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PubMed2001

Topical antibiotics for acute bacterial conjunctivitis: a systematic review.

There has been uncertainty about whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. This study aimed to assess the efficacy of antibiotic therapy in the management of acute bacterial conjunctivitis. Using standard Cochrane search methods, we identified double-blind randomised controlled trials in which any form of antibiotic treatment (topical, systemic or combination) had been compared with placebo in the management of acute bacterial conjunctivitis. Data extraction and analysis followed a pre-defined protocol. Meta-analysis was performed to obtain summary measures of relative risk. Six published trials were identified, of which three fulfilled the eligibility criteria for inclusion in this review. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as clinical remission occurred by days 2 to 5 in 64% (95% confidence interval (CI) = 57-71) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days 2 to 5: relative risk (RR) = 1.31, 95% CI = 1.11-1.55), with a suggestion that this benefit was maintained for late clinical remission (days 6 to 10: RR = 1.27, 95% CI = 1.00-1.61). Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission, and early and late microbiological remission. Since trials to date have been conducted in selected specialist care patient populations, generalisation of these results to a primary care-based population should be undertaken with a degree of caution.

Acute Disease↗
PubMed1984

Sensitivity of detecting Chlamydia trachomatis elementary bodies in smears by use of a fluorescein labelled monoclonal antibody: comparison with conventional chlamydial isolation.

Commercially produced fluorescein labelled monoclonal antibodies for the detection of Chlamydia trachomatis have recently become available. One is for detecting inclusions in cell culture (culture confirmation) and the other for detecting elementary bodies in smears from potentially infected sites. We have compared the two monoclonal antibodies with our routine isolation method, which utilises Giemsa staining of cycloheximide treated McCoy cell cultures. The culture confirmation system offered no advantages over Giemsa staining for the detection of inclusions in cell monolayers. By contrast, using monoclonal antibody to detect elementary bodies in smears was much quicker and simpler and slightly more sensitive than isolation of chlamydiae in cell culture. For specimens from seven babies with conjunctivitis and from 35 female contacts of men with non-gonococcal urethritis, there was complete agreement between the results of detecting inclusions in culture and those of seeking elementary bodies in smears. For samples from 100 men with non-gonococcal urethritis and from 100 men with gonorrhoea there was 99% and 94% agreement, respectively, between the results of the two tests. Other aspects and possible uses of the new detection system are discussed.

Antibodies, Monoclonal↗
PubMed2005

[Complementary to notification required by the national Protection against Infection Act. State-specific mandatory infectious disease notification in Saxony-Anhalt].

In May 1991 a decree supplementing the federal Epidemic Law concerning the mandatory notification of communicable diseases was implemented by the Ministry of Health in Saxony-Anhalt. This was updated and newly implemented in 1997. With implementation of the national Protection against Infection Act in 2001 further amendment of the state regulation (published in April 2005) be came necessary. The following diseases or laboratory evidence of the underlying pathogens, respectively, will now be notifiable with inclusion of the affected individual's name: aseptic meningitis, mumps, rubella, varicella, epidemickera to conjunctivitis, pertussis, and pneumococcal meningitis. The possibility of preventing further spread of the pathogen to others though immediate implementation of preventive measures by the public health service justifies notification of the individual's name. Furthermore, the epidemiological situation is to be monitored and evaluated. This also applies to Lyme disease, which will be anonymously notifiable. Particular emphasis is placed on vaccine-preventable diseases in the state regulation for mandatory notification in Saxony-Anhalt, since priority is placed on attaining the health goal "age-appropriate vaccination status in over 90% of the population". The state-specific notification regulation of Saxony-Anhalt has worked well in preventing and controlling communicable diseases. It is a source of reliable data, which may be helpful in the discussion regarding the amendment of the Protection against Infection Act. Non-anonymous notification should be enforced nationally at least for all vaccine-preventable diseases for which a post-exposure vaccination is recommended by the Standing Committee on Vaccination (STIKO).

Communicable Disease Control↗
PubMed1996

Preserved color imagery in an achromatopsic.

The loss of color vision secondary to central nervous system disease (achromatopsia) is thought to preclude visual imagery of colors. We report a patient with achromatopsia, secondary to bilateral temporo-occipital infarcts inclusive of the lingual and fusiform gyri, with preserved color imagery. Our findings, in conjunction with previous cases in the literature, are consistent with a single neural network for color processing in which a disconnection of internal activation from stored color representations produces impaired color imagery with preserved color perception, whereas a disconnection of visual input to these representations produces achromatopsia with preserved color imagery.

Cerebral Infarction↗
PubMed1996

Intrasellar abscess following transsphenoidal surgery.

