Cyclooxygenase-2 inhibition by rofecoxib reverses naturally occurring fever in humans

Cyclooxygenase (COX) exists as constitutive (COX-1) and inducible (COX-2) isoforms. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen and diclofenac inhibit both COX-1 and COX-2. The role of COX-2 in the genesis of fever in monkeys and humans was examined with use of the specific COX-2 inhibitor rofecoxib. Rofecoxib was administered to monkeys made febrile by 6 microg/kg intravenous lipopolysaccharide. Induced pyrexia was followed by oral rofecoxib (1 or 3 mg/kg), diclofenac (3 mg/kg), or vehicle. Rofecoxib and diclofenac rapidly reversed the elevated temperature (P < .05 versus vehicle for 3 mg/kg rofecoxib and diclofenac at 70 to 90 minutes after dosing). A single-dose, parallel-group, double-blind randomized trial was conducted in 94 patients with fever caused by a viral-type illness. Mean baseline temperature was similar for all groups (-38.5 degrees C). Patients received oral doses of 12.5 mg rofecoxib, 25 mg rofecoxib, 400 mg ibuprofen, or placebo and the mean +/- SE change in oral temperature at 4 hours after dosing was -0.97 degrees C +/- 0.11 degrees C, -1.19 degrees C +/- 0.09 degrees C, -1.20 degrees C +/- 0.11 degrees C, and 0.01 C +/- 0.17 C, respectively (P < .001 for active treatments versus placebo). Specific inhibition of COX-2 by rofecoxib results in antipyretic activity in monkeys and humans comparable to dual COX-1/COX-2 inhibitors such as diclofenac or ibuprofen. The data support the hypothesis that it is the COX-2 isoform that is primarily involved in the genesis of fever in humans.

A multicenter, investigator-blinded, randomized comparison of oral levofloxacin and oral clarithromycin in the treatment of acute bacterial sinusitis

A multicenter, investigator-blinded, randomized, parallel-group study was conducted to compare oral levofloxacin 500 mg once/day for 14 days with clarithromycin 500 mg twice/day for 14 days in the treatment of acute bacterial sinusitis. Of 216 adult outpatients randomized to treatment, 190 were evaluable for efficacy. The primary efficacy measure was clinical response, based on resolution of signs and symptoms 2-5 days after therapy. A secondary efficacy measure was relapse rate 1 month after therapy. Among evaluable patients, clinical success rates (cured or improved) were 96.0% and 93.3% for levofloxacin (L) and clarithromycin (C), respectively (95% CI -9.2%, 3.7%). The confidence interval (CI) for treatment difference (C-L) included zero and its upper limit was less than 15%, indicating that levofloxacin was as effective as clarithromycin. In all, 4.1% of patients receiving levofloxacin and 7.2% receiving clarithromycin had a relapse of symptoms 1 month after therapy (95% CI-12.2%, 3.2%). Long-term success (initial success, absence of relapse at 1 month, no further antibacterial therapy 2-5 days after therapy) was 79.2% in the levofloxacin group and 76.4% in the clarithromycin group (95% CI -14.7%, 9.0%). Based on investigator-assessed treatment-emergent adverse events, overall tolerability of the drugs was similar, except for a higher frequency of taste perversion and diarrhea in the clarithromycin group. Levofloxacin had an advantage over clarithromycin based on two quality-of-life (QOL) parameters: number of times taking other drugs for targeted medical conditions and mean total cost of these drugs. No statistical significance was found in other QOL variables. These findings suggest that the efficacy and tolerability of levofloxacin 500 mg once/day are comparable with those of clarithromycin 500 mg twice/day in the treatment of acute bacterial sinusitis.

