Antibiotic use for upper respiratory tract infections: how well do pediatric residents do?

BACKGROUND: Antibiotics are often used inappropriately for the treatment of upper respiratory tract infections in children, and the emergence of resistant bacteria is a growing public health concern. OBJECTIVE: To assess awareness and compliance with the Centers for Disease Control and Prevention (Atlanta, Ga) and American Academy of Pediatrics (Elk Grove Village, Ill) principles for judicious antibiotic use for upper respiratory tract infections among residents from a sample of pediatric residency programs in the mid-Atlantic region of the United States. PARTICIPANTS AND METHODS: Residents at the participating programs were requested to complete a survey questionnaire. RESULTS: Of the 524 pediatric residents surveyed, 74% (388 participants) completed the questionnaire. Familiarity with the principles increased with a year of training; 16%, 36%, and 50% of first-year (PL1), second-year (PL2), and third- or fourth-year (PL3/PL4) residents, respectively, had heard or read about the principles (chi(2)(trend); P<.001). In response to a direct question about the use of antibiotics for an otherwise well, afebrile 18-month-old child with purulent rhinorrhea, 29%, 25%, and 15% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics within 10 days of onset of illness (chi(2)(trend); P =.008). A significant difference was found between PL1 vs PL3/PL4 participants (difference = 20%; 95% CI = 3%-26%). If the same infant had a temperature of 38.8 degrees C, then 63%, 45%, and 47% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics (chi(2)(trend); P =.008). CONCLUSIONS: Awareness among pediatric residents about the judicious use of antibiotics for upper respiratory tract infections is often lacking, and inappropriate use of antibiotics for this condition continues to be prevalent. This was especially noted among PL1 residents, with an improving trend noted with increasing years of training.     

Antimutagenic assay of carotenoids from green algae Chlorococcum humicola using Salmonella typhimurium TA98, TA100 and TA102

ObjectiveTo evaluate the nonmutagenic and antimutagenic properties of the different carotenoids from the selected green algae Chlorococcum humicola (C. humicola) using Ames mutagenicity assay.MethodsAntimutagenicity of fresh water green algae C. humicola was tested using its carotenoid extract. From the crude carotenoid extract, the different carotenoids were fractionated by column chromatography and further identified by high performance liquid chromatography (HPLC). In the in vitro antimutagenicity assay the total and individual carotenoids were used to check the nonmutagenicity and antimutagenicity effect using the strains of Salmonella typhimurium (S. typhimurium) TA98, TA100 and TA102 with and without metabolic activation. The in vivo antimutagenic studies were carried out using animal model.ResultsThe results showed that the selected green algae were rich in carotenoids. In the crude carotenoid extract, astaxanthin, lutein and β-carotene were found to be the major concentration. α-carotene, zeaxanthin and violaxanthin were also found to be present. In the in vitro antimutagenic assay, the total carotenoids showed the maximum inhibition (P<0.001) against all three selected strains of S. typhimurium with and without metabolic activation. In the separated carotenoids, astaxanthin, lutein and β-carotene showed significant mutational inhibition and exhibited good antitumor activity in the presence of S9 fraction. For direct acting mutagens sodium azide, ethidium bromide and hydroxyl amine with the specified concentration, the total carotenoids gave 63%, 60%, 66% inhibition for TA98, TA100 and TA102, respectively. In vivo antimutagenic assay was also confirmed the effective antimutagenic activity of total and separated carotenoids. The results also confirmed that the total and individual carotenoids had no mutagenic activity.ConclusionsThe overall findings of the present study conclude that the green algae C. humicola possess higher concentration of bioactive carotenoids having antimutagenic activity, therefore, it can be used as a chemopreventive agent.     

Re-expansion pulmonary oedema: revisited

A case of re-expansion pulmonary oedema (RPO) following chest tube insertion for left spontaneous pneumothorax is reported. There were no severe symptoms and routine chest radiograph done four hours after tube thoracostomy showed features of pulmonary oedema in the re-expanded left lung. RPO is an uncommon complication of rapid pleural drainage of air or fluid with potentially serious cardiopulmonary manifestations but appears to run a benign course if there is no prior systemic hypoxaemia and if pneumothorax is drained without suction. Chest radiograph should be done routinely within four hours after chest tube insertion for early detection of RPO.     

A critical analysis of the concept of secondary Oral Hypoglycemic Agent (OHA) failure in type 2 diabetes at a tertiary care hospital

Data from UKPDS study suggests that the onset of ß cell dysfunction in diabetes occurs well before the development of hyperglycemia. To study the concept of secondary OHA failure in type 2 diabetes patients of more than 10 years duration in a tertiary care hospital. A retrospective analysis of all the cases of type 2 diabetes mellitus of more than 10 years duration from 2002 to 2003 was done and the data was divided into three groups: oral hypoglycemic agents (OHA) only, Insulin only, OHA + insulin. ANOVA/Students t test was the primary statistical test used. Odds ratio and 95% CI were calculated to compare risks of other diseases and drug use. 62.35% were on only OHAs, 8.82% on only insulin and 28.82% on both insulin and OHAs. This confirms good efficacy of OHAs. Diabetic population in our study tends to have a preserved beta cell function and secondary OHA failure is a late feature.     

