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Affiliation(s)
- Peter Dicpinigaitis
- Albert Einstein College of Medicine, Bronx, NY, USA.
- Montefiore Medical Center, Bronx, NY, USA.
| | - Imran Satia
- Division of Respirology and Firestone Institute of Respiratory Health, Department of Medicine, St Josephs Healthcare, McMaster University, Hamilton, Canada
- Division of Infection, Immunity and Respiratory Medicine and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Beck LA, Thaçi D, Deleuran M, Blauvelt A, Bissonnette R, de Bruin-Weller M, Hide M, Sher L, Hussain I, Chen Z, Khokhar FA, Beazley B, Ruddy M, Patel N, Graham NMH, Ardeleanu M, Shumel B. Dupilumab Provides Favorable Safety and Sustained Efficacy for up to 3 Years in an Open-Label Study of Adults with Moderate-to-Severe Atopic Dermatitis. Am J Clin Dermatol 2020; 21:567-577. [PMID: 32557382 PMCID: PMC7371647 DOI: 10.1007/s40257-020-00527-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Management of moderate-to-severe atopic dermatitis (AD) commonly requires long-term treatment. OBJECTIVE The aim of this study was to report the safety and efficacy of dupilumab treatment for up to 3 years in adults with moderate-to-severe AD. METHODS This ongoing, multicenter, open-label extension study (LIBERTY AD OLE; NCT01949311) assessed dupilumab treatment in adults previously enrolled in dupilumab trials. Patients received dupilumab 300 mg weekly up to 148 weeks. The primary outcome was safety. RESULTS Of 2677 patients enrolled and treated, 347 reached week 148. Mean self-reported drug compliance was 98.2%. Safety data were consistent with previously reported trials (270.1 adverse events [AEs]/100 patient-years; 6.9 serious AEs/100 patient-years) and the known dupilumab safety profile. Common AEs (≥ 5% of patients) included nasopharyngitis, AD, upper respiratory tract infection, conjunctivitis, headache, oral herpes, and injection-site reactions. AD signs and symptoms showed sustained improvements during treatment with mean (standard deviation, mean percentage change from parent study baseline) Eczema Area and Severity Index 1.4 (3.2, - 95.4%) and weekly Pruritus Numerical Rating Scale 2.2 (1.8, - 65.4%) at week 148. LIMITATIONS No control arm; fewer patients at later time points; regimen different from the approved 300 mg every 2 weeks dose. CONCLUSION These safety and efficacy results support dupilumab as a continuous long-term treatment for adults with moderate-to-severe AD. TRIAL REGISTRATION ClinicalTrials.gov: NCT01949311. Dupilumab provides favorable safety and sustained efficacy for up to 3 years in an open-label study of adults with moderate-to-severe atopic dermatitis (MP4 139831 kb).
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Affiliation(s)
- Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michihiro Hide
- Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, CA, USA
| | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Faisal A Khokhar
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Bethany Beazley
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Marcella Ruddy
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | | | - Neil M H Graham
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Marius Ardeleanu
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Brad Shumel
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA.
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Zhang L, Yang Y, Li Y, Qian ZM, Xiao W, Wang X, Rolling CA, Liu E, Xiao J, Zeng W, Liu T, Li X, Yao Z, Wang H, Ma W, Lin H. Short-term and long-term effects of PM 2.5 on acute nasopharyngitis in 10 communities of Guangdong, China. Sci Total Environ 2019; 688:136-142. [PMID: 31229811 DOI: 10.1016/j.scitotenv.2019.05.470] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aimed to assess the effects of short-term and long-term exposure to ambient fine particle matter (PM2.5) on acute nasopharyngitis. METHODS A total of 9468 participants aged 18 years and above were recruited from 10 communities in four cities of Guangdong, China during the baseline survey in 2014, and they were followed-up from January 2015 to December 2016. Air pollution exposure was assessed based on the daily concentrations (short-term) and annual concentrations (long-term) of the nearby air monitoring station and the survey date. A mixed-effect logistic model and Cox proportional hazards model were used to quantify the short-term and long-term associations after adjustment for potential confounding factors. RESULTS Significantly positive associations were found between both short-term and long-term exposures of PM2.5 and acute nasopharyngitis. The adjusted odds ratio was 1.15 (95% CI: 1.07, 1.23) for each 10 μg/m3 increase in daily PM2.5 at lag2 day (short-term effects), and the hazard risk was 1.18 (95% CI: 1.10, 1.25) for each 10 μg/m3 increase in annual PM2.5 (long-term effects). Stronger associations between short-term PM2.5 exposure and acute nasopharyngitis were observed among men (OR = 1.10; 95% CI: 1.04, 1.17) and participants aged above 65 years (OR = 1.13; 95% CI: 1.04, 1.23) in the stratified analyses. No significant association was found in women (OR = 1.00; 95% CI: 0.92, 1.10) or young participants ≤65 years (OR = 0.96; 95% CI: 0.88, 1.04). However, for the long-term exposure, the hazard risk was higher for participants younger than 65 years (OR = 1.22; 95% CI: 1.12, 1.32) than the older group (OR = 1.11; 95% CI: 1.00, 1.24). CONCLUSION This study indicates that both short-term and long-term exposures to higher concentrations of PM2.5 could increase the risk of acute nasopharyngitis.