A role for pheromones in mate choice in a lekking sandfly

There is increasing evidence to suggest that pheromone-mediated communication may play an important role in mate choice in many insects. We investigated the possible role of pheromones in mate choice in the lekking sandfly, Lutzomyia longipalpis, and explored whether males or females display any behavioural traits that predict patterns of male mating success. Pairs of virgin males were introduced into a small mating chamber and allowed to interact for approximately 10 min prior to the introduction of a single virgin female. The trial continued until the female copulated with one of the males. We recorded trials on video for later analysis. After a successful copulation, we determined the quantity of pheromone remaining in the glands of both males and measured the size of the pheromone glands and tergites. We corrected behaviours and measurements for body size (tergite width). Mated males had significantly more pheromone present in their glands after a trial than unmated males. Males differed in how much time they invested in wing fanning. Members of each pair of males spent similar amounts of time wing fanning but mated males and males with more residual pheromone spent more time wing fanning than their counterparts throughout the trial. The time spent wing fanning and the amount of residual pheromone were not correlated, however. A male's ability to win fights did not relate to his reproductive success. Finally, a female was equally likely to wing-fan directly at, or walk away from, either male in a given pair. The possible relationships between the amount of pheromone released and the residual pheromones left in the glands, and the level of male wing fanning and pheromone productivity, are discussed. Copyright 1998 The Association for the Study of Animal Behaviour.

Life threatening airway obstruction: a hazard of concealed eating disorders

The ingestion of unusual objects is not uncommon in florid mental illness. Less common is the accidental ingestion of a foreign body which has been used to induce vomiting. A case is reported of complete dysphagia that resulted from impaction of a plastic fork in the hypopharynx. The patient had been attempting to induce vomiting and, as a result of the presentation, was found to be suffering from a previously concealed eating disorder (bulimia). Self induced vomiting is one criterion for the diagnosis of bulimia and a review of the literature indicates that accidental ingestion of large foreign bodies is an increasingly familiar hazard of occult bulimia.

Localized amyloidosis of the parotid gland: a case report and review of the localized amyloidosis of the head and neck

BACKGROUND

Localized amyloidosis in the head and neck is a rare and benign process.

METHODS

We present the first case report in the literature of localized amyloidosis of the parotid glands and also comprehensively review the literature regarding localized amyloidosis of the head and neck.

RESULTS

Amyloidosis affecting the head and neck region is uncommon and is mostly in the form of localized amyloidosis. Larynx is the commonest site of involvement and accounts for 0.2% to 0.5% of benign laryngeal tumors. Laryngeal involvement could be either diffuse subepithelial deposition or discrete tumor nodules. Although localized amyloidosis occurs much more frequently in the oral cavity and pharynx, only seven cases of nasopharyngeal amyloidosis and eight cases of nasal septum amyloidosis have been reported. There is no documentation to suggest that localized amyloidosis can progress to systemic amyloidosis. Local surgical excision is the treatment of choice for laryngeal amyloidosis and laser excision is probably the best.

CONCLUSION

While localized amyloidosis of the head and neck region is rare, it should be recognized, understood, evaluated, and properly treated.

Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: a randomized, placebo-controlled trial

OBJECTIVE

To evaluate the efficacy of a triphasic, combination oral contraceptive (OC), (norgestimate-ethinyl estradiol), in comparison with placebo in the treatment of moderate acne vulgaris.

METHODS

Two hundred fifty women were enrolled in a multicenter, randomized, double-blind, placebo-controlled clinical trial to evaluate the effectiveness of norgestimate-ethinyl estradiol in the treatment of acne vulgaris. Subjects were 15-49 years old and had moderate acne vulgaris. Each month for 6 months, subjects received either 3 consecutive weeks of active OC treatment followed by 1 week of inactive drug, or 4 consecutive weeks of color-matched placebo tablets. Efficacy was assessed by facial acne lesion counts, the investigator's global assessment, and the subject's self-assessment. Hormone levels were also measured.

RESULTS

Despite the large placebo effect inherent in an acne trial (due to, for example, careful skin care, frequent office visits, regression to the mean), of the 164 subjects who completed the study without major protocol deviations, the OC group was significantly better than the placebo group for all primary efficacy measures: inflammatory lesions (mean reduction, 51.4% compared to 34.6%; P = .01), total lesions (mean reduction, 46.4% compared to 33.9%; P = .001); investigator's global assessment (83.3% compared to 62.5%; P = .001). Free testosterone decreased significantly and sex hormone-binding globulin increased significantly in the OC group, but remained unchanged in the placebo group.