BACKGROUND: Intrasellar abscess following transsphenoidal surgery has been described only twice in the English language medical literature. Overall mortality associated with intrasellar abscesses is 51%, while mortality in reported cases not treated surgically is 100%. METHODS: Two cases of intrasellar abscess following uncomplicated transsphenoidal surgery for pituitary pathology are reported. The incidence, radiographic features, clinical presentations, and treatment of intrasellar abscesses are discussed. RESULTS: Both patients described underwent uncomplicated transsphenoidal procedures for treatment of a primary pituitary lesion. Neither developed postoperative CSF rhinorrhea, and initial recovery was uneventful. The first patient presented with new symptoms several weeks after transsphenoidal surgery; the second patient almost two years postoperatively. The first displayed signs of an expanding sellar mass, requiring transsphenoidal drainage and postoperative antibiotics. The second presented with recurrent meningitis without discernible CSF leak, and was treated with transnasal endoscopic drainage in conjunction with antibiotic therapy. CONCLUSIONS: The high mortality associated with intrasellar abscess mandates its inclusion in the differential diagnosis of patients presenting with symptoms of meningitis or an expanding sellar mass after transsphenoidal intervention. Although antibiotic therapy is an important adjunct, surgical drainage is required for definitive treatment.

Brain Abscess↗
PubMed2003

Neurodegeneration: linking ubiquitin/proteasome pathway impairment with inflammation.

Neurodegenerative disorders have been reported to be associated with accumulation of ubiquitinated proteins in neuronal inclusions and also with signs of inflammation. In these disorders, the abnormal protein aggregates may, themselves, trigger the expression of inflammatory mediators, such as, cyclooxygenase 2 (COX-2). Impairment of the ubiquitin/proteasome pathway may contribute to this neurodegenerative process. Accordingly, proteasome inhibitors and oxidative stressors such as cadmium, were found to decrease survival, induce the accumulation of ubiquitinated proteins and elicit up-regulation of cyclooxygenase 2 in neuronal cell cultures. Products of cyclooxygenase 2, such as prostaglandin J2, can, in turn, increase the levels of ubiquitinated proteins and also cause cyclooxygenase 2 up-regulation, creating a "self-destructive" feedback mechanism. In neurodegenerative disorders characterized by neuronal inclusions containing ubiquitinated proteins, a disruption of the ubiquitin/proteasome pathway may, therefore, act in conjunction with cyclooxygenase 2 up-regulation to exacerbate the neurodegenerative process. Cyclooxygenase 2 inhibitors and agents that prevent protein aggregation could be of therapeutic value to these forms of neurodegeneration.

Animals↗
PubMed2005

Inbreeding and kinship in the ant Plagiolepis pygmaea.

In ants the presence of multiple reproductive queens (polygyny) decreases the relatedness among workers and the brood they rear, and subsequently dilutes their inclusive fitness benefits from helping. However, adoption of colony daughters, low male dispersal in conjunction with intranidal (within nest) mating and colony reproduction by budding may preserve local genetic differences, and slow down the erosion of relatedness. Reduced dispersal and intranidal mating may, however, also lead to detrimental effects owing to competition and inbreeding. We studied mating and dispersal patterns, and colony kinship in three populations of the polygynous ant Plagiolepis pygmaea using microsatellite markers. We found that the populations were genetically differentiated, but also a considerable degree of genetic structuring within populations. The genetic viscosity within populations can be attributed to few genetically homogeneous colony networks, which presumably have arisen through colony reproduction by budding. Hence, selection may act at different levels, the individuals, the colonies and colony networks. All populations were also significantly inbred (F=0.265) suggesting high frequencies of intranidal mating and low male dispersal. Consequently the mean regression relatedness among workers was significantly higher (r = 0.529-0.546) than would be expected under the typically reported number (5-35) of queens in nests of the species. Furthermore, new queens were mainly recruited from their natal or a neighbouring related colony. Finally, the effective number of queens coincided with that found upon excavation, suggesting low reproductive skew.

Animals↗
PubMed2003

Adolpho Lutz and controversies over the transmission of leprosy by mosquitoes.