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Affiliation(s)
- Lingli Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China; School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510220, PR China
| | - Yin Yang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Yanhong Li
- Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhengmin Min Qian
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO 63104, United States of America
| | - Wanli Xiao
- Weifang University of Science and Technology, Shouguang 62700, PR China
| | - Xiaojie Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510220, PR China
| | - Craig A Rolling
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO 63104, United States of America
| | - Echu Liu
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO 63104, United States of America
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangzhou 511430, PR China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangzhou 511430, PR China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangzhou 511430, PR China; General Practice Center, Nanhai Hospital, South Medical University, Foshan 528200, PR China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangzhou 511430, PR China
| | - Zhenjiang Yao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510220, PR China
| | - Hao Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510220, PR China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangzhou 511430, PR China; General Practice Center, Nanhai Hospital, South Medical University, Foshan 528200, PR China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
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Lou-Meda R, Stiller B, Antonio ZL, Zielinska E, Yap HK, Kang HG, Tan M, Glazer RD, Valentin MA, Wang L. Long-term safety and tolerability of valsartan in children aged 6 to 17 years with hypertension. Pediatr Nephrol 2019; 34:495-506. [PMID: 30397789 PMCID: PMC6349801 DOI: 10.1007/s00467-018-4114-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study aimed to assess the long-term safety and tolerability of valsartan in hypertensive children aged 6-17 years, with or without chronic kidney disease (CKD). METHODS This was an 18-month, open-label, multicentre, prospective study conducted in 150 patients with history of hypertension with or without CKD. The primary endpoint was long-term safety and tolerability of valsartan and valsartan-based treatments, assessed in terms of adverse events (AEs), serious AEs, laboratory measurements, estimated glomerular filtration rate (eGFR), urinalysis and electrocardiogram. RESULTS Of 150 enrolled patients, 117 (78%) completed the study. At week 78, a clinically and statistically significant reduction in mean sitting systolic and diastolic blood pressures was observed in all patients (- 14.9 mmHg and - 10.6 mmHg, respectively). Within the first 3 months of treatment, mean urine albumin creatinine ratio decreased in CKD population, which was sustained. A higher percentage of CKD patients had at least one AE compared to non-CKD patients (85.3% vs. 73.3%, respectively). The majority of AEs were mild (50.7%) or moderate (18.7%) in severity. As expected, in patients with underlying CKD, increases in serum potassium, creatinine and blood urea nitrogen were more commonly reported compared to non-CKD patients. A > 25% decrease in Schwartz eGFR was observed in 28.4% of CKD patients and 13.5% of non-CKD patients. CONCLUSIONS Valsartan was generally well tolerated, with an AE profile consistent with angiotensin receptor blockers in the overall population and in patients with underlying CKD. Long-term efficacy was maintained and a beneficial effect on proteinuria was observed.
