Rapid antibody responses to Epstein-Barr virus correlate with reduced severity of primary infection.

BACKGROUND: We investigated Epstein-Barr virus (EBV) antibody kinetics in university freshmen who developed laboratory-documented primary EBV infection during prospective studies and correlated these kinetics with disease severity. METHODS: EBV-naïve participants had blood collected periodically and sera tested for EBV-specific antibodies with line blot and enzyme immunoassays. The line blot assay contained EBNA-1, p18, p23, BZLF-1, p138, and p54 antigens; the enzyme immunoassay contained viral capsid antigen and EBNA-1. Severity of illness (SOI) was graded 0 (asymptomatic) to 6 (bedridden). Participants with maximum SOI scores 0-2 were compared with those whose maximum SOI scores were 3-6. Time to first antibody response was analyzed using the semi-parametric COX model. RESULTS: A total of 201 sera from 38 college students collected before, during, and after primary EBV infection were tested. Earlier antibody responses correlated with milder symptoms. This was most pronounced for late-developing antibodies. The median time to development of p18 IgG was significantly earlier among low-SOI participants (64 days) than high-SOI patients (119 days; P = 0.0003).). Participants with mild disease developed EBNA-1 antibodies sooner than participants with more severe disease (125 days versus >270 days; P = 0.017). Participants with mild disease also showed more rapid loss of antibodies against IgG EA p138 and p54 ≥12 weeks post-infection (P = 0.012 and P = 0.026, respectively). CONCLUSIONS: These data suggest that rapid antibody responses to EBV correlate with reduced severity of primary EBV infection.

Common Cold - an Umbrella Term for Acute Infections of Nose, Throat, Larynx and Bronchi.

Acute respiratory tract infections, i. e. rhinitis, sinusitis, pharyngitis, laryngitis, bronchitis, belong to the most common medical conditions with a high economic burden. Nonetheless, there is little agreement concerning their differential diagnosis.This paper will discuss to what extent different anatomical sites of acute respiratory tract infections can be uniquely identified or whether the overlap and consecutive development in signs and symptoms renders these distinctions meaningless.Acute respiratory tract infections are variable but definition of diagnostic categories based on the anatomical sites of the dominant complaints shows that signs and symptoms both overlap to a great extent and/or emerge successively. Thus, in common cold distinguishing between acute symptom-based diagnoses arising from different anatomical sites of the aerodigestive system remains elusive. Therefore, preferred symptomatic treatments should foster a resolution of all possible symptoms as opposed to an isolated treatment of a single symptom (e. g. mucus hypersecretion) according to the presumed anatomical site (i. e. acute bronchitis).

Effect of Short-Term Mobile Phone Base Station Exposure on Cognitive Performance, Body Temperature, Heart Rate and Blood Pressure of Malaysians.

Individuals who report their sensitivity to electromagnetic fields often undergo cognitive impairments that they believe are due to the exposure of mobile phone technology. The aim of this study is to clarify whether short-term exposure at 1 V/m to the typical Global System for Mobile Communication and Universal Mobile Telecommunications System (UMTS) affects cognitive performance and physiological parameters (body temperature, blood pressure and heart rate). This study applies counterbalanced randomizing single blind tests to determine if sensitive individuals experience more negative health effects when they are exposed to base station signals compared with sham (control) individuals. The sample size is 200 subjects with 50.0% Idiopathic Environmental Intolerance attributed to electromagnetic fields (IEI-EMF) also known as sensitive and 50.0% (non-IEI-EMF). The computer-administered Cambridge Neuropsychological Test Automated Battery (CANTAB eclipse(TM)) is used to examine cognitive performance. Four tests are chosen to evaluate Cognitive performance in CANTAB: Reaction Time (RTI), Rapid Visual Processing (RVP), Paired Associates Learning (PAL) and Spatial Span (SSP). Paired sample t-test on the other hand, is used to examine the physiological parameters. Generally, in both groups, there is no statistical significant difference between the exposure and sham exposure towards cognitive performance and physiological effects (P's > 0.05).

Effect of two different superstrate layers on bismuth titanate (BiT) array antennas.

