Respiratory Illness Ebook

Avoid / Cure A Cold Fast

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Upper Respiratory Tract Infections

Vitamin C Is widely used to both prevent and treat common URTI, such as the common cold and Influenza, largely based on Its Immune system effects, ability to reduce histamine levels and the observations that the gastrointestinal absorption of vitamin C Increases In the common cold, suggesting an Increased demand for this A 2004 Cochrane review of 29 placebo-controlled studies involving 11,077 participants found that regular ingestion of vitamin C in doses of 200 mg did not reduce the incidence of the common cold in the normal population however, a subgroup of six trials that involved a total of 642 marathon runners, skiers, and soldiers on subarctic exercises did find significant protective effects (Douglas et al 2004). Data from 9676 respiratory episodes suggested that regular vitamin C supplementation was consistently associated with a small reduction in the duration and severity of common cold symptoms however, the magnitude of the effect was described as small. When high doses of...

Upper Respiratory Tract Infections And The Common Cold

COMMON COLD SYMPTOM RELIEF AND REDUCED INCIDENCE The second systematic review conducted by Poolsup et al from the Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon-Pathom, Thailand, was a review of four randomised controlled trials (n 433) and they came to a similar conclusion, finding that Andrographis paniculata either by itself or in combination with Eleutherococcus senticosus (Kan Jang) is effective for uncomplicated acute URTI. Symptoms responding According to double-blind studies, numerous symptoms respond to treatment with andrographis. According to two trials that used a dose of 340 mg andrographis taken three times daily, total symptom scores improved, with throat signs and symptoms responding most strongly (Melchior et al 2000). A third study observed a decrease in rhinitis, sinus pain and headache compared with placebo (Hancke et al 1995). A fourth study using a treatment dose of 1200 mg andrographis daily found a significant reduction in tiredness...

Seasonal Allergic Rhinitis

Polysaccharides from soy sauce have been shown to have anti-allergic activities in vitro and in vivo and an 8-week double blind study involving 51 subjects with seasonal allergic rhinitis found that oral supplementation with 600 mg of soy polysaccharides was effective in significantly improving symptom scores such as sneezing, nasal stuffiness, and hindrance of daily life, as well as significantly improving the appearance and state of the nasal mucosa (Kobayashi 2005, Kobayashi et al 2005).

Common Cold

Oral zinc supplements, lozenges and nasal sprays and gels have been investigated in the treatment of the common cold. It has been demonstrated that a transient increase in zinc concentrations in and around the nasal cavity prevents rhinovirus binding to cells and disrupts infection (Novick et al 1996) and or modulates inflammatory cytokines that may exacerbate cold symptoms. Nasal preparations A randomised, double-blind placebo-controlled trial with 160 people tested the effects of a nasal spray of 0.12 zinc sulfate and found that it reduced the total symptom score, but had no effect on the duration of cold symptoms or the mean time to resolution (Belongia et al 2001). The effectiveness of intranasal zinc gluconate as a preventative agent against experimentally induced rhinovirus infection was tested in a study of 91 subjects (Turner 2001). It was administered for 3 days prior to rhinovirus inoculation followed by 6 days of treatment. This regimen had no effect on total symptom score,...

Answers To Patients Frequently Asked Questions

Andrographis has been traditionally used to improve digestion, as a liver tonic and to fight off infection. Clinical studies confirm that it is an effective symptom-reliever for the common cold, uncomplicated URTIs and pharyngotonsillitis. It has also been used to reduce the risk of developing the common cold in winter. When will it start to work

Allergic Fungal Rhinosinusitis

Allergic fungal rhinosinusitis (AFRS or AFS in the literature) is a hypersensitivity disease of the paranasal sinuses afflicting patients who are immunocompetent albeit with a history of atopy and allergic rhinitis to fungi. The disease process begins as the fungi become entrapped within the nasal cavity, presumably because of ostium obstruction or mucociliary disorder, and initiate a hypersensitive immune response. Just as with the other forms of fungal sinusitis, A. fumigatus is the most common etiological agent associated with AFRS (Table 1.1).

Invasive Fungal Sinusitis

Most cases of acute sinusitis begin with the onset of the common cold (NIAID, 2002). These viral colds do not cause acute sinusitis per se, but rather act to inflame the sinuses and surrounding mucosa. Even if immunocompromised, most hosts would still be able to clear fungal spores from the nasal cavity via ciliated cells (Baraniuk, 1994). However with the overproduction of mucus and increased inflammation caused by the cold, the size of the ostium becomes limited, and any fungi present in the sinuses can no longer be mediated effectively. This is also the case for other opportunistic organisms such as Haemophilus influenzae and Streptococcus pneumoniae (NIAID, 2002).

The Cause of Bloom Syndrome

Tommy was a full-term baby but weighed only 4.5 pounds (2 kg) at birth. At about 9 months of age, an unusual and persistent rash appeared on his face, and he frequently caught colds and infections. The illnesses caused no serious problems so his parents were not concerned. Throughout childhood, Tommy remained small by age 18, he was only 4 feet 6 inches (137 cm) in height.

Reflection of Effects on Th1 Th2 and Treg Differentiation

Also Lactobacillus strains have been shown to confer differential effects on cytokine production and expression of surface markers on murine dendritic cells (85). Furthermore, lactobacilli induced in vitro, in a strain dependent manner, Treg-like low proliferating Th population producing TGF-b and IL-10 (86). TGF-b is the key cytokine in induction of T-cell differentiation towards Tregs (Fig. 2) (87). In a clinical study, improvement in atopic eczema symptoms following oral administration of lactobacilli was accompanied by increased serum concentrations of TGF-b (17). Interestingly, oral supplementation of lactobacilli in breast-feeding mothers was followed by increased TGF-b concentrations in breast-milk (88). This increase may have contributed to subsequently lower prevalence of atopic eczema in children. It should be noted, however, that allergic sensitization was not affected and allergic rhinitis and asthma may have increased in frequency (89). Nevertheless, these studies are not...

Determining Whether Bayesian Algorithms Are Well Calibrated

We note that an algorithm can trivially meet this requirement by simply outputting the prior probability of an outbreak for each day therefore, such an evaluation represents a necessary but not sufficient test of the algorithm. As illustrated in Figure 13.13 (Chapter 13), the RODS system uses the case detection algorithm SyCO2 to compute a time series of daily counts of respiratory syndrome'' by summing the posterior probability of respiratory syndrome'' produced by SyCO2 for all patients visiting an emergency room on each day. If SyCO2 is well-calibrated, the daily sums should equal the actual number of patients with respiratory illness each day, which could be verified by examination of patient charts or some other gold-standard ascertainment method.

Surveys of Sick Individuals about their Use of OTC Healthcare Products

Another survey found that 76 of individuals who reported an upper respiratory tract infection in the last two weeks self-treated with an OTC medication only 14 visited a physician (McIsaac et al., 1998). This survey did not assess the timing of OTC use relative to the timing of visits to physicians, but it did assess the timing of visits to physicians in the course of illness. The study found that nearly two-thirds of sick individuals who visited a physician did not do so until after the second day of illness and one-third did not do so until after the fourth day of illness. This survey was extensive. The researchers interviewed

Aspirin nsaid hypersensitivity

NSAID hypersensitivity tends to present in early adult years as rhinorrhea, nasal congestion, and hyposmia. In patients with asthma, NSAID hypersensitivity may develop concurrently or some years after the diagnosis of asthma has been established. In both groups, peripheral blood and tissue eosinophilia and pansinusitis with nasal polyposis are common. Approximately 10 of patients with steroid-dependent asthma have been found to be NSAID hypersensitive, whereas one-third of asthmatics with associated nasal polyposis and chronic sinusitis are sensitive to this class of drug. Although most normal patients tolerate these drugs, epidemiological studies suggest adverse reaction rates of up to 1 . patients with this syndrome, pansinusitis is common. Although nasal polyps may complicate ordinary allergic rhinitis (approximately 1-2 in some studies) and are a common manifestation of cystic fibrosis (up to 50 of such patients), the highest incidence of nasal polyps occurs in the patients with...