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Affiliation(s)
- Randall Lou-Meda
- Fundación para el Niño Enfermo Renal/H. Roosevelt, 6 Avenida 9-18 zona 10 Edificio Sixtino II, Ala I, Oficina 804, Guatemala City, Guatemala.
| | - Brigitte Stiller
- University Heart Center Freiburg, Bad Krozingen, Department of Congenital Heart Fundación para el Niño Enfermo Renal Disease and Pediatric Cardiology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Zenaida L Antonio
- Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Ewa Zielinska
- Niepubliczny Zakład Opieki Zdrowotnej, Ezmed, Warsaw, Poland
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hee Gyung Kang
- Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Monique Tan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Linda Wang
- Shanghai Novartis Trading Ltd, Shanghai, China
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Heck S, Al-Shobash S, Rapp D, Le DD, Omlor A, Bekhit A, Flaig M, Al-Kadah B, Herian W, Bals R, Wagenpfeil S, Dinh QT. High probability of comorbidities in bronchial asthma in Germany. NPJ Prim Care Respir Med 2017; 27:28. [PMID: 28432297 PMCID: PMC5435094 DOI: 10.1038/s41533-017-0026-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 03/02/2017] [Accepted: 03/21/2017] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Clinical experience has shown that allergic and non-allergic respiratory, metabolic, mental, and cardiovascular disorders sometimes coexist with bronchial asthma. However, no study has been carried out that calculates the chance of manifestation of these disorders with bronchial asthma in Saarland and Rhineland-Palatinate, Germany. Using ICD10 diagnoses from health care institutions, the present study systematically analyzed the co-prevalence and odds ratios of comorbidities in the asthma population in Germany. The odds ratios were adjusted for age and sex for all comorbidities for patients with asthma vs. without asthma. Bronchial asthma was strongly associated with allergic and with a lesser extent to non-allergic comorbidities: OR 7.02 (95%CI:6.83-7.22) for allergic rhinitis; OR 4.98 (95%CI:4.67-5.32) allergic conjunctivitis; OR 2.41 (95%CI:2.33-2.52) atopic dermatitis; OR 2.47 (95%CI:2.16-2.82) food allergy, and OR 1.69 (95%CI:1.61-1.78) drug allergy. Interestingly, increased ORs were found for respiratory diseases: 2.06 (95%CI:1.64-2.58) vocal dysfunction; 1.83 (95%CI:1.74-1.92) pneumonia; 1.78 (95%CI:1.73-1.84) sinusitis; 1.71 (95%CI:1.65-1.78) rhinopharyngitis; 2.55 (95%CI:2.03-3.19) obstructive sleep apnea; 1.42 (95%CI:1.25-1.61) pulmonary embolism, and 3.75 (95%CI:1.64-8.53) bronchopulmonary aspergillosis. Asthmatics also suffer from psychiatric, metabolic, cardiac or other comorbidities. Myocardial infarction (OR 0.86, 95%CI:0.79-0.94) did not coexist with asthma. Based on the calculated chances of manifestation for these comorbidities, especially allergic and respiratory, to a lesser extent also metabolic, cardiovascular, and mental disorders should be taken into consideration in the diagnostic and treatment strategy of bronchial asthma. BRONCHIAL ASTHMA PREVALENCE OF CO-EXISTING DISEASES IN GERMANY: Patients in Germany with bronchial asthma are highly likely to suffer from co-existing diseases and their treatments should reflect this. Quoc Thai Dinh at Saarland University Hospital in Homburg, Germany, and co-workers conducted a large-scale study of patients presenting with bronchial asthma in the Saarland region between 2009 and 2012. Patients with asthma made up 5.4% of the region's total population, with a higher prevalence occurring in females. They found that bronchial asthma was strongly associated with allergic comorbidities such as rhinitis. Indeed, asthmatic patients had a seven times higher chance to suffer from allergic rhinitis than the rest of the population, and were at higher risk of respiratory diseases like pneumonia and obstructive sleep apnea syndrome. Further associations included cardiovascular, metabolic and mental disorders. Dinh's team call for asthma treatments to take such comorbidities into account.