CONCLUSION

A triphasic combination of norgestimate and ethinyl estradiol is an effective treatment for moderate acne vulgaris in women with no known contraindication to OC therapy.

General practitioner consultations after a paediatric tonsillectomy

General Practitioner (GP) consultations were audited in paediatric patients who have undergone an elective tonsillectomy on our unit over a 6 month period. As there is no formal follow-up, it is the department's practice to discuss with the patients the problems to expect following the operation. This is reinforced with a tonsillectomy advice sheet. An initial audit of GP consultations was performed by a telephone survey of the relevant GP. This revealed an attendance rate of 41%. Following the implementation of a change in management (chewing gum was added to the post operative care instructions) a subsequent audit of 91 children was performed. A marked reduction in the GP attendance was observed. We now routinely recommend the use of chewing gum in the post-operative period after tonsillectomy to our patients.

Butenafine 1% cream in the treatment of tinea cruris: a multicenter, vehicle-controlled, double-blind trial

BACKGROUND

Butenafine hydrochloride, a potent antifungal agent related to the allylamines, has been used in Japan for treating various cutaneous mycoses including tinea cruris.

OBJECTIVE

We compared the safety and efficacy of butenafine hydrochloride and its vehicle when used once daily for 2 weeks to treat tinea cruris.

METHODS

Patients (n = 93) with tinea cruris and a positive potassium hydroxide examination and mycologic culture were enrolled. Of the 76 patients assessed for efficacy, 37 applied butenafine and 39 applied vehicle once daily for 2 weeks. Assessments were made at the end of the 2-week treatment period and 4 weeks after the end of treatment.

RESULTS

Patients in the butenafine group had a higher mycologic cure rate by day 7 (66% vs 13%, p < 0.0001), with marked improvement 4 weeks after the end of treatment (81% vs 13%, p < 0.0001). They also had a higher rate of effective treatment at day 7 (29% vs 5%, p < 0.01) and at 4 weeks after treatment (73% vs 5%, p < 0.0001). Adverse events definitely related to butenafine treatment were limited to one case of burning sensation after application.

CONCLUSION

Butenafine applied once daily for 2 weeks is effective in treating tinea cruris. The proportion of patients cured increased between the end of treatment and 4 weeks after treatment.

Spontaneous retropharyngeal haematoma attributable to Epstein-Barr virus infection

Life-threatening sequelae of Epstein-Barr virus infection are uncommon but may present as: local pharyngeal manifestations, splenic rupture, neurological and haematological disorders and altered hepatic function. We present a case of retropharyngeal haematoma with posterior hypopharyngeal wall necrosis, thrombocytopenia and altered clotting function as a result of Epstein-Barr virus infection. A review of the literature on retropharyngeal haematoma reveals this to be the only recorded case which can be directly attributed to Epstein-Barr virus infection.

Alzheimer's disease and apolipoprotein E genotype in Western Australia: an autopsy-verified series

OBJECTIVE

To determine the relationship between the apolipoprotein E epsilon 4 allele and autopsy-verified Alzheimer's disease (AD) in an Australian population.

DESIGN

Retrospective case-control study.

SETTING

Royal Perth Hospital, Perth, Western Australia (a tertiary referral hospital).

SUBJECTS

50 subjects with "definite" AD (according to the histological and clinical criteria of the Consortium to Establish a Registry for Alzheimer's Disease [CERAD]) and 30 control subjects who had died from a non-neurological disease were randomly selected from the hospital's neuropathology register.

OUTCOME MEASURES

Histological grading of brain sections stained with the modified Bielschowsky stain according to the criteria of CERAD; number (burden) of neuritic plaques; apolipoprotein E genotype (APOE).

RESULTS

Frequency of the epsilon 4 allele was significantly higher in the AD group (37%) than in the control group (2%) (chi 2 = 25.8; P < 0.00001). In the AD group, 50% of subjects were heterozygous for the epsilon 4 allele and 12% were homozygous, while in the control group one subject was heterozygous for the allele and none were homozygous. No association was seen between the epsilon 4 allele and neuritic plaque burden in the hippocampus, entorhinal cortex, middle frontal gyrus or inferior parietal lobule in subjects with AD.