Patients with Cystic Fibrosis

Amongst children with cystic fibrosis (CF) mortality rates due to respiratory illness have fallen markedly in the last three decades (Panickar et al., 2005) and the long term outlook has much improved. Perhaps as a result of this improvement, European and North American CF centers have recently recorded NTM infection prevalence rates of 2-28 (mostly Mycobacterium avium intracellulare) compared with just 16 CF case reports prior to 1990. When a clinical specimen raises the possibility of NTM disease in the context of progressive CF, it is often difficult to resolve whether this infection represents colonization or clinically significant disease. In a comprehensive US prevalence study in which approximately 10 of the US CF population over 10 years was enrolled, the prevalence of NTM infection was 13 (Olivier et al., 2003b). No genetic association or clustering of NTM infection was observed. However, NTM infection was strongly associated with age (approximately 50 of those affected were...

Measured and modelled exposure

Studies have sought an association between transport-related air pollution and allergic respiratory illness or symptoms. Using models for exposure, Brauer et al. (2002) detected associations with increased incidence of asthma in the first two years of life. Although not statistically significant, this association was in general robust, because the ORs were not altered to any great extent by the inclusion of potential confounding variables in the regression models or the sensitivity analyses. One must consider that the children observed were too young to have a reliable diagnosis of asthma, but the determination of wheeze, and its association with transport-related air pollution (also detected in this study), supports this diagnosis. The German part of the TRAPCA project, in which only a few asthma cases were reported, however, found no association of asthma incidence with transport-related air pollution (Gehring et al., 2002).

Internet As Sentinel I Promedmail

There were 15 additional postings between February 10 and March 14. On March 14, ProMED-mail disseminated five reports of outbreaks of deadly or severe respiratory illness in four countries in East Asia (Singapore, Taiwan, Vietnam, and China), many in hospitals, and all with no known etiology (ProMED-mail, 2003b). That same day, ProMED-mail disseminated a Government of Ontario Press Release about four cases of atypical pneumonia in Canada (Toronto and British Columbia), and the editor noted an unconfirmed report that the British Columbia case had a travel history to Hong Kong (ProMED-mail, 2003a). On March 15, 2003, ProMED-mail followed up with a formal WHO report of a new entity named SARS (ProMED-mail, 2003f).

Clinical Presentation

Lymphadenopathy may be a presenting sign or symptom or an incidental finding. Up to two thirds of patients have non-specific causes or upper respiratory illness. Patients may present with sore throat, cough, fever, night sweats and fatigue or weight loss. There are many diseases associated with lymphadenopathy. The major categories are listed in Table 44.1.

Clinical Manifestations

Most patients with SJS have a distinct prodrome of an upper respiratory illness with fever, sore throat, rhinitis, malaise, vomiting, and diarrhea 1 to 14 days prior to the mucocutaneous eruption. Two or more mucosal sites must be involved to make the diagnosis of SJS. The oral mucosa is always involved with extensive superficial necrosis of the lips and mouth, leading to hemorrhagic crusts and followed by denudation of the mucosa and severe stomatitis (Fig. 7). Purulent conjunctivitis with photophobia can be seen. Anal and genital mucosa, and less commonly the esophagus, respiratory epithelium, and nasal mucosa can also be involved.

Prevalence Of Latelife Depression And Anxiety

Depression is often thought of as the common cold of geriatric mental health but Blazer (1997) states that anxiety is more common than major depression in later life. Using data from the ECA, Regier et al. (1988) reported one-month prevalence rates of 5.5 for older adults. As with depression, anxiety was less common in later life as the prevalence rate was 7.3 for younger adults (for review see Powers et al., 2002). Lindesay, Brigs & Murphy (1989) reported prevalence rates of 10 overall for anxiety disorders in their older adults sample. In older people, generalized anxiety disorder (GAD) and the phobias (agoraphobia,

Enhance Wound Healing

Nasal spray A RCT of 48 outpatients diagnosed with rhinitis sicca anterior found that dexpanthenol nasal spray is an effective symptomatic treatment for this condition (Kehrl & Sonnemann 1998). Two years later, another RCT compared the effects of xylometazoline-dexpanthenol nasal spray versus xylometazoline nasal spray over a 2-week period in 61 patients with rhinitis after nasal surgery (Kehrl & Sonnemann 2000) and showed that the combination of xylometazoline-dexpanthenol nasal spray was significantly superior to the other treatment and well tolerated.

Allergy and Dermatitis

There is clear evidence that otitis media with effusion is highly related to an allergic diathesis. When this converts to chronic draining otitis media, the allergic component would seem to still be relevant, although direct evidence is scant (17-19). Therefore, the surgeon must consider allergy evaluation, based on a patient history of other allergic diatheses, especially of the unified respiratory epithelium. Patients with chronic draining ear and allergic rhinitis, chronic rhinosinusitis, and asthma are strong candidates for allergy workup before contemplating surgical treatment.

Antidepressants MAOI group

In addition to their anticholinergic side-effects (similar to those described above for the tricyclics), MAOIs may cause potentially dangerous interactions with sympathomimetic drugs (including common-cold remedies) and tyramine-containing foods (Box 23.5), which must therefore be avoided. Such interactions produce headache and palpitations rarely, they can produce a hypertensive crisis that may lead to stroke or sudden death. In order to do so, however, the

Health Outcomes Of Stressful Life Events

Life Events Theory Health Psychology

Efforts in contemporary life event research aim at a better understanding of the linkage between stress and the manifestation of illness. Research striving to identify single events as the cause of illness often fail. Ideally, nding a truly causal relationship between a specic stressor (e.g., loss of a loved person) and a specic disease (e.g., breast cancer) would be a breakthrough in this eld. The onset of specic diseases has been related frequently to prior stress experience. Tension headache, for example, seems to be closely connected to daily hassles, whereas a link to major life events has not been found. Infectious diseases such as the common cold can be triggered by stress. Prospective studies have shown that people develop a cold several days after the onset of negative life events. Experimental studies with the intentional administration of cold viruses have found that persons under stress are more likely to develop a cold than if they are relaxed. In a British common cold...

Rhinocerebral Mucormycosis

And soft-tissue swelling are initially seen, followed in a few days by double vision, increasing fever, and obtundation. Examination reveals a unilateral generalized reduction of ocular motion, chemosis, and proptosis. Facial skin adjacent to paranasal sinuses may be invaded by direct extension, turning progressively red, purple, and black. Fever, decreased vision, and facial swelling are the most common complaints in the first 72 hours of the disease (6). Other common complaints include facial pain and nasal congestion or discharge. Headache was found early in the disease in only 25 of patients in one large study but may be a common late finding.