The microwave industry has shown increasing interest in electronic ceramic material (ECM) due to its advantages, such as light weight, low cost, low loss, and high dielectric strength. In this paper, simple antennas covered by superstrate layers for 2.30 GHz to 2.50 GHz are proposed. The antennas are compact and have the capability of producing high performance in terms of gain, directivity, and radiation efficiency. Bismuth titanate with high dielectric constant of 21, was utilized as the ECM, while the superstrate layers chosen included a split ring resonator and dielectric material. The superstrate layers were designed for some improvement in the performance of directivity, gain, and return loss. The proposed antennas were simulated and fabricated. The results obtained were small antennas that possess high gain and high directivity with 360°, omni-directional signal transmission that resonant types of conventional dipole antenna cannot achieve. The gain of the antenna with the superstrate layer was enhanced by about 1 dBi over the antenna without a superstrate layer at 2.40 GHz.

[Effect of ivabradin on heart rate, left ventricular function a NT-proBNP concentration in patients with systolic chronic heart failure--case reports]. / Efekt ivabradinu na tepovou frekvenci, vývoj funkce levé komory a koncentraci NT-proBNP u pacientu se systolickým chronickým srdecním selháním - príklady z praxe.

Ivabradin is indicated in patients with compensated chronic heart failure and sinus rhythm with resting heart rate 75 beats per minute despite maximal tolerated beta-blocker dose. Three case reports show favourable effect of ivabradin therapy on heart rate, reverse cardiac remodeling and B-type natriuretic peptide concentration in patients with systolic heart failure.

[Deficits in lipid lowering therapy and achieving target lipid concentrations in patients with high risk of a cardiovascular event]. / Rezervy v hypolipidemické terapii a dosazení cílových koncentrací lipidu u pacientu s vysokým rizikem kardiovaskulárních príhod.

Lipid concentrations were analysed in 529 consecutive patients, 190 females (34%) and 339 males (66%) with mean age 66 years, at high cardiovascular risk, undergoing elective coronary angiography between 1st January and 31st May 2010. LDL-cholesterol level < 2,5 mmol/l was identified only in 36% of patients in primary prevention, LDL-cholesterol level < 2,0 mmol/l was identified only in 28% of subjects in secondary prevention of cardiovascular events. The study proves inadequate control of dyslipidaemia in patients at high cardiovascular risk.

Critical evaluation of the optimal medical therapy in the cardiac resynchronization therapy candidates--single centre experience.

UNLABELLED: The aim of the present study was to evaluate the optimal medical therapy in the chronic heart failure (CHF) patients referred from the comunity centres and the outpatients cardiology clinics for the cardiac resynchronization therapy with defibrilator (CRTD) to the Department of Cardiology, Na Homolce Hospital with the device implantation between 1st January 2008 and 30st September 2009. METHODS: The optimal medical therapy was analysed retrospectively from the medical records of 179 consecutive CHF patients NYHA class III-IV. Beta-blockers (BB) were used only in 81% subjects referred for CRTD, ACE inhibitors (ACEI) were used only in 68% patients Angiotensin receptor blockers (ARB) were used in 18% subjects. ACEI or ARB were used in 81%, spironolacton was use in 59%. Recommended target DD for BB (carvedilol 25 mg bid) was used only in 13% subjects, recommended target DD for ACEI (enalapril 10 mg bid) was used only in 9.4% patients. RESULTS: In the Department of Cardiology, the optimal medical therapy was changed after CRTD, BB were used in 95% subjects at discharge (p < 0.01) and the number of patients reaching at least of 50% of recommended daily dose (DD) of BB increased (p < 0.05). ACEI were recommended after CRTD in 80% subjects after implantation (p < 0.05), the number of patients reaching at least of 50% of recommended DD for ACEIs increased too (p < 0.05). There was no significant difference in ARB use recomended in the hospital (19% after CRTD - NS). ACEI or ARB were used in 98% patients after the device implanted (p < 0.05) and spironolacton in 77% after CRTD (p < 0.05). CONCLUSIONS: Despite optimal composition of the optimal medical heart failure therapy only small number of CRTD candidates are reaching recommended drug dose. The optimization of the medical therapy in the specialized center lead to significantly higher proportion of CHF using the optimal therapy with the increased dose of BB and ACEI.

Efficacy and tolerability of EPs 7630 tablets in patients with acute bronchitis: a randomised, double-blind, placebo-controlled dose-finding study with a herbal drug preparation from Pelargonium sidoides.

