these infections are caused by viruses. Exercise-induced symptoms are more frequent in the older child. Heat and water loss from the respiratory mucosa appears to be the mechanism by which exercise induces bronchoconstriction. Acute exacerbations may also be precipitated by emotional upset, laughing or excitement. It is hard to assess the importance of allergen exposure to the onset of acute symptoms in an individual asthmatic, partly because of the ubiquitous nature of the common allergens (house dust mite, grass pollens, moulds) and partly because delay in the allergic response makes a cause and effect relationship difficult to recognise. A rapid fall in air temperature, exposure to a smoky atmosphere and other chemical irritants such as paints, and domestic aerosols may trigger an acute attack.

Distribution and Clearance of Adenovirus from the Respiratory Tract

Adenovirus is an important respiratory pathogen affecting individuals of all ages with an annual incidence of between 5 to 10 million in the United States. Infections can occur sporadically, epidemically and nosocomially but most individuals are infected at a young age adenovirus accounts for 7 to 10 of all respiratory illnesses in infants and children 8, 9 . Although adenovirus frequently causes a mild, acute upper respiratory illness, e.g., the common cold, respiratory infections occur as a broad spectrum of distinct clinical syndromes ranging from self-limited acute pharyngitis to fatal pneumonia 10-12 , Adenovirus has also been identified an etiological factor of exacerbations in individuals with chronic obstructive lung diseases and infections can be especially problematic in immunocompromised individuals. Examples of the latter include persistent bladder infections in individuals with chemotherapy-induced neutropenia, fatal pneumonia in neonates, and exacerbation of graft...

Alternative Complementary And Integrative Medicine

Proponents of complementary or integrative medicine tend to be interested in herbal remedies, vitamins, and other so-called dietary supplements. When Congress passed the Dietary Supplement and Health Education Act of 1994, it allowed significant differences between the marketing of prescription medicines and dietary supplements. Prescription drugs must provide proof of safety and efficacy to secure Food and Drug Administration (FDA) approval, but the agency cannot recall products sold as dietary supplements from the market unless the FDA can prove that they are harmful. Supplement manufacturers are permitted to use advertisements and testimonials claiming that their products are ''all natural'' and ''completely safe.'' Stores specializing in dietary supplements, herbs, and vitamins sell products that purportedly boost metabolism, improve cardiovascular health, prevent health attacks, and so forth. Food and beverage companies have experimented with ''functional'' or ''nutraceutical...

Adjuvant Therapies Acute Bacterial Sinusitis

Patients with a viral URTI may benefit from symptomatic therapy, aimed at improving their quality of life during the acute illness. The use of normal saline as a spray or lavage can provide symptomatic improvement by liquefying secretions to encourage drainage. The short-term (three days) use of topical alpha-adrenergic decongestants can also provide symptomatic relief, but their use should be restricted to older children and adults due to the potential for undesirable systemic effects in infants and young children. Topical glucocorticosteroids may also be useful in reducing nasal mucosal edema, mostly in those cases where a patient who has seasonal allergic rhinitis develops the complication of an acute URTI. The antipyretic and analgesic effects of nonsteroidal anti-inflammatory agents can relieve or ameliorate the associated symptoms of fever, headache, generalized malaise, and facial tenderness. Until the clinical diagnosis of acute bacterial sinusitis is established, management...


The anatomy of the airway itself changes with age, and consequently different problems affect different age groups. Infants less than 6 months old are obligate nasal breathers. As the narrow nasal passages are easily obstructed by mucus secretions, and upper respiratory tract infections are common in this age group, these children are at particular risk of airway compromise. In 3 to 8 year olds adenotonsillar hypertrophy is a problem. This not only tends to cause obstruction, but also causes difficulty when the nasal route is used to pass pharyngeal, gastric, or tracheal tubes.


Since their discovery, adenoviruses have served the scientific community as a powerful tool for research of important virological as well as cellular events. Adenoviruses were first isolated as a result of researchers pursuing the causative agent of the common cold. Rowe and colleagues, in 1953, observed cytopathic effect in primary cell cultures derived from human adenoids 1 . The following year, the same effect was seen in cells exposed to respiratory secretions by Hilleman and Werner, who were trying to uncover the cause of acute respiratory disease in Army recruits 2 . It was later shown that adenoviruses, so named after its source of origin, were not the etiologic agent of the common cold, since they cause practically no respiratory morbidity among the general population. However, adenovirus (Ad) has been shown to cause severe respiratory distress in immunocompromised individuals 3 . Ad infection can also result in epidemic conjunctivitis 4 as well as a number of other syndromes,...