Common presenting symptoms

Common presenting symptoms in Australian practices are presented in Table 1.1 , 5 where they are compared with the United States of America. 6 The similarity is noticed but the different classification system does not permit an accurate comparison. In the third national survey of morbidity in general practice in Australia 5 the most common symptoms described by patients were cough (7.5 per 100 encounters), throat complaints (4.7 per 100), back complaints (3.8 per 100) and skin symptoms (3.6 per 100). In addition very common presentations included a check-up (13.6 per 100) and a request for prescription (8.8 per 100). McWhinney lists the ten most common presenting symptoms from representative Canadian and British practices but they are divided between males and females. 7 For males in the Canadian study these symptoms are (in order, starting from the most common) cough, sore throat, colds, abdominal pelvic pain, rash, fever chills, earache, back problems, skin inflammation and chest...

Allergic rhinosinusitis

Allergic rhinosinusitis is a diagnosis made clinically, as there are no definitive objective tests available for routine clinical use to confirm this entity. There are two major forms of this disorder seasonal and perennial. Thus, it is a diagnosis based on history (often by questionnaire) and physical examination. In some epidemiological studies, the presence of allergy is confirmed by results of skin prick tests or in vitro allergy testing. The prevalence of this disorder varies widely in the literature, based upon the different sources of the data (i.e., questionnaires, phone interviews, and direct examination), but the majority of the literature suggests that 20 to 25 of children and about 15 of adults suffer from this condition (1). Peak prevalence is between 10 and 30 years in most countries (2). Atopic individuals are at much increased risk for this disorder and there is a significant correlation between the report of nasal symptoms and the prevalence of allergen-specific IgE....

Promoting Health And Preventing Disease 41 Creative Clinical Programs

A new clinical service was developed in Washington State to permit pharmacists for an urban ambulatory pediatric clinic serving a large immigrant population to evaluate and treat children and adolescents aged 6 months to 19 years who were suffering from minor acute illnesses and to provide patients with bilingual education materials (Kalister, et al., 1999). The program developed protocols and encounter forms for the evaluation of coughs and colds, fever, diaper rash, vomiting and diarrhea, and head lice. In addition, patient education materials addressing these topics were prepared and published in 8 different languages. Safety was assessed by reviewing the records of all patients who returned within one week of an encounter with the pharmacy, and through a telephone survey of the parents. Almost three-quarters of the 191 patients treated during the first year of the pharmacy service were immigrants. A retrospective review of 48 records found that the majority of the errors were...

Biological Basis Of Adenoviruses

The adenovirus was first isolated in the early 1950s as a cytopathogenic agent from primary cell cultures derived from human adenoids and respiratory secretions of patients with acute respiratory illnesses (23,24). This virus was actually a group of nonenveloped viruses containing linear, double-stranded DNA encapsulated in an icosahedral protein capsid. To date, more than 100 types of adenoviruses that infect a wide range of mammalian and avian hosts have been identified (25). At least 51 human adenovirus serotypes have been isolated they are classified into six subgroups (A to F) (25,26) on the basis of their ability to agglutinate red blood cells (27). Except for the group C and E viruses, other human adenoviruses can induce tumors in rats and hamsters, yet no evidence has been found that links adenoviruses to cancers in humans (25). Adenovirus infections in humans usually result in mild signs and symptoms of respiratory illness, conjunctivitis, or gastroenteritis (25). However, an...

Clinical Characteristics

The prevalence and clinical symptoms of hMPV-infected patients, identified by RT-PCR in respiratory samples obtained from patients in a university hospital, indicated that the prevalence and clinical severity due to hMPV infections are slightly lower than those of hRSV infections during the winter season van den Hoogen, 2003 . Most of the hMPV-positive patients were children < 2 years old who did not have any underlying illnesses. hMPV was found significantly less frequently in children < 2 months old than was hRSV. Of the 31 hMPV-positive children < 2 years old, only 4 (31 ) were < 2 months old, whereas 43 (35 ) of the 122 hRSV-positive children < 2 years old were also < 2 months old. Others have found that the mean age of patients infected with hMPV was slightly lower than that compared to hRSV Williams, 2004 . Of the hMPV-positive patients who were > 5 years old, most had other diseases (e.g. cystic fibrosis, leukemia, and non-Hodgkin lymphoma) or had recently...

Differential Diagnosis of Atrial Fibrillation

Lone Atrial Fibrillation No underlying disease state. Cardiac Causes Hypertensive heart disease with left ventricular hypertrophy, heart failure, mitral valve stenosis or regurgitation, pericarditis, hypertrophic cardiomyopathy, coronary artery disease, myocardial infarction, aortic stenosis, amyloidosis. Noncardiac Causes Hypoglycemia, theophylline intoxication, pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary embolism, heavy alcohol intake or alcohol withdrawal, hyperthyroidism, systemic illness, electrolyte abnormalities. Stimulant abuse, excessive caffeine, over-the-counter cold remedies, illicit drugs.

Pharmacological Toxicological Effects 51 Immunological Effects

A double-blind, placebo-controlled, randomized trial evaluating Echinacea for the treatment of colds involved 559 adult patients and three different Echinacea products (Echinaforce E. purpurea 95 herb and 5 root , E. purpurea concentrate, and E. purpurea root preparation). In the patients that were treated, two of the Echinacea products produced a statistically significant reduction in symptoms compared to placebo and the E. purpurea root preparation (10). In another study evaluating the prophylactic role of Echinacea, 302 patients were enrolled in a three-armed, randomized, double-blind, placebo-controlled trial. Each of the groups was given ethanolic extract of E. purpurea roots, E. angustifolia roots, or placebo for 12 weeks. They did not find a significant reduction in occurrence of URI in either treatment group however, they speculated from their results and the results of two other similar studies that there was a 10 to 20 relative risk reduction for URI. It was concluded that...

Independent Nonprescription And Alternative Therapies

A senior who is taking a coxib should not also take an over-the-counter NSAID (e.g., ibuprofen or naprosyn). These medications are found in many cold remedies and the like, and vigilance is required to avoid inadvertently taking such medication while taking a prescription coxib. The combination of NSAID and coxib may increase the likelihood of an adverse event, with particular concern about effects on the intestinal tract, cardiovascular system, or kidneys. The concern about over-the-counter medications extends to aspirin and acetaminophen as well as other nonanalgesic products. Because many nonprescription medications are in many combination products, it is important to check all of the ingredients before taking any such medication.

Perivenous Encephalomyelitis

AHL is usually fatal disorder characterized clinically by an abrupt onset of fever, neck stiffness, hemiplegia or other focal signs, seizures, and impaired consciousness. Thankfully, it is rare but has been reported in patients of all ages. Most cases follow an upper respiratory tract infection, typically 1 to 13 days earlier. At autopsy, the brain is congested and swollen, sometimes asymmetrically, and herniation is frequent. Multiple petechial hemorrhages are distributed diffusely throughout the brain. The perivas-cular lesions chiefly consist of ball or ring hemorrhages surrounding necrotic venules, sometimes with fibrinous exudates present within the vessel wall or extending into adjacent tissue. Perivascular cuffs of mononuclear cells with neutrophils are often prominent. Perivenous demyelinating lesions, identical to those of ADEM, may be present. Most authors believe that AHL represents a hyperacute form of ADEM.

