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Changgeng Yi Xue Za Zhi. 1998 Dec;21(4):409-14.
Chest physiotherapy does not exacerbate gastroesophageal reflux in patients with chronic bronchitis and bronchiectasis.

Chen HC, Liu CY, Cheng HF, Ho SC, Chiang LL, Kuo HP.

Department of Intermal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.

BACKGROUND: Chest physiotherapy is beneficial to patients with mucus hypersecretion. However, it is not risk-free. Chest physiotherapy may affect gastrointestinal motility and the competence of the gastroesophageal sphincter during the procedure. Our study was aimed to investigate whether gastroesophageal reflux is exacerbated or induced by chest physiotherapy. MATERIALS AND METHODS: Thirty-two adult patients with chronic bronchitis or bronchiectasis received chest physiotherapy. An esophageal pH meter was placed 5 cm above the gastroesophageal junction and monitored the reflux episodes from 8 AM on the first day to 12 noon on the second day. Physiotherapy was performed with the patient in three different positions on the second day for one hour. RESULTS: Thirteen patients were found to have gastroesophageal reflux disease. For the study group as a whole, neither the frequency nor the duration of having a pH < 4 during the physiotherapy was significantly different from the mean hourly frequency and mean hourly duration recorded on the first day or from those values recorded at a corresponding time on the first day. As for the patients with gastroesophageal reflux disease, the frequency and total duration of gastroesophageal reflux during physiotherapy were not significantly different from the mean hourly frequency and the mean hourly duration or from the values recorded at the corresponding time on the first day. There was no significant difference in the gastroesophageal reflux frequency or the duration in different body positions. CONCLUSION: Chest physiotherapy including postural drainage, percussion and forced expiration techniques in different positions did not induce or increase the incidence of gastroesophageal reflux in patients with chronic bronchitis and bronchiectasis.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10074726&dopt=Abstract

Presse Med. 1999 Feb 20;28(7):343-50.
[Prescription and consumption of antibiotics in ambulatory care]

[Article in French]

[No authors listed]

OBJECTIVE: This study was conducted to describe changes in prescription practices outside the hospital, to evaluate the adaptation of such prescriptions to current scientific knowledge, and to compare medical practices in France with those in other European countries. METHODS: Data were collected from several sources: analysis of the literature, surveys conducted in the Loiret department and in the Rhone-Alpes region, ten-year health surveys (INSEE), data from the Sentinel network, sales statements from pharmaceutical firms, the Permanent Survey of Medical Prescription (EPPM) of the Medical Information and Statistics (IMS) firm. Comparisons between France, the United Kingdom and Germany were conducted by the French Medicine Agency's Pharmaco-economic Studies and Information Department using data furnished by the IMS firm and by pharmaceutical firms. RESULTS: In France, antibiotic sales increased by a mean annual rate of 2.1%, expressed in antibiotic units, and 2.6%, expressed in turnover (manufacturer price) between 1991 and 1996. The majority of these antibiotics were prescribed for respiratory and ENT infections with a presumed viral etiology such as rhinopharyngitis and acute bronchitis. The results of the different surveys were in agreement showing that antibiotic prescriptions are made in approximately 40% of all consultations for rhino-pharyngitis and in 80% of those for acute bronchitis. Antibiotics were prescribed in more than 90% of cases of pharyngitis whatever the age of the patient. The situation was different for acute middle ear infections as the number of consultations has remained relatively unchanged over the last 10 years while antibiotic prescriptions have strongly increased, reaching 80% of the consultations. The number of consultations for pharyngitis and acute rhino-pharyngitis appears to be greater in France than in the United Kingdom and in Germany. Likewise, the proportion of patients using antibiotics after consulting for presumed viral conditions would be higher in France with different antibiotic classes being used. CONCLUSIONS: There is a gap between official guidelines (product description documents, therapeutic information document good practice guidelines, consensus conferences) and the state of current practices. Excessive and poorly-adapted antibiotic prescription favors the disturbing phenomenon of resistance which is all the more alarming because the emergence of resistant strains is difficult to predict and concern bacteria causing the most common infections. To improve medical practices and achieve a persistent reduction in the use of antibiotics for viral infections, validated recommendations should be distributed to physicians. An effort should be made to prescribe the most appropriate active substance at optimal dose and treatment duration to limit the development of bacterial resistance. In addition, patients and the general public should be informed of the absence of any beneficial effect and the individual and collective risks involved in using antibiotic for viral infections in order to help them better understand and comply to their physician's prescription.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10083880&dopt=Abstract

Med Klin. 1999 Jan 15;94(1):39-44.
[Acute hantavirus infection caused by a genetically newly identified viral strain. Severe and complicated course of hemorrhagic fever with renal syndrome (nephropathia epidemica)]

[Article in German]

Lauer B, Wiemer M, Kramer A, Pilaski J, Heering P, Horstkotte D, Schultheiss HP, Strauer BE.