OBJECTIVE: Acute bronchitis is one of the most frequent health complaints for which patients seek medical advice. Although viral infections prevail, antibiotics are commonly prescribed. In this study, the efficacy and tolerability of EPs 7630 tablets, a herbal drug preparation from the roots of Pelargonium sidoides, were investigated in adults with acute bronchitis outside the strict indication for antibiotics. RESEARCH DESIGN AND METHODS: In this randomised, double-blind, placebo-controlled, multicentre dose-finding trial using an adaptive group-sequential design, 406 patients were randomly assigned to one of four parallel treatment groups (10 mg EPs 7630 tablets three times a day (30-mg group), 20 mg EPs 7630 tablets three times a day (60-mg group), 30 mg EPs 7630 tablets three times a day (90-mg group) or placebo three times a day) for a treatment period of 7 days. Primary endpoint was the change in the total score of bronchitis-specific symptoms (BSS) from baseline to day 7. RESULTS: Between day 0 and day 7, the mean BSS score decreased by 2.7 +/- 2.3 (placebo), 4.3 +/- 1.9 (30-mg group), 6.1 +/- 2.1 (60-mg group), and 6.3 +/- 2.0 points (90-mg group), respectively. The differences between the EPs 7630 groups and placebo were statistically significant (p < 0.0001, each). The secondary endpoints showed comparable results. EPs 7630 was well-tolerated. All documented adverse events were of mild to moderate intensity; their frequency was dose-dependent. No serious adverse events were reported. CONCLUSION: This study demonstrated statistically significant and clinically relevant superiority of all three tested dosages of EPs 7630 over placebo. All dosages of EPs 7630 were well-tolerated. Taking into account both efficacy and safety, the results of this study indicate that the 20 mg tablets of EPs 7630 taken three times daily constitute the optimal dose with respect to the benefit-risk ratio.

Efficacy and tolerability of EPs 7630 in children and adolescents with acute bronchitis - a randomized, double-blind, placebo-controlled multicenter trial with a herbal drug preparation from Pelargonium sidoides roots.

OBJECTIVE: The study aim was to demonstrate the efficacy and to investigate the tolerability of EPs 7630, a herbal drug preparation from Pelargonium sidoides roots, in the treatment of patients (1 - 18 years) with acute bronchitis outside the strict indication for antibiotics. MATERIALS AND METHODS: A total of 200 patients were randomized to receive either active drug containing EPs 7630 (1 - 6 years: 3 x 10 drops/d; > 6 - 12 years: 3 x 20 drops/d; > 12 - 18 years: 3 x 30 drops/d) or placebo for 7 consecutive days. PRIMARY OUTCOME MEASURE: change in the total score of bronchitis-specific symptoms (BSS) from Day 0 to Day 7. Main secondary outcome measures: treatment outcome, patients' satisfaction with treatment, onset of effect, bed rest. RESULTS: From baseline to Day 7, the mean BSS score improved significantly more for EPs 7630 compared with placebo (3.4 +/- 1.8 vs. 1.2 +/- 1.8 points, p < 0.0001). On Day 7, treatment outcome was significantly better (p < 0.0001), satisfaction with treatment more pronounced (77.6% vs. 25.8%, p < 0.0001), onset of effect faster, and time of bed rest shorter as compared with placebo. Tolerability was similarly good in both groups. All adverse events were assessed as non-serious. CONCLUSION: EPs 7630 was shown to be efficacious and safe in the treatment of acute bronchitis in children and adolescents outside the strict indication for antibiotics with patients treated with EPs 7630 perceiving a more favorable course of the disease and a good tolerability as compared with placebo.

Efficacy and tolerability of EPs 7630 in patients (aged 6-18 years old) with acute bronchitis.