Causes and symptoms

Other neurological factors include lesions to the brain, congenital rubella, undiagnosed and untreated phenylketonuria (PKU), tuberous sclerosis, and Rett's disorder (a related condition in which the baby develops in an apparently normal manner through age five months, and then begins to lose communicative and social interaction skills). There is also evidence of a higher proportion of perinatal complications (complications arising around the time of giving birth) among children with autistic symptoms. These complications include maternal bleeding after the first trimester and meconium in the amniotic fluid. (Meconium is a substance that accumulates in the bowel of the developing fetus and is discharged shortly after birth.) Some evidence suggests that the use of medications during pregnancy may be related to the development of autistic symptoms. As newborns, children with autistic behaviors show a higher rate of respiratory illness and anemia than healthy children.

Disease associations of HHV6A and 6B variants

It was previously thought that primary infection of HHV-6 in infants and young children lead to roseola and febrile illnesses. This infection was attributed to HHV-6B (Yamanishi et al., 1988). Some of the symptoms identified include diarrhea, vomiting, seizure, nasal congestion, rash and high fever. Similar symptoms were noted in Africa in children and the DNA analysis from the peripheral blood from these children revealed HHV-6A infections (Hidaka et al., 1997 Kasolo et al., 1997 Randhawa et al., 1997). It is, therefore, obvious that both variants A and B participate in infecting growing children with identical pathologies. Hall et al. (1994) also observed that one third of congenital infection was due to HHV-6A. Later on these children still retained HHV-6A DNA. There have not been longitudinal follow-up studies to assess whether these children with congenital HHV-6A infection could be at risk of developing a central nervous system (CNS) illness such as multiple sclerosis.

Practice makes perfect

In my case, I practised on patients with a cold. The first four months in my post were as a GP and coincided with the winter months. Thus, every GP's ''heartsink'' patient - stricken by the common cold and demanding antibiotics - became my favourite assay. I tried everything on everyone. In fact, I looked forward to my next case so I could test out my latest technique. Mother with a sick child Express concern for their child and stress the side effects of the antibiotics. 25-year-old professional Show your admiration for their soldiering on within the tough working environment. 40-year-old who is worried about that horrible sore throat they had last year Buckle under and give them the prescription but predict that the cold will get better by this Sunday. And if it does not, then they can take the antibiotics immediately on that day . . . but not before.

Local Regional and Global Environmental Changes

This is particularly the case with urban air pollution, which has, in recent decades, become a worldwide public health problem.9,10 That is, although it does not constitute an integrated 'global' environmental change, its widespread occurrence as a locally generated and locally acting health hazard makes it, now, a 'worldwide' problem. An estimated 130000 premature deaths and 50-70 million incidents of respiratory illness occur each year due to episodes of urban air pollution in developing countries, half of them in East Asia. An even greater toll of chronic disease is attributable to long-term exposures to urban air pollution. i2 A recent analysis of three European countries estimated that 6 of total mortality (over 40 000 attributable cases per year) was caused by air pollution. 13 This study also demonstrated that air pollution resulting from motorized traffic accounted for over 16 million person-days of restricted activities. For the world as a whole, it has been...

System Example New York City

Noted an increase in the frequency of syndrome visits or admission of seriously ill patients. If there is concern a field investigation is done with chart review, patient interviews, and on-site discussions with clinicians. In the first year of operation the system did not identify any BT-related illness but was able to identify community increases in gastrointestinal illness, respiratory illness, and fever associated with the peak of influenza activity.

Ramona Sunderworth md

The widening economic disparity between the rich and poor counties contributes to social inequity and worsens the poverty responsible for diseases claiming children's lives. Infant mortality rates are approximately five times higher in less developed nations than in the more developed nations. At present, between 11 and 12 million children under 5 die each year (99 of these in developing nations). About 70 of these deaths are caused by five largely preventable illnesses acute respiratory illness (ARI), diarrhea (dehydration), measles, malaria, and perinatal causes. Malnutrition (protein caloric and micronutrient) is a factor contributing to 60 of these deaths. One third of African children are underweight. Poverty is a major cause of malnutrition combined with inadequate health services, care and support for women and children.

Antioxidants And Aging

Although Linus Pauling did not discuss the possibility that v itamin C might protect against mental deterioration associated with aging in Vitamin C and the Common Cold, this possibility has become one of the most popular reasons for taking large daily doses of v itamin C and other antioxidant s such as vitamin E and beta-carotene (p-carotene). The rationale is rooted in the chemical react ions of these compounds with reactive oxygen species. Cells of living organisms contain energy factories called mitochondria, which carry out the final steps in the conversion of energy to a form that can be used to do the work of the cells. These steps require oxygen, which we obtain by breathing. The process is quite efficient, but small amount s of oxygen are converted to byproduct s such as hydrogen peroxide, ozone, nitric oxide, superoxide radicals, and hydroxyl radicals. These substances are called reactive oxygen species because they are derived from oxygen and react readily with essential...

Noninvasive Fungal Masses Fungal Balls

The masses themselves are mycelial mats which can rest in the sinus cavities for months or years without any sort of tissue invasion. They are described as cheeselike, gritty, rubbery, or greasy masses that are easily discernible from the surrounding mucosa. They may be black or brownish in color, and often have a fetid odor associated with them. A small, localized inflammatory response may be seen, but the integrity of the nasal architecture is unchanged (Washburn, 1994). The benign mass is usually limited to the maxillary sinus cavity, with infections occurring infrequently in the sphenoid cavity as well. Symptoms include chronic nasal congestion, pain localized to the maxillary sinus, and a postnasal drip. Often a superimposed acute bacterial infection will occur, though the infection is opportunistic and not directly integrated with the fungal sinusitis.

Perfecting Case And Outbreak Detection

Figure 13.13 Daily sum of syndrome probabilities produced by SyCO2. SyCO2 computes the posterior probability that a patient has a flu-like illness from his chief complaint. (From Espino, J., Dara, J., Dowling J, et al. (2005). SyCo2 A Bayesian Machine Learning Method for Extracting Symptoms from Chief Complaints And Combining Them Using Probabilistic Case Definitions. Pittsburgh, PA Center for Biomedical Informatics, University of Pittsburgh, with permission.) An outbreak-detection system would sum the posterior probabilities of flu-like illness from all patients seen in 24-hour periods to form a time series of expected daily counts of patients with respiratory illness. Readers familiar with Bayesian statistics will recognize this sum as the expectation for the number of individuals with a given diagnosis. figure 13.13 Daily sum of syndrome probabilities produced by SyCO2. SyCO2 computes the posterior probability that a patient has a flu-like illness from his chief complaint. (From...

Flu Remedies and Chest Rubs

Of historical interest, a study by Welliver et al. (1979) was the first to provide a quantitative estimate of the lead time of OTC sales data over data collected during physician office visits. Welliver and colleagues observed a strong peak in sales of cold remedies (another synonym for flu remedies) just before the rise in physician encounters with patients subsequently diagnosed as having influenza B virus, and one week before the peak in those encounters. They also observed an earlier rise in sales of cold remedies approximately coincident with the early winter rise in non-influenza respiratory virus activity as evidenced by laboratory test results. They found no correlation between sales of antifever medications, such as aspirin (either adult or pediatric), and influenza. Welliver's study was based on two outbreaks in a single city, and utilized OTC data that were aggregated at the weekly level.

Cough Cold Sinus and Allergy Medications

Ohkusa et al. (2005) used correlation analysis to study the relationship between sales of OTC cold remedies and influenza activity in Japan. They found a poor correlation, with the adjusted r2 never rising above 0.50. However, they performed the analysis at the national level with respect to geography, as opposed to other studies discussed in this chapter, which analyzed data at the metropolitan level. Also, the study included herbal remedies in the cold remedy category, a type of medication not included in other analyses. Finally, the authors caution that their results are preliminary, and that they plan to conduct additional analyses.