Klinik fur Innere Medizin/Kardiologie, Universitat Leipzig.

HISTORY AND CLINICAL FINDINGS: A 49-year-old patient, a hobby hunter, fell ill acutely with joint and limb pain, abdominal pain, nausea and subfebrile temperatures. At hospitalization, the patient was in bad general condition, showing ascites and lid edema, and acute renal failure was diagnosed. INVESTIGATIONS: Laboratory tests revealed marked thrombocytopenia (15,000/ml), leucocytosis, elevated levels of creatinine, blood urea nitrogen and liver enzymes, respectively. Blood gas analysis showed metabolic acidosis. Chest X-ray showed an interstitial fluid accumulation, abdominal ultrasound disclosed ascites and enlarged kidneys as in acute renal failure. Immunologic tests verified the diagnosis of an acute hantavirus infection, by use of specific molecular biology techniques a previously unknown virus strain was identified. TREATMENT AND COURSE: Hantavirus infections in western Europe usually show a benign course. However, in the present case, acute progressive pulmonary failure developed despite effective dialysis so that mechanical ventilation was necessary for several weeks. Dialysis had to be carried out for 17 days. As a complication a severe ulcero-destructive tracheobronchitis developed, caused by Aspergillus fumigatus. After several weeks, both renal and pulmonary function had returned to normal. CONCLUSION: Hantavirus infections may lead to severe and complicated courses also in western Europe. By use of new immunologic and molecular biology techniques a specific diagnosis is possible.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10081288&dopt=Abstract

Ann Allergy Asthma Immunol. 1999 Mar;82(3):287-92.
Trends in asthma mortality in young people in southern Brazil.

Chatkin JM, Barreto SM, Fonseca NA, Gutierrez CA, Sears MR.

The Medical School, Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.

BACKGROUND: Mortality from asthma increased and is now declining in some countries, but little is known about these trends in South America. OBJECTIVE: We aimed to assess trends in mortality from asthma in southern Brazil in children and young adults. METHODS: Death certificates of 425 people in the state of Rio Grande do Sul aged between 5 and 39 years in whom asthma was reported to be the underlying cause of death during the period 1970 to 1992 were reviewed. Population data were available in 10-year age groups. Testing for trends in mortality rates was conducted using linear and log-linear regression procedures. RESULTS: Asthma mortality rates in the age groups 5 to 19 and 20 to 39 years ranged between 0.04 and 0.39/100,000 and 0.28 to 0.75/100,000, respectively, and were nonuniformly distributed over the study period. The mean annual increase in rate in 5- to 19-year olds was +0.01 (95% CI 0.003 to 0.016), an average annual percentage increase of +6.8% (95% CI 3% to 11%), with a total increase of 352% between 1970 and 1992. This increase was not due to a shift in labeling from bronchitis to asthma. In the 20 to 39-year age group, asthma and bronchitis mortality rates showed no trend to increase or decrease. CONCLUSIONS: Asthma mortality in southern Brazil is low, but rose significantly between 1970 and 1992 in the 5 to 19-year age group. This trend differs from that found in other states of Brazil and several other Latin American countries. Reasons for this difference remain unclear.

PIP: Levels of mortality due to asthma are declining in some countries. To measure trends in mortality from asthma in southern Brazil among children and young adults, the death certificates of 425 people in the state of Rio Grande do Sul aged 5-39 years in whom asthma was reported to be the underlying cause of death during the period 1970-92 were reviewed. Asthma mortality rates among people aged 5-19 and 20-39 years were 0.04-0.39/100,000 and 0.28-0.75/100,000, respectively, and were nonuniformly distributed over the study period. The mean annual increase in mortality rate among 5-19 year olds was 0.01, an average annual percentage increase of 6.8%, with a total increase of 352% during 1970-92. This increase was not due to a shift in labeling from bronchitis to asthma. Among people aged 20-39 years, asthma and bronchitis mortality rates showed no trend of increase or decrease. Reasons for the dramatic increase in asthma-related mortality among 5-19 year olds are unclear.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10094220&dopt=Abstract

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