During his years of study in Switzerland and Germany, Adolpho Lutz published his first articles on zoology, clinical practice, and therapeutics. In Limeira, São Paulo, he began studies on animal and human diseases caused by germs and parasites. In 1885-86, Lutz traveled to Hamburg to study the morphology of germs related to skin diseases, in conjunction with Paul Gerson Unna, one of Germany's foremost dermatologists. He proposed the inclusion of Hansen's and Koch's bacilli in a new genus. In 1889, Unna nominated his student as physician-in-chief of the Leper Settlement on Molokai Island, Hawaii. From then on, Lutz sustained the theory that the disease was transmitted by mosquitos. He conducted research to prove this theory when he was head of the Instituto Bacteriológico de São Paulo (1893-1908) and, later, after he moved to the Instituto Oswaldo Cruz (1908-1940). Although this research was not successful, on commissions and at congresses in which he participated until his death in October 1940, he still held to his conviction that leprosy was transmitted by mosquitoes.

Animals↗
PubMed2004

[Pathologic diagnosis of non-Alzheimer type dementia].

OBJECTIVE: To characterize histopathologic features of non-Alzheimer type dementia. METHODS: Bodian, Gallyas-Braak silver staining, tau and ubiquitin immunohistochemistry were applied in an analysis of 22 cases of autopsy-proven neurodegenerative dementia. Appearance, distribution and immunoreactivity of neuronal and glial inclusions in the brain were observed. The final histological diagnoses were made according to the pathological criteria for several types of common non-Alzheimer type dementia. RESULTS: Among the 22 cases of neurodegenerative dementia, 12 cases were identified as non-Alzheimer type dementia, including Pick's disease (2 cases), progressive supranuclear palsy (3 cases) and corticobasal degeneration (3 cases), dementia with Lewy bodies (1 case), and Parkinson's disease (3 cases). Another 10 cases consisted of pure Alzheimer's disease (AD, 9 cases) and AD combined with argyrophilic grain disease (1 case). Characteristic neuronal and glial inclusions, such as classical and cortical Lewy body, Pick body, Globous NFTs, astrocytic plaque and tufted astrocyte, argyrophilic grain were found in the brains of non-Alzheimer type dementia. Classical and cortical Lewy bodies were not argyrophilic but were immunoreactive to ubiquitin. Pick bodies, Globous NFTs, astrocytic plaques, tufted astrocytes and argyrophilic grains were all argyrophilic. Pick bodies showed tau and ubiquitin immunoreactivity. However, Globous NFTs, astrocytic plaques, tufted astrocytes, and argyrophilic grains were reactive only to tau immunohistochemistry. CONCLUSIONS: Findings of characteristic neuronal and glial inclusions may help to differentiate non-Alzheimer type dementia from AD, and in conjunction with Gallyas-Braak staining and immunohistochemistry for tau and ubiquitin, to further define histopathologic subcategories of non-Alzheimer type dementia.

Aged↗
PubMed1997

A rapid viability assay for Cryptosporidium oocysts and Giardia cysts for use in conjunction with indirect fluorescent antibody detection.

There is an urgent need to develop rapid methods to determine the viability of Cryptosporidium oocysts and Giardia cysts in environmental samples, especially water. The inclusion of the vital dye propidium iodide (PI) by oocysts and cysts has been previously shown to correlate well with nonviability. The ability of nonviable oocysts and cysts to include PI has been employed to develop a rapid viability determination method that could be used in conjunction with the current indirect fluorescent antibody (IFA) method for detecting oocysts and cysts. The efficacy of this PI-IFA method to detect and determine the viability status of oocysts/cysts has been tested using oocyst samples inactivated by three different approaches. The ability to incorporate PI staining with IFA detection provides the advantage of both detection and viability determination at the same time, using the same sample.

Animals↗
PubMed2000

Antibiotics for acute bacterial conjunctivitis.

BACKGROUND: There are concerns regarding whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. OBJECTIVES: The aim of this review is to assess the benefit and harm of antibiotic therapy in the management of acute bacterial conjunctivitis. SEARCH STRATEGY: We searched the Cochrane Eyes and Vision Group specialised register, the Cochrane Controlled Trials Register - Central, MEDLINE and the reference lists of identified trial reports. We used the Science Citation Index to look for articles that cited the relevant studies, and we contacted investigators and pharmaceutical companies for information about additional trials. The most recent searches were carried out in September 1998. SELECTION CRITERIA: We included double masked randomised controlled trials in which any form of antibiotic treatment had been compared with placebo in the management of acute bacterial conjunctivitis. This included topical, systemic and combination (for example, antibiotics and steroids) antibiotic usage. DATA COLLECTION AND ANALYSIS: One reviewer extracted data and the accuracy was checked by a second reviewer. Relative risks were summarised. We tested for heterogeneity between studies. MAIN RESULTS: Six published trials were identified of which three fulfilled the eligibility criteria for inclusion in this review. One trial was single masked and therefore excluded. A second report, when translated, was found to have no placebo group and was therefore excluded. One trial is currently 'awaiting assessment'. This has been published in abstract form and has yet to be fully reported. All the trials thus far identified appear to have been conducted on a selected specialist care patient population. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as clinical remission (cure or significant improvement) occurred by days two to five in 64% (95% confidence interval (CI) 57% to 71%) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days two to five: relative risk (RR) 1.31 95% CI 1.11 to 1.55, NNT=5) with a suggestion that this benefit was maintained for late clinical remission (days six to 10: RR 1.27 95% CI 1.00 to 1.61, NNT=5). Antibiotic treatment was associated with rates of microbiological remission (pathogen eradication or reduction). No serious outcomes were reported in either the active or placebo arms of these trials, indicating that important sight-threatening complications are an infrequent occurrence. REVIEWER'S CONCLUSIONS: Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission and early and late microbiological remission. Since trials to-date have been conducted in selected specialist care patient populations these results may not necessarily be generalisable to a primary care based population. A trial based in primary care designed to assess the cost-effectiveness of commonly prescribed antibiotic(s) versus placebo in acute bacterial conjunctivitis is warranted.