CONCLUSIONS

Our findings confirm an association between the epsilon 4 allele and autopsy-verified AD. The epsilon 4 allele may be an important risk factor for susceptibility to AD in the general Australian population.

Psychology of computer use: XXXI. Relating computer users' stress, daily hassles, somatic complaints, and anxiety

The relation of computer users' stress, measured by the Computer Hassles Scale, and global stress, measured by the Daily Hassles Scale, with stress reactions, measured by the somatization-anxiety items of the SCL-90, was investigated in a college sample (N = 101). Computer hassles ratings were correlated .54 with daily hassles ratings and .57 with somatization-anxiety ratings. Daily hassles ratings were correlated .74 with somatization-anxiety ratings. These results provide important evidence on convergent validity for the Computer Hassles Scale as a measure of computer users' stress.

Building Internet accessible medical education software using the World Wide Web

We describe work to enhance existing software protocols and develop a suite of new software utilities based upon a set of standards known as the World Wide Web (WWW). Specifically, we have developed an effective X-windows based WYSIWYG WWW browser/editor and a prototype for integrated wide-area authentication and authorization support for delivery and maintenance of WWW service. These software development activities, along with parallel work in content development, are empowering individuals to better use the Internet as a resource to easily author, publish, and access materials. As an illustrative application, we describe one Web-based self-instructional unit designed to increase users' knowledge of hazardous substances in the environment. This on-line monograph was adapted from a series of paper-based case studies developed by the Agency for Toxic Substances and Disease Registry of the U.S. Department of Health & Human Services. The on-line version illustrates many of the innovative features provided by the Web, and demonstrates how such materials can significantly impact medical education at all levels.

Variation of isozyme patterns among Arachis species

The genus Arachis contains a large number of species and undescribed taxa with patterns of genetic variation that are little understood. The objectives of this investigation were to estimate genetic diversity among species of Arachis by utilizing electrophoretic techniques and to establish the potential for use of isozymes as markers for germplasm introgression. One-hundred-and-thirteen accessions representing six of the seven sections of the genus were analyzed for isozyme variation of 17 enzymes. Section Rhizomatosae species were not included because they produce very few seeds. Seeds were macerated and the crude extract was used for starch-gel electrophoretic analyses. Although the cultivated species has few polymorphic isozymes, the diploid species are highly variable and two-to-six bands were observed for each isozyme among accessions. Because of the large number of isozyme differences between A. hypogaea and A. batizocoi (the presumed donor of the B genome), this species can no longer be considered as a progenitor of the cultivated peanut. Seed-to-seed polymorphisms within many accessions were also observed which indicate that germplasm should be maintained as bulk seed lots, representative of many individuals, or as lines from individual plants from original field collections. The area of greatest interspecific genetic diversity was in Mato Grosso, Brazil; however, the probability of finding unique alleles from those observed in A. hypogaea was greatest in north, north-central, south and southeast Brazil. The large number of polymorphic loci should be useful as genetic markers for interspecific hybridization studies.

Selection of human anti-hapten antibodies from semisynthetic libraries

Semisynthetic human Fab libraries were constructed, displayed on the surface of filamentous phage and selected for binding to three hapten conjugates. A number of Fabs were isolated and characterized with respect to affinity and specificity. Fabs exhibited affinities of between 80 and 29 nM, as determined by surface plasmon resonance, for the conjugate on which they were selected. Conservation of Asp101 in the third heavy-chain complementarity determining region (HCDR3) appears to be important in the construction of synthetically diverse repertoires.

Psychology of computer use: XXIX. Measuring computer users' stress: the Computer Hassles Scale

Measurement of computer users' stress was based on the Computer Hassles Scale. 65 questionnaires were returned from 113 mailed to users of accounting information systems who worked for manufacturing companies. Correlations were calculated for the total sample and subsamples divided by gender. The analysis indicated that persons with college degrees experienced greater computer users' stress than those who were without. Those persons who reported more computer hassles experienced more somatic complaints which indicated that the computer hassles were stressful. There were no significant mean differences between women and men on computer hassles or somatic complaints. The correlations of computer hassles with somatic complaints differed by gender. Women's computer hassles were significantly correlated .61 with somatic complaints, but men's computer hassles were not significantly correlated (r = .18) with somatic complaints. The gender differences suggest that there is a complex relationship between stressors (computer hassles) and stress reactions (somatic complaints).