AIM: For EPs-7630, a herbal drug preparation from Pelargonium sidoides roots, therapeutic effects in respiratory tract infections outside the strict indication for antibiotics have already been demonstrated in adults. Now, a dose-finding study for EPs-7630 was performed in children and adolescents. METHODS: A total of 400 patients (aged 6-18 years) were randomized to receive either 30 mg, 60 mg or 90 mg EPs-7630 or placebo daily. Primary outcome criterion was the change in the Bronchitis Severity Score (BSS) from day 0 to day 7. RESULTS: After 7 days of treatment, the change in the BSS total score was significantly better in the 60 mg and 90 mg groups compared with placebo that of the without relevant differences between these two dosages. Especially 'coughing', 'sputum' and 'rales at auscultation' improved under EPs-7630. Onset of effect was faster, time of bed rest shorter and treatment outcome and satisfaction with treatment were rated better. Tolerability was comparable with placebo in all treatment groups. CONCLUSION: EPs-7630 is effective in acute bronchitis outside the strict indication for antibiotics in 6-18 years old patients, with a dose of 60 mg or 90 mg daily offering the best benefit/risk ratio. EPs-7630 significantly reduces the severity of symptoms, leads to a more favourable course of the disease and a faster recovery from acute bronchitis compared with the placebo, and is well tolerated.

Characteristics of colorectal mucinous adenocarcinoma in Iran.

AIMS AND BACKGROUND: Mucinous adenocarcinoma (MA) colorectal cancer accounts for 10 to 15% of colorectal carcinoma. It is generally thought that patients with MA present at a more advanced stage of disease and have a poorer prognosis than those with other types of carcinoma. The purpose of the present study was to clarify the clinicopathological characteristics of mucinous colorectal carcinoma in the Iranian population. METHODS: Between January 2002 and March 2008, Of the 1283 colorectal cancer patients, 110 patients were considered to have mucinous tumors according to pathology report. Patients evaluated on the basis of sex, age, location of tumor, stage, differentiation of tumor and family history of cancer. Kaplan-Meier curves and log-rank tests were used for survival analysis. RESULTS: The median age of these patients at diagnosis was 50.07 years. More than 50% of patients were younger than aged 50 years. 34.5% of patients had a family history of colorectal cancer in their first-degree relatives. Most tumors were presented in right colon. 54.3% of MA patients had advanced stage lesions. The Kaplan-Meier method indicated that, the 1, 3 and 5 year survival rates are 92.6, 80.1 and 41.3 percent, respectively. Survival of the patients was related to disease stage (P = 0.023). CONCLUSION: Our suggests that genetic factors may be play an important role in the development of this disease in our country and screening programs, especially genetic screening programs, should be considered as a main measure for prevention and control of colorectal cancer in Iran.

Correlation of the functional liver mass with left ventricular ejection fraction and left atrial diameter in patients with congestive heart failure.

BACKGROUND: Abnormalities in liver function tests have impact on prognosis of patients with chronic heart failure (CHF). The aim of the present study was to assess the functional liver mass in patient with systolic CHF with (13)C-methacetin breath test. PATIENTS AND METHODS: Liver function was assessed with (13)C-methacetin breath test in twenty patients, 15 men and 5 women, with systolic CHF, LVEF

Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy.

Giant cell tumour (GCT) is a benign, but aggressive, primary tumour of the bone. The recurrence rate after surgical treatment has been reported to be as high as 50%. Many surgical techniques have been employed in the treatment of this tumour. More aggressive interventions, such as en bloc resection and bulk allograft or prosthetic reconstruction, are generally understood to be associated with lower rates of local recurrence. However, because of lessened morbidity, intralesional techniques have come to be favoured for this condition. In addition to curettage, various adjuvant procedures and packing materials have been advocated in order to control and reconstruct long bone defects secondary to this neoplasm. We report our experience with 40 long bone GCT patients treated with curettage, burring, bone grafting and no adjuvants between 1997 and 2002. There was a local recurrence rate of 32.5%, with most recurrences noted within the first 30 months after surgery. Minor complications were found in 18% of patients. The risk of local recurrence in this study is acceptable (within the range that has been historically reported for curettage and bone grafting). In cases where more resources are available, the addition of adjuvant therapies, as noted in the recent literature, may be beneficial. The results of this study should be considered when designing multicenteric studies in the future.

Serum copper as a marker of inflammation in prediction of short term outcome in high risk patients with chronic heart failure.