Acute Disease↗
PubMed1991

Cytological evaluation of adenoviral follicular conjunctivitis by cytobrush.

Conjunctival brush samples from 38 patients with acute conjunctivitis were examined to determine whether cellular features could be utilized for cytodiagnosis. Of all cases, 32 (84%) patients showed a characteristic cell pattern for adenoviral follicular conjunctivitis (AFC) and in the remaining 6 (16%) patients herpetic infection was suggested cytologically. The background of the conjunctival smears from patients with AFC was characterized by the predominance of lymphocytes with little fibrinous discharge. In addition, two types of nuclear alterations were demonstrated i.e. intranuclear inclusions and a so-called ground-glass nuclear appearance. Ground-glass nuclei occurred more frequently than intranuclear inclusions in patients with AFC. However, the presence of lymphocytes in conjunctival smears was a useful criterion for making the differential diagnosis between herpetic and adenoviral infections. Thus, in the absence of these three cellular changes, i.e. ground-glass nuclei, intranuclear inclusions and lymphocytic background, infectious conditions other than AFC may be considered, regardless of the numbers of conjunctival cells present. Emphasis is placed on the value of conjunctival brush cytology for the rapid diagnosis of cases of suspected AFC.

Adenovirus Infections, Human↗
PubMed1985

On the replication and spread of rabies virus in the human central nervous system.

Ultrastructural and immunohistochemical studies on the brains of two autopsy cases of human rabies revealed: By the peroxidase-antiperoxidase method, viral antigens were present in all eosinophilic inclusions detected in formalin fixed paraffin sections. Numerous antigenic masses, which apparently corresponded to the matrices and cylindrical particles in neurites revealed by electron microscopy, were present in the neuropil remote from neuronal perikarya. There were virions in the intercellular spaces and virus-budding from the plasma membrane into the extracellular space in the absence of a matrix, strongly indicating that rabies virus in the human central nervous system could spread through the intercellular spaces and that the replication of the virus was not necessarily accompanied by the formation of inclusion bodies. The synapse was involved in rabies as indicated by virions in the synaptic terminals. The implications of these observations are discussed in conjunction with the results of previous in vitro and animal experiments.

Adolescent↗
PubMed1984

Isolation of Chlamydia psittaci from cases of conjunctivitis in a colony of cats.

This report describes the isolation in cell cultures of Chlamydia psittaci from cases of conjunctivitis in a colony of cats. The organism was identified in McCoy cell monolayers by staining the intracytoplasmic chlamydial inclusions with a fluorescent antibody technique, and serological evidence of chlamydial infection in cats was obtained by indirect immunofluorescence. The possible role of C psittaci as an ocular, upper respiratory and reproductive tract pathogen in cats is discussed.

Animals↗
PubMed2002

A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders.

AIMS: To test the usefulness of tailoring cognitive-behavioral therapy (CBT) for patients with temporomandibular disorders (TMD) who demonstrated poor psychosocial adaptation to their TMD condition, independent of physical diagnosis. METHODS: A randomized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists. For study inclusion, Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Axis II criteria, were used to target patients with elevated levels of TMD pain-related interference with daily activities, independent of physical diagnosis (i.e., Axis I). RESULTS: At the post-treatment assessment, about 4 months after the baseline evaluations, the comprehensive care group, when compared to the usual treatment group, showed significantly lower levels of characteristic pain intensity, significantly higher self-reported ability to control their TMD pain, and a strong trend (P = .07) toward lower pain-related interference in daily activities. From post-intervention to 1-year follow-up, all subjects showed improvement. At the 1-year follow-up, the comprehensive care group, while not losing any of its early gains, was not significantly different from the usual care group with regard to reported levels of pain, ability to control pain, and levels of interference in activities. For many of these psychosocially disabled TMD patients, pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate randomized clinical trial on the basis of better psychosocial adaptation. CONCLUSION: The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment, but was too brief an intervention to result in further improvement after the sessions ended. Patient ratings of treatment satisfaction and helfulness were high for both groups, but they were significantly higher for the comprehensive care group.