Molecular profile of an antibody response to HIV-1 as probed by combinatorial libraries

A large number (33) of human Fab fragments reacting with HIV-1 surface glycoprotein gp120 have been generated by selection from a combinatorial IgG1 kappa library displayed on the surface of phage. The library was prepared from a long term asymptomatic HIV-seropositive donor. Analysis of the sequences from these Fabs shows the heavy chains can be placed in groups, many of which contain intraclonal variants, almost certainly corresponding to chains used in vivo. Further variants can be accessed via chain shuffling experiments in which a given light chain is recombined with a library of heavy chains. Heavy chain promiscuity, i.e. the ability of heavy chains to pair with different light chains with retention of antigen binding, is dependent on the particular heavy chain considered and probably excludes the identification of in vivo light chain partners. The antibodies examined here are primarily to the CD4 binding site on gp120 and broadly reflect the serum profile of the donor. The antibodies show evidence of extensive somatic modification indicative of an antigen-driven response. The heavy chain CDR3 regions of the antibodies show a remarkably conserved extended length. A number also show strong sequence conservation in CDR3 against a background of considerable diversity in the rest of the VH gene supporting a central role for this region in antigen recognition.

The Centennial Patient Care Program: binding patient, student, and clinician-teacher in a learning triad

The University of Chicago is building a technology-based clinical environment to provide a longitudinal experience for patients and medical students. This environment uses an open systems, computer communication and information support network to forge an interactive education and care relationship between patient, medical student, and clinical faculty mentor. The project proactively addresses some of the most important activities required to reform both the health care and medical education systems: anchoring patient care in a generalist setting; educating medical students in outpatient medicine; fostering primary care as a career choice; and using medical informatics as a tool rather than as an end in itself. Moreover, the project effectively deploys concepts such as patient-centered education, student-based learning, and mentored teaching experiences. This paper reports the curricular, pedagogical, and technological motivations and framework under which the project was designed, and describes the process that a patient-student-clinician/teacher triad will experience as participants in this program.

Human monoclonal Fab fragments derived from a combinatorial library bind to respiratory syncytial virus F glycoprotein and neutralize infectivity

Respiratory syncytial virus (RSV) is the most important cause, throughout the world, of severe viral lower respiratory tract illness in young children. Antibodies are known to mediate resistance to RSV infection and illness. We have isolated a number of human monoclonal Fab fragments to RSV F glycoprotein from a combinatorial antibody library expressed on the surface of phage. One of these neutralized a wide range of virus isolates, 10 subgroup A and 9 subgroup B isolates, with a titer (60% neutralization) of approximately 0.1-1.0 micrograms/ml. Another Fab neutralized diverse isolates at a concentration somewhat higher. These human Fab fragments show great promise for use in the prophylaxis or therapy of serious RSV lower respiratory tract disease. For intramuscular or intravenous administration, whole antibodies will be required, whereas for aerosol application, F(ab')2 or Fab fragments may suffice.

Recombinant human Fab fragments neutralize human type 1 immunodeficiency virus in vitro

A panel of 20 recombinant Fab fragments reactive with the surface glycoprotein gp120 of human type 1 immunodeficiency virus (HIV-1) were examined for their ability to neutralize MN and IIIB strains of the virus. Neutralization was determined as the ability of the Fab fragments to inhibit infection as measured in both a p24 ELISA and a syncytium-formation assay. One group of closely sequence-related Fab fragments was found to neutralize virus in both assays with a 50% neutralization titer at approximately 1 micrograms/ml. Another Fab neutralized in the p24 ELISA but not in the syncytium assay. The other Fab fragments showed weak or no neutralizing ability. The results imply that virion aggregation or crosslinking of gp120 molecules on the virion surface is not an absolute requirement for HIV-1 neutralization. Further, all of the Fab fragments were shown to be competitive with soluble CD4 for binding to gp120 and yet few neutralized the virus effectively, implying that the mechanism of neutralization in this case may not involve receptor blocking. The observation of a preponderance of high-affinity Fab fragments with poor or no neutralizing ability could have implications for vaccine strategies.