Gene Therapy Primer

When we get sick, it often is due to invading microbes that destroy or damage cells and organs in our body. Cholera, smallpox, measles, diphtheria, AIDS, and the common cold are all examples of what we call an Commonly used viruses are the retrovirus and the adenovirus. A retrovirus gets its name from the fact that it has an RNA genome that is copied into DNA after it infects a cell. Corona viruses (which cause the common cold) and the AIDS virus are common examples of retroviruses. The adenovirus (from adenoid, a gland from which the virus was first isolated) normally infects the upper respiratory tract, causing colds and flulike symptoms. This virus, unlike the retrovirus, Vectors used in gene therapy. Adenoviruses have a DNA genome contained in a crystalline protein capsid, and normally infect cells of the upper respiratory tract, causing colds and flulike symptoms. The protein filaments are used to infect cells. Retroviruses have an RNA genome that is converted to DNA when a cell...

Figure 832

Hypertensive crises secondary to monoamine oxidase inhibitor-tyramine interactions. Severe paroxysmal hypertension complicated by intracerebral or subarachnoid hemorrhage, hypertensive encephalopathy, or acute hypertensive heart failure can occur in patients treated with monoamine oxidase (MOA) inhibitors after ingestion of certain drugs or tyramine-containing foods 48,49 . Because MAO is required for degradation of intracellular amines, including epinephrine, norepinephrine, and dopamine, MAO inhibitors lead to accumulation of catecholamines within storage granules in nerve terminals. The amino acid tyramine is a potent inducer of neurotransmitter release from nerve terminals. As a result of inhibition of hepatic MAO, ingested tyramine escapes oxidative degradation in the liver. In addition, the high circulating levels of tyramine provoke massive catecholamine release from nerve terminals, resulting in vasoconstriction and a paroxysm of severe hypertension. A hyper-adrenergic...

Adjunctive Therapy

Adjunctive therapy is intended to promoted drainage of secretions and improve oxygenation to the obstructed sinus ostia. Multiple agents with different mechanisms of action are often administered. These include decongestants that are alpha-adrenergic agonists that constrict the capacitance vessels and decrease mucosal edema. Topical therapy such as oxymetazoline or neosynephrine may be used in an acute setting, but overuse can cause a rebound effect and rhinitis medicamentosa. Systemic decongestants can be used for longer periods of time, but may cause insomnia and exacerbation of underlying systemic hypertension. Antihistamines are used in patients with underlying allergic rhinitis. They can relieve symptoms of itching, rhinorrhea, and sneezing in allergic patients, but in nonallergic patients they can cause thickening of secretions, which may prevent needed drainage of the sinus ostia. Guaifenesin (glyceryl guaicolate) given in a daily dose of 2400 mg thins secretions, thus...

Tourette Syndrome

A variety of environmental factors have been proposed as etiologic or modifying agents. Classical tics can be exacerbated by external factors (stress, anxiety, and fatigue), elevations of temperature, infections, and the use of other medications.9,10,25 Postulated predisposing factors include low birth weight, conditions influencing intra-uterine growth,26 exposure to medications or illicit drugs,27,28 hyper-thermia,29,30 and infections.31-34 A hypothesized role for infections, especially streptococcal infections, as a primary etiology for tics has been suggested for many years.31,35-38 Proposals of relationships between tics and infectious agents are not, however, limited to Group A b-hemolytic streptococcal (GABHS) infection. Typical symptoms of TS have also been reported in isolated cases following acute infections with Streptococcus pyogenes, lyme borreliosis, and Mycoplasma pneumoniae,33,34,39 and exacerbations have followed common colds.40 Individuals may also have multiple...


Related to a combination of the anatomical abnormalities of the mandible, with functional impairment of the genioglossus and other pharyngeal muscles that are concerned with maintenance of the airway.Varying degrees of obstruction exist, ranging from none at all, to obstruction when the infant is asleep and, in the worst cases, obstruction in the awake state. In any infant, obstruction worsens during an upper respiratory tract infection, feeding, and crying. In addition, studies suggest that the site of obstruction varies from patient to patient. From endoscopic observations, these have been classified (Sher 1992).


Epiphora in a child with a history of tearing since birth has been caused mostly by an obstructive membrane within the naso-lacrimal duct (Valve of Hasner). Intermittent acquired epiphora in an adult usually results from partial stenosis of the membranous duct and or dacryolithiasis, and may also be seen in patients with allergic rhinitis. The relationship of symptoms to the previous medical therapy (topical idoxuridine, phospholine iodide, systemic 5-fluoro-uracil), orbital trauma, and environmental factors, however, as to the head position, stress, etc., are also factors. Previous sinus surgery should indicate the possibility of duct injury as well. The presence of recurrent sinus disease can cause rhinitis or intranasal polyps.

Dietary Restrictions

To date, there is no definite evidence that oral desensi-tization, injection immunotherapy, or similar techniques used for allergies to inhalant allergens, insect venoms, and medications, are beneficial in the prevention or modulation of food allergy. One exception to this is the oral allergy syndrome in which desensitization to the pollen benefits not only the symptoms of rhinitis but also food-induced oral manifestations. Immunomodulation via oral, subcutaneous and sublingual desensitization remain an area of controversy and these techniques are not routinely recommended in the management of food allergy.