Computerinterpretable Case Definitions

Case definitions, as currently written, are not well suited for automation. The authors of the SARS case definition intended it for use by physicians and epidemiologists, not computers. The clause findings of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing) does not enumerate all findings of lower respiratory illness. A computer requires a complete enumeration of all findings that it should count as evidence of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing, wheezing, cyanosis, tachypnea, dullness to percussion, fremitus, whispered pectoriloquy, rales, and rhonchi). The findings would also have to be described more precisely. For example, a physician or an epidemiologist would not count chronic cough or cough associated with asthma as a finding of lower respiratory illness when applying this case definition, but a computer would (unless told otherwise). Note that it is difficult, if not impossible, to enumerate all...

Categories of ICD Codes Code Sets

Despite the potential for high diagnostic precision, biosurveillance researchers and developers group ICD codes into categories (code sets'') such as respiratory illness.'' The set of all 60 ICD codes for tuberculosis mentioned above is an example of an ICD code set. It is not necessary to group ICD codes into codes sets, although it is almost always done. For example, we could monitor for the single ICD code for inhalational anthrax (022.1). Creators of code sets usually group codes of diseases and syndromes that share similar early presentations to form syndrome code sets. Respiratory, gastrointestinal, neurological, rash and febrile illnesses are representative of code sets in common use.

Availability Of Overthecounter Sales Data

Bought cough syrup and tissues is more likely to have an acute respiratory illness (or an acquaintance or child with respiratory illness) than someone who purchased cough syrup and a pack of cigarettes. The major barrier to obtaining these additional data is the reluctance of retailers to provide the data due to concerns about the volume of data they would have to process on behalf of a biosurveillance organization, proprietary business concerns, and that participation in loyalty card programs may be adversely affected.

Immunomodula Tion

Red ginseng powder has been shown to restore immunity after chemotherapy and reduce the recurrence of stage III gastric cancer. The 5-year disease-free survival and overall survival rates were significantly higher in patients taking the red ginseng powder during postoperative chemotherapy versus control (68.2 vs 33.3 , 76.4 vs 38.5 , respectively, P < 0.05). Despite the limitation of a small number of patients (n 42), these findings suggest that red ginseng powder may help to improve postoperative survival in these patients. Additionally, red ginseng powder may have some immunomodulatory properties associated with CD3 and CD4 activity in patients with advanced gastric cancer during postoperative chemotherapy (Suh et al 2002). Vaccine adjuvant activity Ginseng extract (100 mg ginsan G11 5 day) improved the response to an influenza vaccine in a multicentre, randomised, double-blind, placebo-controlled two-arm study of 227 subjects. Compared with vaccine without the ginseng, the...

Antipyretic And Antiinflammatory

Testing in different animal models has identified antipyretic activity (Mandal et al 2001). Clinical testing in randomised double-blind trials involving volunteers with the common cold suggests that this activity is clinically relevant. The mechanism of action is unlike that of NSAIDs, as andrographis does not influence the biosynthesis of any lipoxygenase pathways, but may involve promoting ACTH production and enhancing adrenocortical function (Amroyan et al 1999).

Desmopressin Acetate DDAVP

Adverse effects may cause headache, nasal congestion, abdominal cramps, hypertension. Comments use with caution in hypertension, coronary artery disease, patients with predisposition to thrombus chlorpropamide, carbamazepine, and clofibrate potentiate the antidiuretic effect.

Do Vitamin C and Other Antioxidants Benefit Health

Linus Pauling was a creative and prolific chemist who was awarded two Nobel Prizes the Chemistry Prize in 1954 for fundamental work on the structure of molecules and the Peace Prize in 1963 for articulating the dangers of nuclear proliferation. He might have become the only person to receive three Nobels if he had beaten Watson and Crick in deducing the structure of DNA . Late in his long life, Pauling became a proponent of the multiple health benefits of large daily doses of vitamin C. I remember hearing Pauling lect ure about v itamin C to a large and enthusiast ic audience at the University of Nevada, Reno, in 1985, when he was 84 years old. He was a persuasive advocate who used charm and humor, as well as an arsenal of data and anecdotes, to deflect criticism. He summarized his ideas in a book called Vitamin C and the Common Cold, first published in 1970. Many books of nutritional advice for the general public have been published, but his has had a staying power matched by few...

Occupational exposure

Several studies found an increased risk ofrespiratory symptoms or disease in people with occupational exposure to vehicle exhausts. A study ofhighway tollbooth workers reported an increased number of acute irritative symptoms in exposed people, such as headache, nasal congestion, eye irritation and dry throat (Yang et al., 2002). Bus drivers, conductors and taxi drivers in Shanghai showed higher prevalence ofrespiratory symptoms and chronic respiratory diseases than controls not exposed to vehicle emissions (Zhou et al., 2001). The adjusted ORs were 1.95 for throat pain (95 CI 1.55-2.46), 3.90 for phlegm (95 CI 2.61-5.81), 1.96 for chronic rhinitis (95 CI 1.11-3.46) and 4.19 for chronic pharyngitis (95 CI 2.49-7.06).

Nonneoplastic Conditions

Sinusitis acute infections are usually bacterial and often follow the common cold. Empyema or mucocoele may result if the draining of the secretions is obstructed. Chronic sinusitis follows acute sinusitis and may be associated with obstruction (e.g., by polyp or tumour) or immune compromise. Maxillary sinusitis may occur alone or may be associated with involvement of frontal and or ethmoidal sinuses. Most cases respond to antibiotics and topical medications Inflammatory polyps a frequent complication of long-standing rhinitis, often but not exclusively allergic in origin. Often multiple and bilateral, they are a cause of sinusitis and nasal obstruction. Histologically, there is abundant myxoid or oedematous stroma covered by respiratory epithelium ulceration and or squamous metaplasia are common in larger polyps where they contact the nasal walls. The antrochoanal polyp is an uncommon large single inflammatory polyp that arises in the maxillary sinus and extends into the nasal...

Congenital General Anosmia

It is estimated that approx 1 of the Western world population suffers from chemosensory disorders. Most of the people suffering from smell disorders have an acquired condition, which develops during life, owing to allergy, viral upper respiratory tract infection, nasal sinus diseases, head trauma, inhalation of noxious chemicals, or medicinal drug intake (32,33). A much smaller minority is born without a sense of smell, an affliction referred to here as

Evaluation Of The Returned Worker

Although there is limited data on humanitarian disaster workers and patterns of disease and injury, some data from travel medicine studies can be extrapolated. It should be remembered that common accidents (car accidents, drowning) and illnesses (coronary artery disease, upper respiratory tract infections, bronchitis, pneumonia, urinary tract infections) still happen abroad. Fever, diarrhea, and skin conditions are common complaints. A detailed discussion of the febrile traveler is beyond the scope of this chapter. However, initial evaluation entails a careful history and physical exam. Laboratory results can help limit the differential diagnosis and should include a complete blood count with differential, thick and thin blood film for malaria (where endemic), blood cultures, urinalysis, and liver function tests. Chest x-ray and serolog-ical studies may be obtained depending on the history. Patients with diarrhea should have three sets of stool examined for fecal leukocytes, ova, and...