Prenatal determination of demographic and attitudinal factors regarding feeding practice in an indigent population

Demographic and attitudinal factors influencing the decision to breast- or bottle-feed were evaluated early in pregnancy by survey of 307 women in a low-risk prenatal obstetric clinic at a publicly funded hospital in Houston, Texas. Subjects responded to 17 demographic and 24 attitudinal questions. Racial classification revealed blacks 36.4%, whites 29.2%, and hispanics 30.8%. Twenty-five percent of the completed surveys were in Spanish. Of the total sample, 26.7% planned to breast-feed, 48.2% planned to bottle-feed, and 25.1% planned to do both. Multiple logistic regression analysis revealed six prominent independent risk factors for bottle-feeding. The most significant variable was lack of support for breast-feeding from a significant other (husband, mother, other relative, or friend), which had a odds ratio (OR) of 456.3. Other attitudinal variables achieving independent significance were disagreement with the statements "breastfeeding protects against disease" (OR = 4.0), "breasts were made for breastfeeding" (OR = 8.0), and "I want to know more about breastfeeding" (OR = 120.0). Significant demographic variables identified were completion of less than 12th grade (OR = 32.1), and age less than 35 years (OR = 43.3). These findings indicate the influence of significant others in the decision to breast-feed and suggest that future educational programs should require their inclusion if the prevalence of breast-feeding in this population is to be increased.

Attitudes and education of pediatric house staff concerning breast-feeding

Pediatricians are expected to offer information and advice on breast-feeding to expectant and lactating mothers, but the educational experience for pediatric residents may not adequately prepare them for this responsibility. To examine knowledge and confidence regarding breast-feeding gained by pediatric house staff during their residency, a survey was administered to pediatric residents in a large, hospital-based training program. Of 108 program residents, 87 (81%) participated. Forty-one percent of the respondents were postgraduate level I (PL-I), 29% were PL-II, and 30% were PL-III. There was no evidence that PL-III residents were more competent or comfortable with routine breast-feeding counseling or intervention than their PL-I counterparts. Residents who had breast-fed, those with spouses who had breast-fed, and those with children of their own had the greatest knowledge and confidence base in several areas, such as their ability to teach breast-feeding techniques and to treat cracked nipples. They were also more familiar with different types of breastpumps. There were no significant differences among those who were or were not breast-fed as a child nor among men versus women. Residency programs must provide comprehensive education on breast-feeding to prepare future pediatricians to meet the needs of patients and their parents.

Antibody redesign by chain shuffling from random combinatorial immunoglobulin libraries

A number of experiments on the shuffling of heavy and light chains from antibodies of defined specificity for the transition-state analogue hapten nitrophenyl phosphonamidate are described. The experiments report on the promiscuity of heavy and light chains in binding antigen and the feasibility of antibody redesign by this shuffling process. The concepts of incestuous and extraclonal promiscuous association are described. Shuffling opens the possibility of generating panels of antibodies with related specificity but of distinct idiotypic composition that may have significance in the use of human monoclonal antibodies in therapy.

Psychology of computer use: XXIII. Validating a measure of computer-related stress

Prediction of the final grade in a computer course using the Computer Technology Hassles Scale, a measure of computer-related stress, was investigated. A sample of 154 university students enrolled in computer courses completed questionnaires covering demographic data, information on computer use, the Computer Technology Hassles Scale, and somatic complaint items of the Hopkins Symptom Checklist. Pearson correlations indicated scores on the Computer Technology Hassles Scale were significantly associated .27 with somatic complaints, -.24 with computer-course grades, and -.18 with self-rated computer knowledge. Regression analysis indicated that self-rated computer knowledge and scores on the Computer Technology Hassles Scale significantly predicted computer-course grade.