Eosinophil-derived IL-13 promotes emphysema

The inflammatory responses in chronic airway diseases leading to emphysema are not fully defined. We hypothesised that lung eosinophilia contributes to airspace enlargement in a mouse model and to emphysema in patients with chronic obstructive pulmonary disease (COPD).A transgenic mouse model of chronic type 2 pulmonary inflammation (I5/hE2) was used to examine eosinophil-dependent mechanisms leading to airspace enlargement. Human sputum samples were collected for translational studies examining eosinophilia and matrix metalloprotease (MMP)-12 levels in patients with chronic airways disease.Airspace enlargement was identified in I5/hE2 mice and was dependent on eosinophils. Examination of I5/hE2 bronchoalveolar lavage identified elevated MMP-12, a mediator of emphysema. We showed, in vitro, that eosinophil-derived interleukin (IL)-13 promoted alveolar macrophage MMP-12 production. Airspace enlargement in I5/hE2 mice was dependent on MMP-12 and eosinophil-derived IL-4/13. Consistent with this, MMP-12 was elevated in patients with sputum eosinophilia and computed tomography evidence of emphysema, and also negatively correlated with forced expiratory volume in 1 s.A mouse model of chronic type 2 pulmonary inflammation exhibited airspace enlargement dependent on MMP-12 and eosinophil-derived IL-4/13. In chronic airways disease patients, lung eosinophilia was associated with elevated MMP-12 levels, which was a predictor of emphysema. These findings suggest an underappreciated mechanism by which eosinophils contribute to the pathologies associated with asthma and COPD.

Vocal fold hemorrhage associated with coumadin therapy in an opera singer

Vocal fold hemorrhage can represent a disastrous and potentially career ending injury to a singer or professional voice user. The risk factors of vocal fold hemorrhage, including laryngeal trauma, phonotrauma, aspirin and nonsteroidal antiinflammatories, and hormonal imbalances are well known. We present a case of an opera singer who developed recurrent vocal fold hemorrhage associated with coumadin anticoagulation therapy. This case highlights the importance of the risk of vocal fold hemorrhage to professional singers and professional voice users and offers an alternative to long-term coumadin therapy in this select population.

Tonic clonic seizures and tachycardia induced by fluoxetine (Prozac) overdose

Use of the serotonin uptake antidepressants is growing. These agents are thought to be safer than the tricyclic antidepressants, but clinicians should be aware that with overdoses, seizure activity and cardiac dysrhythmias have been reported in the medical literature. Physicians should be prepared to recognize and manage these overdosages. An illustrative case and a review of the literature are presented.

Staphylococcus aureus: a continuing problem

Caution is required in managing any immunocompromised host, not only because these patients will be carriers, but because they are also very susceptible to infections with S. aureus. These hosts are not candidates for short-course antibiotic therapy, and catheters should be removed when S. aureus bacteremia is diagnosed. The S. aureus cell wall is a major determinant of the host response and the pathogenicity of this organism. The clinician should recognize the three most important toxins produced by S. aureus: exfoliatin, TSST-1, and enterotoxin-B. Toxic shock syndrome can occur in any host, not just menstruating females, and the clinician should be very thoughtful when dealing with any Staphylococcus aureus infections arising from the use of a catheter.

Pyomyositis in a diabetic host

A case of pyomyositis in a diabetic host is presented. Pyomyositis is occurring more often and clinicians must be aware of this entity, especially in the immunocompromised host. The reasons for more frequent and severe infections in the diabetic patient are outlined.

Interaction of indomethacin and sulindac with labetalol

The effects of sulindac and indomethacin on the blood pressure response to labetalol were determined in well-controlled predominantly obese hypertensive patients (n = 26). A stabilized dose of labetalol alone was administered on weeks 1 and 3, and either indomethacin or sulindac was administered with labetalol on week 2, with cross-over to the other drug on week 4. Indomethacin and sulindac increased the sitting and standing systolic blood pressure (BP) to a statistically significant extent compared with placebo. The effects of indomethacin on systolic BP, diastolic BP, and weight were not significantly different from those with sulindac. Indomethacin but not sulindac produced minor increases in diastolic BP and weight compared with placebo.