Characterizing Functional Lung Heterogeneity in COPD Using Reference Equations for CT Scan-Measured Lobar Volumes

BackgroundCT scanning is increasingly used to characterize COPD. Although it is possible to obtain CT scan-measured lung lobe volumes, normal ranges remain unknown. Using COPDGene data, we developed reference equations for lobar volumes at maximal inflation (total lung capacity [TLC]) and relaxed exhalation (approximating functional residual capacity [FRC]).MethodsLinear regression was used to develop race-specific (non-Hispanic white [NHW], African American) reference equations for lobar volumes. Covariates included height and sex. Models were developed in a derivation cohort of 469 subjects with normal pulmonary function and validated in 546 similar subjects. These cohorts were combined to produce final prediction equations, which were applied to 2,191 subjects with old GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II to IV COPD.ResultsIn the derivation cohort, women had smaller lobar volumes than men. Height positively correlated with lobar volumes. Adjusting for height, NHWs had larger total lung and lobar volumes at TLC than African Americans; at FRC, NHWs only had larger lower lobes. Age and weight had no effect on lobar volumes at TLC but had small effects at FRC. In subjects with COPD at TLC, upper lobes exceeded 100% of predicted values in GOLD II disease; lower lobes were only inflated to this degree in subjects with GOLD IV disease. At FRC, gas trapping was severe irrespective of disease severity and appeared uniform across the lobes.ConclusionsReference equations for lobar volumes may be useful in assessing regional lung dysfunction and how it changes in response to pharmacologic therapies and surgical or endoscopic lung volume reduction.     

Antihypercholesterolemic effect of Bacopa monniera linn. on high cholesterol diet induced hypercholesterolemia in rats

ObjectiveTo explore the effect of alcoholic extract of Bacopa monniera (AEBM) on high cholesterol diet-induced rats.MethodsThe shade-dried and coarsely powdered whole plant material (Bacopa monniera) was extracted with 90% ethanol, finally filtered and dried in vacuum pump. The experimental rats were divided into 4 groups: control (group-I), Rats fed with hypercholesterolemic diet (HCD) for 45 days [4% cholesterol (w/w) and 1% cholic acid], Rats fed with HCD for 45 days+AEBM (40mg/kg, body weight/day orally) for last 30 days (group-III) and AEBM alone (group-IV). Blood and tissues (Aorta) were removed to ice cold containers for various biochemical and histological analysis.ResultsAEBM treatment significantly decreased the levels of TC, TG, PL, LDL, VLDL, atherogenic index, LDL/HDL ratio, and TC/HDL ratio but significantly increased the level of HDL when compared to HCD induced rats. Activities on liver antioxidant status (SOD, CAT, GPx, GR, GST) were significantly raised with concomitant reduction in the level of LPO were obtained in AEBM treated rats when compared to HCD rats. Treatment with AEBM significantly lowered the activity of SGOT, LDH and CPK. Histopathology of aorta of cholesterol fed rat showed intimal thickening and foam cell deposition were noted.ConclusionsThese results suggests that AEBM extended protection against various biochemical changes and aortic pathology in hypercholesterolemic rats. Thus the plant may therefore be useful for therapeutic treatment of clinical conditions associated hypercholesterolemia.     

New Algorithm for the Prediction of Cardiovascular Risk in Symptomatic Adults with Stable Chest Pain

Purpose of Review

To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptomatic patients with stable chest pain and identify better prediction tools and propose a simplified algorithm to guide the health care providers in identifying low risk patients to defer further testing.

Recent Findings

There are a few risk prediction models described for stable chest pain patients including Diamond-Forrester (DF), Duke Clinical Score (DCS), CAD Consortium Basic, Clinical, and Extended models. The CAD Consortium models demonstrated that DF and DCS models overestimate the probability of CAD. All CAD Consortium models performed well in the contemporary population. PROMISE trial secondary data results showed that a clinical tool using readily available ten very low-risk pre-test variables could discriminate low-risk patients to defer further testing safely.

Summary

In the contemporary population, CAD Consortium Basic or Clinical model could be used with more confidence. Our proposed simple algorithm would guide the physicians in selecting low risk patients who can be managed conservatively with deferred testing strategy. Future research is needed to validate our proposed algorithm to identify the low-risk patients with stable chest pain for whom further testing may not be warranted.

     

Unusually large complex odontoma in maxillary sinus associated with unerupted tooth. Report of case and review of literature

An unusual case of a large complex odontoma with an associated impacted tooth is presented. Odontomas are hamartomatous growths of enamel, dentin, cementum and pulp tissue. Although they are usually tooth-sized or smaller, occasionally, the complex variant can exhibit considerable growth, as was seen in the case presented here. It occupied most of the maxillary sinus and displaced the floor of the orbit and the medial and posterior walls of the left maxillary sinus. Panoramic radiographs, as well as axial and coronal CT studies, showed the extent of the lesion in various dimensions. A differential diagnosis of various calcifying tumors was formulated on the basis of these findings. The lesion was surgically excised, and histologic analysis confirmed the radiographic impression. Although odontomas of this magnitude are rare, this case demonstrates the value of imaging, radiographic histopathologic diagnosis and surgical treatment planning prior to any definitive treatment.     

The mineralized and elongated styloid process: a review of current diagnostic criteria and evaluation strategies

The mineralized and elongated styloid process and Eagle's syndrome are similar processes of elongation in which mineralization of the stylohyoid ligament leads to styloid process of the temporal bone. The mineralized and elongated styloid process and Eagle's syndrome differ significantly in terms of the symptoms displayed and the treatment modalities that are sought. The mineralized and elongated styloid process refers to unilateral or bilateral elongation of the styloid process that does not result in any significant pain, discomfort, or limitation of neck movement. It often remains asymptomatic until it is discovered on extraoral radiographs. Eagle's syndrome refers to pain and discomfort in the cervicofacial region resulting specifically from the elongated styloid process. Surgical shortening may be the only treatment that will alleviate the patient's symptoms. This article reviews the entire process of elongation pertaining to the styloid process and discusses the associated syndromes, including current knowledge of the theories of elongation, diagnostic criteria, and treatment strategies.