Communicable Disease

The delay in seeking care for tuberculosis may result from a number of factors including a fear of immigration authorities and misconceptions about the disease and its treatment. It has been found, for instance, that legislation that increases the fear of detection by immigration authorities may exacerbate delays in seeking care (Asch, et al., 1994). Misconceptions about the nature of the disease and its treatment may also play a role. In absolute numbers, immigrants from Mexico and the Philippines are the two largest immigrant groups in the U.S. to develop TB (Zuber, et al., 1997). A focus group study conducted with Filipino immigrants at California and Hawaii community health centers to explore beliefs about TB found that the participants viewed TB as being highly contagious and caused by environmental exposures, such as cigarettes and alcohol, unsanitary conditions, wet clothing, and bacteria and viruses, imbalances of the body occasioned by overwork, poor nutrition, respiratory...

Taste Nerve Pathways

The direct connection between the outside environment and the brain makes the sense of smell very vulnerable to damage. Smell and taste disorders can be triggered by colds and flu, allergies, nasal polyps (swollen mucous membranes inside the nose), a head injury, chemical ex

Carriage of K kingae

Although the niche of the organism was initially unknown, it was suspected that the bacterium was a respiratory tract commensal. This assumption was supported by several lines of evidence 1 other members of the Neisseriaceae family are part of the normal respiratory flora 2 K. kingae has been found in 1 of nasal and throat cultures 3 children with invasive K. kingae infections frequently present with concomitant signs of upper respiratory tract infections 4 K. kingae has been isolated from blood or respiratory secretions of patients with pneumonia, pleural empyema or laryngo-tracheo-bronchitis (Yagupsky, 2004).

Garlic

One of the world's most popular spices, garlic is used extensively from China to the Americas, in French aioli, Turkish cacik, Vietnamese pho bo, Indian korma, or Greek skordalia. Garlic's name is derived from the Anglo-Saxon word garleac, meaning spear plant. Since ancient times, garlic has been used as a cure as well as a food. Egyptians used garlic since 3700 BC to provide strength and prevent disease. Jews ate it on their long journeys, Romans honored garlic for providing strength and courage, and Greeks used it to treat colds and coughs. Many cultures call it white onion, including Malaysians, Indonesians, Sri Lankans and Ethiopians.

Risk Factors for AOM

AOM occurs most frequently in winter months, and is usually preceded by a viral upper respiratory tract infection (Henderson et al., 1982 Arola et al., 1990). Apart from young age (< 2 years), and a history of a previous episode of AOM, other risk factors for AOM include the risk factors for viral upper respiratory infections attending day care outside the home, exposure to cigarette smoke, having at least one sibling, and possibly use of a dummy (pacifier) (Uhari et al., 1996 Owen et al., 1993). The protective effect of breast feeding is unclear, with studies showing both a beneficial effect, as well as either no effect or increased incidence (Rovers et al., 2004).

Folk medicine

Www Shesh Naga Oringale Photo

Shamans (medicine men or women) in developing countries claim uncountable natural sources for curing myriad maladies and diseases, from common colds to cancers. The efficacy of these curatives is suspect, but ethnobotanists and ethno-biologists often at the behest of pharmaceutical companies travel to the most remote parts of the world in an attempt to assess such sources as well as identify previously unknown natural chemical compounds. For the most part folk remedies are derived from plants. Nevertheless, animal organs, often from endangered taxa, also find their way into folk prescriptions. A woman in Huisache, San Luis Potos , Mexico, attempts to sell salted snake skins and sun-dried rattlesnake carcasses to passersby. The purchaser will grind them up into fine particles and use it as folk medicine. Natives believe the powder cures a variety of maladies from colds to cancer. (Photo by Manny Rubio. Reproduced by permission.) A woman in Huisache, San Luis Potos , Mexico, attempts to...

Elizabeth Hewat

Human rhinoviruses (HRVs) are a major cause of the common cold. They are small, icosahedral viruses, 300 A in diameter, and belong to the Picornaviridae family, which includes Rhinovirus, Aphthovirus, Enterovirus, Cardiovirus, etc. Their capsid is composed of 60 copies each of four viral coat proteins, VP1, VP2, VP3, and VP4, on a T 1 (or pseudo T 3) icosahedral lattice 2 . The three major capsid proteins VP1, VP2, and VP3 all have the same basic eight-stranded P-barrel fold and a molecular weight of around 30 kDa. VP4 is a small protein located inside the capsid. The capsid encloses a single positive RNA strand of about 7000 bases. The HRV capsid has a star-shaped dome on each of the five-fold axes surrounded by a shallow depression or canyon and a triangular plateau centered on each three-fold axes and around each five-fold axes (Fig. 1). 2. Rossmann, M. G., Arnold, E., Erickson, J. W., Frankenberger, E. A., Griffith, J. P., Hecht, H. J., Johnson, J. E., Kamer, G., Luo, M., Mosser,...

Infection

Common cold prevention A 12-week, double-blind randomised study involving 146 people demonstrated that allicin-containing garlic preparations significantly reduce the incidence of colds and accelerate recovery compared with placebo (Josling 2001). More specifically, the number of symptom days in the placebo group was 5.01 compared with 1.52 days in the garlic treated group. Additionally, garlic reduced the incidence of developing a second cold whereas placebo did not. Helicobacter pylori infection It has been suggested that gastrointestinal lesions, such as gastric ulcers, duodenal ulcers and gastric cancers, are strongly associated with H. pylori infection (Scheiman & Cutler 1999). Medical treatment consisting of 'triple therapy' has a high eradication rate, yet is associated with side-effects and has started to give rise to antibiotic resistance. Since garlic intake has been associated with a lowered incidence of stomach cancer, researchers have started investigating whether...

Irritant Gases

Careful attention to the eyes is important since there may be late development of cataracts with heavy exposures. If the gas has already been identified, then knowing its solubility can help in the triage of exposed victims. For example, high-solubility gases (sulfur dioxide or ammonia) affect the upper airways and only cause lower-airway injuries when the dose effect is large. Thus, if a potential victim, exposed to ammonia, has no upper-airway signs or symptoms (watery, teary eyes, red face, rhinitis, red sore nose, erythema of the posterior pharynx or hoarseness), it is unlikely that the patient has inhaled a dose high enough to cause lower-airway injury. The patient who presents with tachypnea and stridor, particularly with some hoarseness, is at a high risk of developing progressive laryngeal edema and complete obstruction of the airway, and therefore should be considered for emergency intubation. Certainly if symptoms of upper-airway damage are present, a prompt inspection of...

Congenital Syphilis

Similar to acquired syphilis, congenital infection is divided into early and late stages. There are often no abnormalities noted at birth, but exam or diagnostic findings are nearly always present by three months of age. However, the severity of early disease can range from asymptomatic imaging findings to severe, life-threatening multiorgan system disease. Early congenital syphilis characteristically first presents with a serosanguinous nasal discharge and rhinitis known as snuffles. The rash of early syphilis is a diffuse maculopapular rash that develops into epithelial sloughing. Vesicles or bullae may also be present and the fluid within is highly infectious. Oral mucous patches are often seen. Facial lesions on the lips and nose, as well as anal lesions, may heal with radiating scars known as rhagades. Visceral involvement is relatively frequent, with the liver often heavily infected, leading to jaundice, splenomegaly, anemia, and thrombocytopenia. Bony abnormalities related to...