The effect of doxycycline on serum levels of ethinyl estradiol, norethindrone, and endogenous progesterone

Doxycycline and other antibiotics have been implicated in oral contraceptive (OC) failure, but information is sparse and studies of a doxycycline-OC interaction are nonexistent. Because an interaction between doxycycline and OCs, especially those containing low-dose estrogen, could result in an unplanned and unwanted pregnancy, a controlled clinical trial of the effects of doxycycline on OC hormone concentrations was performed. Twenty-four women aged 18-35 years were recruited as volunteers from among the patients seen in a University-based family planning clinic. While they were on a steady dose of the OC Ortho-Novum 1/35, serum concentrations of ethinyl estradiol, norethindrone, and endogenous progesterone were measured on days 18, 19, and 20 of the menstrual cycle (control phase). These measurements were repeated on days 18, 19, and 20 of the following menstrual cycle while the patient was taking doxycycline, 100 mg twice daily (treatment phase). No statistically significant differences in serum levels of ethinyl estradiol, norethindrone, or endogenous progesterone were seen between the control and treatment phases. However, there was large inter-patient and intra-patient variability in ethinyl estradiol and norethindrone levels. No elevations of endogenous progesterone occurred to suggest ovulation during antibiotic administration in either phase. It is not known what effects longer or earlier administration of doxycycline during the OC cycle would have on serum hormone concentrations or ovulation. Pregnancies attributed to failure of OCs because of tetracycline use could in fact be due to other causes or could represent a true interaction that only manifests itself in a small proportion of women at risk.

Effect of naproxen and sulindac on blood pressure response to atenolol

Twenty-eight patients with mild to moderate essential hypertension well controlled by atenolol entered a five-week, double-blind, placebo-controlled trial of the effects of sulindac and naproxen on blood pressure (BP) control. Atenolol alone was administered during weeks 1, 3, and 5. Naproxen or sulindac was administered with atenolol during week 2, with crossover during week 4. Data were analyzed for 27 of the patients (one dropped out after developing a skin rash). Naproxen significantly increased the systolic BP compared with placebo (mean 4.0 mm Hg; 95 percent confidence interval, 1.1-7.0; p less than 0.05). There were no significant differences in systolic BP during sulindac administration compared with placebo or naproxen. No significant effects on diastolic BP were observed. Weight was increased by naproxen and sulindac compared with placebo (mean 0.6-0.8 kg, p less than 0.05), although not to a clinically significant extent. One-week therapy with naproxen has a greater potential than sulindac to increase systolic BP in well-controlled hypertensive patients receiving atenolol; however, the increase is minor and unlikely to be of clinical significance.

Prevalence of Chlamydia trachomatis cervical infection in a college gynecology clinic: relationship to other infections and clinical features

A total of 479 sexually active college women presenting for routine gynecologic care were screened for gonorrheal and chlamydial infection of the cervix. Most of these women were asymptomatic; those with symptoms had minor complaints related to the lower genital tract. A direct fluorescent antibody test (DFA) showed the prevalence of chlamydial infection to be 8.1%, while culture for Neisseria gonorrhoeae indicated that the prevalence of gonorrhea was 1.5%. DFA-positive women had some minor alterations in the appearance of their cervix, but only 10% had overt mucopurulent cervicitis. The presence of purulent cervical discharge was four times more common in DFA-positive women, but only one-fourth of positive women had this finding. The use of an endocervical gram stain showing ten or more white cells per oil immersion field (x970) did not appear to be clinically useful in diagnosing suspected chlamydial infection because there was no significant difference in the number of white cells seen in specimens from DFA-positive (16 polymorphonuclear leukocytes) and DFA-negative women (ten polymorphonuclear leukocytes). Thus, use of the gram stain as an initial screening mechanism would not markedly reduce the number of women to be tested for Chlamydia trachomatis; half of all women met the gram-stain criterion, and nearly a quarter of the DFA-positive women would be overlooked.