Efficacy and safety of azithromycin 1 g once daily for 3 days in the treatment of community-acquired pneumonia: an open-label randomised comparison with amoxicillin-clavulanate 875/125 mg twice daily for 7 days.

This randomised, open-label, non-inferiority study was designed to demonstrate that a 3-day course of oral azithromycin 1 g once daily was at least as effective as a standard 7-day course of oral amoxicillin-clavulanate 875/125 mg twice daily in the treatment of outpatients with community-acquired pneumonia (Fine class I and II). In total, 267 patients with clinically and radiologically confirmed community-acquired pneumonia were randomly assigned to receive either the azithromycin (n=136) or the amoxicillin-clavulanate (n=131) regimen. At screening, 60/136 (58.8%) and 61/131 (62.9%) respectively had at least one pathogen identified by sputum culture, PCR, or serology. The primary endpoint was the clinical response in the intent-to-treat population at the end of therapy (day 8 to 12). Clinical success rates were 126/136 (92.6%) for azithromycin and 122/131 (93.1%) for amoxicillin-clavulanate (treatment difference: - 0.48%; 95% confidence interval: - 5.66%; 4.69%). Clinical and radiological success rates at follow-up (day 22-26) were consistent with the end of therapy results, no patient reporting clinical relapse. Bacteriological success rates at the end of therapy were 32/35 (91.4%) for azithromycin and 30/33 (90.9%) for amoxicillin-clavulanate (treatment difference: 0.52%; 95% confidence interval - 10.81%; 11.85%). Both treatment regimens were well tolerated: the overall incidence of adverse events was 34/136 (25.0%) for azithromycin and 22/132 (16.7%) for amoxicillin-clavulanate. In both treatment groups, the most commonly reported events were gastrointestinal symptoms. Azithromycin 1g once daily for 3 days is at least as effective as amoxicillin-clavulanate 875/125 mg twice daily for 7 days in the treatment of adult patients with community-acquired pneumonia.

Influence of insulin on the microvascular response to inflammatory mediators in neonatal streptozotocin diabetic rats.

OBJECTIVES: To investigate the effect of insulin on microvascular responses to inflammatory mediators in a model of type 2 diabetes mellitus. MATERIALS: We used the neonatal streptozotocin (n-STZ)-induced diabetes model. Diabetes was induced in male newborn (2-day-old) Wistar rats through STZ administration. Experiments were performed 10-12 weeks later. METHODS: Rats were divided into control (sham-injected) and study (n-STZ) groups. Using a closed-circuit video camera coupled to a microscope, changes in mesenteric arteriolar and venular diameters induced by topical application of the inflammatory mediators histamine, bradykinin and platelet-activating factor were assessed in chloral hydrate-anesthetized rats. TREATMENT: The n-STZ rats received NPH insulin s.c. for either 4 h or 12 days. RESULTS: Impaired arteriole and venule responses to the inflammatory mediators tested were observed in n-STZ rats. Both acute and chronic insulin treatment corrected the alterations. CONCLUSION: We conclude that insulin is beneficial, restoring microvascular reactivity to inflammatory mediators in type 2 diabetes.

Personal smoking habit and attitude toward smoking among the health staff of a general hospital.

Tobacco smoke (TS) is the single most important cause of preventable death in industrialized countries. Health staff have great responsibility in its control, but the smoking habits of health staff may influence their attitude toward patients. The aim of the study was to evaluate: 1) the prevalence of smoking among health staff at different professional levels; 2) the knowledge of smoking-related damage; and 3) how personal smoking habits influence behaviour in the workplace. A questionnaire was sent to all health staff of the Morelli Hospital (Sondalo, Italy) asking information about age, activity, smoking habits and attitude toward smoking: the Fagerstrom test was also administered to smokers. A total of 959 valid questionnaires were collected (57% of the whole sample). Results were analyzed by means of Chi-squared and Student t-tests, where appropriate. The prevalence of smokers was 44% former smokers 24% and lifetime nonsmokers 32%. The highest prevalence of TS was found in nursing students and auxiliaries (47%) and the lowest among doctors (39%). A clear cohort-effect due to age was evidenced: the youngest age-group (< 30 yrs old) presents the highest prevalence of lifetime nonsmokers and of light smokers, and the lowest of heavy smokers; the oldest age-group (> 40 yrs old) presents the highest prevalence of quitters and of heavy smokers, and the lowest of smokers and lifetime nonsmokers; the intermediate age-group (31-40 yrs old) presents the highest prevalence of smokers. The knowledge of smoking-related damage was poor, with significant differences between smokers and nonsmokers and the different professional categories. Tobacco smoking proved to be common behaviour (even when on duty) among health staff. A minority of health staff seem fully aware of personal and social smoking related aspects. Smoking habits influence the attitude of health staff toward patient counselling about tobacco smoking.

The influence of personal tobacco smoking on the clinical practice of Italian chest physicians.

Tobacco smoking (TS) is a major cause of lung diseases. This study aimed to determine: 1) the prevalence of TS among chest physicians; 2) the influence of the personal smoking habit on clinical practice; and 3) what training about tobacco-related issues (TI) doctors received in medical school. A total of 983 attendees at the National Meeting of the Italian National Thoracic Society (AIPO) received a questionnaire about TI, which also contained the Fagerstroem Tolerance Questionnaire, and 605 (61.5%) answered. An independent assessment of the prevalence of smokers was carried out to minimize the bias of self-selection. The numbers of smokers was 151 (25%), never-smokers 246 (40.7%) and exsmokers 208 (34.4%). Smoking chest physicians underestimate the health hazards of smoking (p<0.001) and disregard their educational role (p=0.005) more than nonsmoking chest physicians. Compliance with smoking restrictions inside hospitals is frequently poor (30.1% smoke in clinics). In 33.1% of smokers a high nicotine addiction was found, which influenced their behaviour in hospital but not their ability to cope with tobacco-related problems. This ability was generally low: 39.1% of responders reported no training about TI. Smoking is frequent among Italian chest physicians, who are poorly trained about the health effects of tobacco smoking and are poorly skilled in treating smokers.

Prolonged ECG abnormalities in a subject with high altitude pulmonary edema (HAPE).

High Altitude Pulmonary Edema (HAPE) is an uncommon type of non-cardiogenic pulmonary edema. Few data are available regarding ECG abnormalities in patients with HAPE. They are usually slight and related to acute pulmonary hypertension. This paper describes a case of prolonged ECG abnormalities in a subject with HAPE, with no proven cardiac diseases. The Authors discuss the pathopysiological aspects of this kind of hypoxic-induced right ventricular overload with extensive T-wave negativity in precordial leads.

Unilateral high-altitude pulmonary edema in a subject with right pulmonary artery hypoplasia.

High-altitude pulmonary edema (HAPE) is an uncommon type of non-cardiogenic, high-permeability pulmonary edema. The authors describe a case of unilateral, left-sided HAPE that occurred in a man with right pulmonary artery hypoplasia.