Clinical Signs

Fever occurs in many of the cases of nasopharyngitis. With adenoviral and influenza viral disease, the pharyngeal findings are prominent, but with other respiratory viruses, rhinitis is more notable. In adenoviral infections, follicular pharyngitis and exudate are common. In contrast, the other respiratory viruses usually induce only pharyngeal erythema. Nasophar-yngitis of a viral etiology is most often an acute, self-limited disease lasting from 4 to 10 days. Adenoviral illnesses tend to be more prolonged than other respiratory viruses. Other symptomatology in nasopharyngitis is related to the causative virus.


The overwhelming majority of nasopharyngitis occurrence is caused by viral infections. Adenoviruses are the most common cause of nasopharyngitis and types 1 to 7, 7a, 9, 14, and 15, accounting for the majority of illnesses (103). Nasopharyngitis is also common with influenza and parainfluenza viral infections. Although rhinoviral and respiratory syncytial viral infections are common in children and both always have nasal manifestations (rhinitis), the occurrence of objective pharyngeal manifestations is uncommon (103). significantly in otitis media-prone children and in the general population of young children during respiratory illness (111). Brook and Gober characterized the aerobic and anaerobic bacterial flora of nasal discharge (ND) obtained from children at different stages of uncomplicated nasopharyngitis (104). A correlation was made between the bacterial flora and the eventual course of the illness. It also investigated the relationship between colonization of the nasopharynx...

Rhagades Syphilis

Congenital Syphilis Baby Skin

In an infant aged 6 weeks widi die typical findings of congenital syphilis, note die circiiiate lesions over the forehead, die excoriation at the nose due to rhinitis, and the cheilitis at die corners of the mouth. Rhinitis ( snuffles ) usually appears between the 2nd to 6th week of life and is the result of ulceration of the nasal mucosa. When the ulceration is deep enough to involve the cartilage of the nasal bone, die architecture is destroyed, thus giving rise to the classic saddle nose deformity. Mucous membrane patches are seen in approximately one-third of infants with congenital syphilis. At the mucocutaneous junctions these lesions tend to weep and may cause fissures (cheilitis) which often extend from the lips in a radiating fashion over the surrounding skin. When deep, these lesions may leave residual scars (rhagades).

Descriptive Studies

Examination of time relationships can both identify and evaluate hypotheses related to the causes of changes in conditions. The recent decrease in mortality rates for coronary heart disease in many western countries, for instance, has led to hypotheses about the roles of better diets, decreasing cigarette consumption, better control of hypertension, more physical activity, and improved methods of detection and treatment of coronary heart disease that have become the subject of further research. The decline in the incidence of Reye syndrome in the time period following a Public Health Service and American Academy of Pediatrics recommendation to avoid use of aspirin to treat children with respiratory illness, chickenpox, and fever provided evidence that aspirin use and Reye syndrome are causally linked.

Bacterial infections

Upper respiratory tract infections and pyogenic bacterial infection (sinusitis, bronchitis and pneumonia) occur more often in HIV-infected individuals than in the general population. Bacterial infections are particularly common in HIV positive intravenous drug users. The most commonly isolated organisms are Streptococcus pneumoniae and Haemophilus influenzae. Severe pneumonia due to Staphylococcus aureus or Gram negative bacteria such as Pseudomonas aeruginosa also occurs, especially in the later stages of AIDS. Respiratory infection may occur with rapid onset, the patient complaining of a cough with or without sputum and fever with chills patients are frequently bacteraemic. There is a high rate of complications including intrapulmonary abscess formation and empyema. A rapid response usually occurs to treatment with appropriate antibiotics but relapse may occur. Some groups recommend that all HIV positive patients should be immunised with polyvalent pneumococcal polysaccharide...

Quinine And Malaria

Despite Sydenham's conviction that the bark was harmless, the use of quinine can cause some very unpleasant side effects, including headaches, vomiting, rashes, and deafness. Indeed, some physicians used complaints about ringing in the ears to determine the optimum dosage for each patient. Because few practitioners, or patients, could accept the concept of specificity in diseases and remedies, Peruvian bark was freely prescribed for fevers, colds, flu, seasickness, headache, and hangovers. But quinine is a specific remedy for the specific intermittent fever known as malaria. Its use as a general febrifuge and tonic exposed many people to risks without benefits.

IgE Receptors

IgE is known as the main antibody involved in allergic inflammatory processes such as asthma, atopic dermatitis, and allergic rhinitis. Two distinct receptors have been demonstrated for IgE the high-affinity IgE receptor (FceRI), and the low-affinity IgE receptor (FceRII).