Spicules

Anatomy Glass Sponges

The vast majority of hexactinellids live at depths greater than 1,000 ft (304.8 m). In a few coastal locations, however, such as Antarctica, the northeastern Pacific, New Zealand, and some caves in the Mediterranean, species are found at depths accessible by scuba divers. These habitats have in common cold water (35-52 F, or 2-11 C), relatively high levels of dissolved silica, and low light intensity. Although many hexactinellids require a firm substratum, such as rocks, for attachment, others grow on fused skeletons of dead sponges, and still others live over soft sediments. The latter group, though not numerous, support themselves on struts made of bundles of long spicules that project down into the sediment.

Garlic Allergy

Allergic reactions to garlic have also been reported in the literature. Garlic allergy can manifest as occupational asthma, contact dermatitis, urticaria, angioedema, rhinitis, and diarrhea. A 35-year-old woman experienced several episodes of urticaria and angioedema associated with ingestion of raw or cooked garlic, as well as urticaria from touching garlic. Two garlic extracts as well as fresh garlic produced a 4+ reaction on skin prick tests (SPTs) in this patient, but no other food allergens produced positive results. The patient's symptoms were immunoglobulin E (IgE)-mediated, but she also produced specific IgG, which confounded the results of IgE testing (90). A group of 12 garlic workers with respiratory symptoms associated with garlic exposure underwent SPTs using garlic powder in saline, commercial garlic extract, and various other possible allergens bronchial provocation tests with garlic powder oral challenge with garlic dust and specific IgE testing using the CAP (CAP...

Infection Viral

Pharyngitis is a frequent component of the common cold. It may be caused by several upper respiratory viruses. Rhinovirus is the most common pathogen. Others viruses include parainfluenza virus, influenza virus, and coronavirus. The common cold will occur in any age group but extremes of age, immunosuppressed, and immunocompromised persons are most susceptible. The average healthy adult experiences cold-like symptoms at least twice a year. Transmission of viral particles occurs by inhaling respiratory particles or from direct contact. Signs and symptoms of viral pharyngitis are similar to those of bacterial pharyngitis. The incidence of laryngeal involvement is more common with viral infection when compared with bacterial infection and may help distinguish between the two etiologies. Other upper respiratory complaints include rhinorrhea, postnasal drip, nasal congestion, hoarseness, and cough. When associated with the influenza virus, gastrointestinal (GI)...

Pseudomonas spp

Pseudomonas spp. may be isolated from the respiratory, digestive, and genital systems of rats and mice, the more common ones being P. aeruginosa and P. diminuta. P. aeruginosa causes conjunctivitis and rhinitis and, under more severe or experimental conditions, pneumonia and septicemia in rats and guinea pigs.5 In septicemic animals, abscessation of the liver, spleen, kidneys, and middle ears may be observed. Disease due to P. aeruginosa is mainly observed in immune-deficient, immune-suppressed, or stressed animals,87 and, in general, it is secondary to something else. The prevalences in infected colonies of immune-competent animals kept in a high quality environment seldom reach more than 5 to 10 , but the prevalence of diseased animals in colonies of immune-deficient animals kept under poor environmental conditions may reach 100 , e.g., during ventilation breakdowns. Poor hygienic conditions, especially in relation to water used for drinking and cleaning may play an important role...

Traditional Medicine

Europeans have used oils from leafy spices or plants to provide physical, mental, and spiritual benefits, such as to provide a calming effect, to soothe muscle aches, or to cure many ailments such as colds and fevers. Similarly, Middle Easterners and Egyptians used spices for many therapeutic and cosmetic effects. The Middle Eastern system of medicine, called Unani Herbal Medicine, has many similarities to Indian and Chinese traditional medicine, with some roots to ancient Greek and Roman medicine.

Marjoram

Therapeutic Uses and Folklore Greeks used marjoram extensively to treat dropsy, convulsions, and poisons. Traditionally, it was used in tea to cure headaches, head colds, calm nervous disorders, and to clear sinuses. Marjoram has also been used to comfort stomachaches and muscular pains and improve circulation. It is found to have good antioxidant properties with fats and helps to retain color of carotenoid pigments

Human Gene Therapy

When injected into the liver, for example, this virus is not expected to cause any symptoms. Unfortunately, this is not what happened to Jeff Gelsinger, a patient suffering from a defect in the gene that codes for an enzyme called ornithine transcarbamylase. This enzyme removes ammonia from the blood. The correct version of the gene was cloned into an adenovirus vector and injected into Jeff Gelsinger's main liver artery. Shortly after the treatment, he started showing severe allergic response and died soon after. The autopsy showed that the viral DNA had propagated to all his organs and had triggered a massive immune response that killed him. As a result, clinical trials of human gene therapy using an adenovirus vector have been stopped. However, research continues with other viral vectors, particularly for the treatment of cystic fibrosis, a disease that has major manifestations in the lung cells. Clearly, much work is needed to ensure that gene therapy...

Other Effects

Aged garlic extract has been shown in in vitro and animal studies to protect against liver toxicity from environmental substances, such as bromobenzene (72), protect against cardiotoxicity from doxorubicin (73), and improve age-related spatial memory deficits (74). A placebo-controlled human study showed that garlic may also be useful as a tick repellent (75). In addition, a double-blind, randomized, placebo-controlled human study showed that garlic supplements taken over a 12-week period in the winter significantly reduced the incidence of the common cold (p < 0.001), and reduced the duration of symptoms when they occurred (p < 0.001) (76).

RNA Viruses

Viral genomes may be encoded in either DNA or RNA. Some medically important human viruses have RNA as their genetic material, including those that cause influenza, common colds, polio, and AIDS. Almost all viruses that infect plants have RNA genomes. The medical and economic importance of RNA viruses has encouraged their study.

B DNA Tumor Viruses

Human adenoviruses are responsible for upper respiratory tract infections. Many rodent cells can be transformed with adenoviruses. The transformed cells do not contain a complete adenovirus genome but do consistently include the ad-enovirus E1A and E1B genes. Conserved regions of E1A bind the pRb, p107, and p130 family of proteins, as well as p300. Simultaneously, the E1B protein binds the N-terminus of p53 and blocks its transactivation function. Because of these properties, adenoviruses have found great utility as vectors for numerous novel approaches to gene transfer therapy in the treatment of various cancers.

Plan Of The Book

Chapter 2 uses several studies of the health effects of vitamin C and similar compounds to illustrate both nonexperimental and experimental approaches in medical research. Experimental studies in medicine are called randomized, double-blind trials and are often considered the gold standard in such research. I introduce this approach by discussing two experiments to test the effects of large doses of v itamin C on the common cold. These examples illustrate some of the basic decisions that must be made in designing any experiment, such as what to use as a control treatment for comparison with the experimental treatment and how to measure responses to the treatment s. Studies of the effects of vitamin C on the common cold demonstrate some of the pitfalls of designing effective experiment s. Although the hypotheses being tested in these experiment s were straightforward, the procedures were relatively simple, and the analyses of result s were uncomplicated, certain aspects of the...

How Science Works

Tially the same process whether the hypotheses are about effects of vitamin C on colds (Chapter 2) or about the structure of molecules such as DNA, although experiments on the latter may require highly specialized equipment for obtaining and analyzing results. By telling some scientific stories that don't involve complex technology, I hope to give you some tools for understanding the scient ific process that can be applied much more broadly to additional examples, including those in which technology plays a larger role.