BACKGROUND: Oxidative process and inflammation are regarded as important factors in the pathogenesis of chronic heart failure. Our study was aimed at investigating the prognostic value of serum copper levels in high risk subjects with chronic heart failure. METHODS: Serum copper levels and other prognostic indicators were determined in the group of 60 patients with chronic heart failure due to ischemic heart disease: 30 consecutive subjects with acute decompensation of chronic heart failure (acute group A) and 30 patients with chronic stable heart failure (group B). Patients were followed prospectively 12 months. Primary end-point was the mean time to death and/or heart failure hospital admission. RESULTS: The mean time to death was in the group A 279.4+/-18.9 days and 351.7+/-13.6 days in the group B (p<0.0001). Cox proportional hazard model revealed that the time to death for all subjects (n=60) was affected by cardiothoracic ratio (p<0.001). The time to combined end-point death or hospital admission was affected by serum copper concentration (p<0.0001). CONCLUSION: Serum copper levels predicted short term outcome in high risk patients with chronic heart failure.

Timing of the first endomyocardial biopsy in heart transplantation after induction immunosuppressive therapy--experience from Canadian Heart Transplant Centre.

BACKGROUND: The exact time point at which the first endomyocardial biopsy could be safely performed after the heart transplantation has not been systematically studied. In an attempt to determine this time point in our population, the number and severity of acute rejection episodes in the first eight weeks after the heart transplantation were assessed in 91 patients who underwent the procedure at St Paul's Hospital, Vancouver between September 1996 and December 2002. METHODS AND RESULTS: For the purpose of our analysis, acute rejection was defined as the grade > or =2 according the International Society for Heart and Lung Transplantation (ISHLT). Three hundred and sixty two endomyocardial biopsies were performed in 87 patients surviving to the first biopsy from one to eight weeks after the heart transplantation. In 85 patients who received induction immunosuppressive therapy, 13 episodes of acute rejection were identified. In two patients who did not receive the induction therapy, three episodes of acute rejection occurred. Acute rejection grade ISHLT 3 was found in 2 patients who did not receive induction therapy and in three patients who did. ISHLT grade 4 rejection occurred at weeks 5 and 7 in two patients who received induction therapy. Only one patient who received induction therapy had acute rejection within the first three weeks after the heart transplantation. CONCLUSIONS: Our analysis reveals that the frequency of acute rejection within the first eight weeks after the heart transplantation using induction therapy is low in this cohort, suggesting that the first routine endomyocardial biopsy could be delayed until the week four post-transplant.

[Hypothyroidism and heart failure]. / Hypotyreóza a srdecní selhání.

Effects of thyroid gland hormones on cardiovascular system have been known for many years. Thyroid gland hormones deficiency is connected with a range of metabolic and hemodynamic changes which can contribute to a genesis of heart failure. Recent works refer to an importance of connection of thyroid gland hormones metabolism with heart insufficiency pathophysiology. That is especially a syndrome of a low trijodthyronin level marked as euthyroid sick syndrome which is significantly more frequent in patients with chronic heart failure compared to a population of healthy individuals. Recent clinical works proved that treatment administration of thyroid gland hormones to patients with heart failure is connected with favourable hemodynamic changes and increased working capacity if the treatment is well tolerated.

Bronchodilatory effect of Portulaca oleracea in airways of asthmatic patients.

Therapeutic effects of Portulaca oleracea for respiratory diseases are indicated in ancient Iranian medical books. The relaxant effect of this plant have also been observed on smooth muscle tissue in previous studies. Therefore, in the present study, the bronchodilatory effect of the boiled extract of Portulaca oleracea in the airway of asthmatic patients was examined. The relaxant effect of the orally administered 0.25 ml/kg of 5% boiled extract in comparison with 3 mg/kg oral theophylline and 200 microg inhaled salbutamol was studied by measuring forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow (MEF(25-75)), and specific airway conductance (sGaw). The FEV1, PEF, MEF(25-75), and sGaw were measured before, administration and repeated 15, 30, 60, 90, and 120 min after administration of the oral extract and theopylline. For inhaled salbutamol measurements were performed 5, 15, 30, and 60 min post-inhalation. Results showed that the boiled extract of Portulaca oleracea caused significant increases in all measured pulmonary function tests (PFTs), (P < 0.05 to P < 0.01). There was no significant difference between the maximum increase in measured PFTs due to the boiled extract and theophylline. However, maximum increase in PEF and MEF(25-75) due to the boiled extract were significantly lower than those of salbutamol (P < 0.05 for both cases). The onset of brochodilatory effect of extract was similar to that of theophylline beginning 60 min, but the effect of extract decline after 120 min after administration. In conclusion, the results of the present study showed that Portulaca oleracea has a relatively potent but transient bronchodilatory effect on asthmatic airways.