Activities of Daily Living↗
PubMed2005

Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization.

BACKGROUND: Published data indicate that there is a significant treatment gap between the evidence for and the implementation of lipid-lowering therapy and that recidivism is as high as 60% at 1 year. The aim of this study is to examine the impact of a clinical pharmacy cardiac risk service (CPCRS) on lipid screening, control, and treatment outcomes. METHODS: A computer-generated list of all patients with documented coronary artery disease, enrolled in a CPCRS between March 1, 1998, and October 1, 2002, and followed up for a minimum of 6 months was obtained. Outcome measures were the percentage of patients with up-to-date lipid screening results and the percentage achieving low-density lipoprotein cholesterol (LDL-C) goals at enrollment in CPCRS and at study end. RESULTS: A total of 8014 patients (mean age, 69.3 years; 69.8% men) met the entry criteria. The mean duration of follow-up was 2.3 years. Most patients (97.3%) had up-to-date lipid screening results at study end compared with 66.9% of patients at baseline. At study end, a total of 72.9% of patients achieved a LDL-C level of less than 100 mg/dL (<2.6 mmol/L) compared with 25.5% at baseline. The mean +/- SD LDL-C level for the cohort at study end was 89 +/- 24 mg/dL (2.3 +/- 0.6 mmol/L). Of patients receiving medication, most (84.8%) were receiving therapy with statins alone, whereas 11.7% were receiving combination therapy. CONCLUSIONS: A CPCRS working in conjunction with a patient-tracking system can achieve improved lipid results in a large and inclusive cohort of patients with coronary artery disease. Our approach is unique in that the results were sustainable and demonstrate reduced recidivism.

Adult↗
PubMed2004

Fertility awareness-based methods for contraception.

BACKGROUND: "Fertility awareness-based methods" (FAB) of family planning "involve identification of the fertile days of the menstrual cycle, whether by observing fertility signs such as cervical secretions and basal body temperature, or by monitoring cycle days. FAB methods can be used in combination with abstinence or barrier methods during the fertile time" (WHO 2000). Several names have been used to describe this approach to contraception, including "rhythm," "natural family planning" and "periodic abstinence." Fertility awareness-based methods can be used with abstinence from sexual intercourse. Alternatively, they can be used with barrier contraceptives or withdrawal during presumed fertile times. OBJECTIVES: We retrieved and analyzed all randomized controlled trials that examined any fertility awareness-based methods used for contraception. SEARCH STRATEGY: We searched the computerized databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, POPLINE, EMBASE, and LILACS (each from its inception to January, 2004) for randomized controlled trials of fertility awareness-based methods. We examined the reference list of each trial as well as that of review articles. SELECTION CRITERIA: We included all randomized controlled trials in any language that compared any fertility awareness-based methods for contraception with a placebo; another method, including an alternative fertility awareness-based method; or fertility awareness-based methods used in conjunction with another contraceptive. DATA COLLECTION AND ANALYSIS: We assessed all titles and abstracts found for inclusion. We evaluated the methodological quality of the trials for potential biases by qualitatively assessing the study design; randomization method; allocation concealment; blinding; premature discontinuation rates; and loss to follow-up rates. Because of methodological weaknesses, we could not enter the trial results in RevMan, calculate measures of association, or aggregate data. MAIN RESULTS: Because of poor methods and reporting, pregnancy rates could not be determined. A trial in Colombia found similar numbers of pregnancies among women randomized to the ovulation and symptothermal methods. In contrast, a companion trial in Los Angeles observed more pregnancies in the group assigned to the ovulation method. In the two U.S. trials, recruitment of participants was unexpectedly difficult; this aspect was not mentioned in the report from Colombia. Continuation rates were poor. In the two larger trials, most participants discontinued their assigned method before entering the observation phase of the trial. REVIEWERS' CONCLUSIONS: The comparative efficacy of fertility awareness-based methods of contraception remains unknown. Despite intensive training and ongoing support, most participants in these trials discontinued prematurely. Contraceptive methods should be properly evaluated, preferably in randomized controlled trials, before adoption and dissemination.

Awareness↗