Blood Plasma

The young woman had noticed symptoms for several months before she finally went to the doctor. At first it was just fatigue and headaches, which she attributed to studying for final exams. She had frequent colds and bouts of fever, chills, and sweats that she thought were just minor infections. When she developed several bruises and bone pain and noticed that her blood did not clot very quickly after cuts and scrapes, she consulted her physician, who examined her and took a blood sample. One glance at a blood smear under a microscope alarmed the doctor there were far too few red blood cells and platelets and too many white blood cells. She sent the sample to a laboratory to diagnose the type of leukemia, or cancer of the white blood cells, that was causing her patient's symptoms.

Outbreak Detection

Showing that if the diagnostic data available support a more diagnostically precise case detection (i.e., SARS-like syndrome rather than respiratory syndrome), then subsequent analysis of the case data is expected to detect smaller clusters of disease against the background levels of individuals presenting with respiratory illness.

Epidemic Detection

To define retrospective outbreaks of pediatric respiratory and gastrointestinal syndromes over a five year period (1998-2001) in four contiguous counties in Utah. Outcome measures were reported for correlation between chief complaint classifications and ICD-9 classifications and for timeliness of detection. Figure 17.7 from the Ivanov publication shows the time series plot of respiratory illness admissions (reference standard) and chief complaints. It is evident from the plot that chief complaints generated the same type of signal that the reference standard generated. Chief complaint classification detected three respiratory outbreaks with 100 sensitivity and specificity, and time series of chief complaints correlated with hospital admissions and preceded them by an average of 10.3 days.

Detection of Cases

Espino and Wagner conducted the first study of case detection accuracy of an ICD code set for a diagnostically imprecise syndrome (Espino and Wagner, 2001).They studied the ability of ICD codes for ED chief complaints and ICD codes for ED diagnoses to detect patients with acute respiratory syndrome (defined as symptom duration of five days or less). In this ED, registration clerks assigned ICD codes to the chief complaints and ED physicians assigned ICD codes to the diagnoses at the time of the patient's visit. Two internists created the gold standard by reviewing the dictated ED visit note and assigning patients to acute respiratory if the duration of illness was five days or less and the patient had respiratory symptoms, abnormal pulmonary examination, or radiological evidence of pneumonia. The sensitivity and specificity of a respiratory ICD code set (that contained 64 ICD codes) for detecting patients with acute respiratory illness from chief complaints were 0.44 and 0.97,...

Sports

A 2004 Cochrane review that analysed results from six trials involving a total of 642 marathon runners, skiers, and soldiers on subarctic exercises found regular vitamin C supplementation significantly reduced the incidence of the common cold, supporting its use in this population (Douglas et al 2004).

Other Uses

Adhatoda is traditionally used to treat cough, asthma, bronchitis and colds, but has also been used to treat fever, dysentery, diarrhoea, jaundice, to stimulate the birthing process and aid healing afterwards, tuberculosis, headache, and as an antispasmodic (Claeson et al 2000). It has also been used as an abortifacient in some Indian villages.

Immunity

2003), including a reduction in peripheral T cells secondary to atrophy of the thymus and inhibition of thymocyte proliferation (Bowlus 2003) and a reduction in IL-2 production (Bergman et al 2004). Reduced IL-2 production may partly explain the increased susceptibility to infections and cancer in patients with iron deficiency anaemia (Bergman et al 2004). Supplementation of ferrous sulfate (60 mg Fe) once daily for 8 weeks has been shown to reduce the incidence and duration of upper-respiratory tract infections in children (de-Silva et al 2003).

Immune Function

These findings are contrasted by analyses of male smokers who participated in the ATBC study, which found that supplementation with synthetic beta-carotene had no overall effect on the risk of hospital-treated pneumonia or the incidence of the common cold (Hemila et al 2002, 2004), but instead increased the risk of colds in subjects carrying out heavy exercise at leisure but not at work (Hemila et al 2003).

Ginseng Siberian

Historical note Siberian ginseng has been used for over 2000 years, according to Chinese medical records, where it is referred to as Ci Wu Jia. It was used to prevent colds and flu and to increase vitality and energy. In modern times, it has been used by Russian cosmonauts for improving alertness and energy, and to aid in adaptation to the stresses of life in space. It has also been used as an ergogenic aid by Soviet athletes before international competitions and was used after the Chernobyl accident to counteract the effects of radiation.

Andrographis

Historical note Andrographis has long been used in traditional medicine systems in numerous countries. It has been included in the pharmacopoeias of India, Korea and China, possibly because it grows abundantly in India, Pakistan and various parts of South-East Asia. In TCM, andrographis is considered a 'cold' herb and is used to rid the body of heat, as in fevers and acute infections, and to dispel toxins from the body. In Ayurvedic medicine it is used as a bitter tonic, to stimulate digestion and as a treatment for a wide range of conditions such as diabetes and hepatitis. It is still a common household remedy and found in over half the combination tonics used to treat liver conditions in India. Also used to treat the common cold, it is sometimes called Indian echinacea.

Allergies

Quercetin is used in the treatment of acute and chronic allergic symptoms, such as hayfever and chronic rhinitis. The anti-inflammatory activity of quercetin and its ability to stabilise mast cells, neutrophils and basophils and inhibit histamine release (Blackburn et al 1987, Busse et al 1984, Middleton & Drzewiecki 1982, Middleton et al 1981, Ogasawara et al 1996, Pearce et al 1984) provides a rationale for its use in these indications. In a study of 123 patients sensitised to house dust mite and displaying nasal symptoms of mild to severe perennial allergic rhinitis (Otsuka et al 1995), nasal scrapings were taken and histamine release measured as a percentage of the total content in the specimen. Antigen exposure resulted in an increase in mast cells of the epithelial layer of the nasal mucosa resulting in nasal hypersensitivity. Quercetin inhibited histamine release by 46-96 in a dose-dependent manner.

Lemon Verbena

Therapeutic Uses and Folklore lemon verbena has been used traditionally by Europeans as a diuretic and a gout remedy, to treat inflammation of the liver or spleen, and even to aid depression. It is also brewed in tea as a home remedy to relieve colds and fevers. Lemon verbena is a natural insect repellent.

Pathogenesis

An experimental infection model in cynomolgus macaques (Macaca Fasicu-laris) has confirmed that hMPV is a primary pathogen of the respiratory tract in primates Kuiken, 2004 . The hMPV-infected macaques showed mild clinical signs of rhinorrhea corresponding with a suppurative rhinitis at pathological examination. In addition, mild erosive and inflammatory changes in the mucosa and submucosa of conducting airways, and an increased number of alveolar macrophages in

Mycoplasma

Mycoplasma pneumoniae is a small bacterium that lacks a cell wall and commonly causes upper respiratory tract infections and pneumoniae. The overall incidence of infection in the United States has been estimated at 1.7 cases 1000 people year (38) with 6.8 of all pneumonia caused by this pathogen (39). Symptoms include fever, cough, malaise, and headache, but as many as 25 of patients are asymptomatic. Extrapulmonary manifestations do occur, with neurologic sequelae estimated in 0.1 of all cases (39). Neurologic findings are variable and include psychosis, meningitis, transverse myelitis, ataxia, peripheral neuropathies, and cranial neuropathies. Facial nerve involvement, alone or in conjunction with other neurologic sequelae, is considered rare but has been reported by several authors (40-42). Bilateral facial paralysis has also been associated with mycoplasm infections (43,44).