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Affiliation(s)
- S Heck
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - S Al-Shobash
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - D Rapp
- Department of Biometry, Epidemiology and Clinical informatics, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - D D Le
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - A Omlor
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - A Bekhit
- Department of Biometry, Epidemiology and Clinical informatics, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - M Flaig
- Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - B Al-Kadah
- Department of Otorhinolaryngology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - W Herian
- Head of the Regulatory Management Division, Association of Statutory Health Insurance Physicians Saarland, Saarbrucken, Germany
| | - R Bals
- Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - S Wagenpfeil
- Department of Biometry, Epidemiology and Clinical informatics, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Q T Dinh
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
- Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
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Li ZX, Wu SS, Yang ZR, Zhan SY, Sun F. [Impact of glucagon-like peptide-1 receptor agonists on nasopharyngitis and upper respiratory tract infection among patients with type 2 diabetes: a network meta-analysis]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:454-459. [PMID: 27318907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To systematically review the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on two common respiratory system adverse events (RSAE: nasopharyngitis and upper respiratory tract infection) among type 2 diabetes (T2DM). METHODS Medline, Embase, Clinical trials and Cochrane library were searched from inception through May 2015 to identify randomized clinical trials(RCTs) assessed safety of GLP-1RAs versus placebo or other anti-diabetic drugs in T2DM. Network meta-analysis within a Bayesian framework was performed to calculate odds ratios for the incidence of RSAE. RESULTS In the study, 50 RCTs were included, including 13 treatments: 7 GLP-1RAs (exenatide, exenatide-long-release-agent, liraglutide, lixisenatide, taspoglutide, albiglutide and dulaglutide), placebo and 5 traditional anti-diabetic drugs(insulin, metformin, sulfonylureas, sitagliptin and thiazolidinediones ketones). Compared with insulin, taspoglutide significantly decreased the incidence of nasopharyngitis (OR=0.67, 95%CI: 0.46-0.96). Significant lowering effects on upper respiratory tract infection were found when taspoglutide versus placebo (OR=0.57, 95%CI: 0.34-0.99) and insulin (OR=0.39, 95%CI: 0.23-0.73). The result from the network meta-analysis based on Bayesian theory could be used to rank all the treatments included, which showed that taspoglutide ranked last with minimum risk on nasopharyngitis and upper respiratory tract infection. CONCLUSION Taspoglutide was associated with significantly lowering effect on RSAE.
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Affiliation(s)
- Z X Li
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - S S Wu
- National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Z R Yang
- Primary Care Unit, University of Cambridge, Cambridge CB21TN, UK
| | - S Y Zhan
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - F Sun
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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Gizinger OA, Shchetinin SA. [Monitoring of microflora localized at the pharyngeal tonsil surface in the children residing in the city of Chelyabinsk and presenting with chronic adenoiditis]. Vestn Otorinolaringol 2016; 81:33-36. [PMID: 26977565 DOI: 10.17116/otorino201681133-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of the present retrospective study based on the analysis of 791 medical cards was to investigate microflora localized at the pharyngeal tonsil surface in the children living in the city of Chelyabinsk and presenting with exacerbation of chronic adenoiditis. 66% of the patients with this condition were 4-6 year old children. The most commonly documented were the associations composed of resident species S. alpha-haemoliticus and S. epidermidis together with pathobiontic S. aureus. S. beta-haemoliticus and S. pneumoniae occurred most frequently whereas H. influenza and some representatives of the genus Enterobacteriaceae were less numerous. Fungi of the genus Candida were identified in 25.4% of the samples at a titer above 10^4. In 23.7% of the cases, these fungi were found in the associations with S. aureus which resulted in mutual potentiation of the pathogenicity factor.
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Affiliation(s)
- O A Gizinger
- South Ural State Medical University, Russian Ministry of Health, Chelyabinsk, Russia, 45400
| | - S A Shchetinin
- South Ural State Medical University, Russian Ministry of Health, Chelyabinsk, Russia, 45400
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Ferrannini E, Seman L, Seewaldt-Becker E, Hantel S, Pinnetti S, Woerle HJ. A Phase IIb, randomized, placebo-controlled study of the SGLT2 inhibitor empagliflozin in patients with type 2 diabetes. Diabetes Obes Metab 2013; 15:721-8. [PMID: 23398530 DOI: 10.1111/dom.12081] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 12/28/2012] [Accepted: 02/04/2013] [Indexed: 12/15/2022]
Abstract
AIM This Phase IIb, randomized, double-blind, placebo-controlled trial evaluated the efficacy, safety, tolerability and pharmacokinetics of empagliflozin in patients with type 2 diabetes. METHODS Four hundred and eight patients (treatment-naïve or after a 4-week wash-out period) were randomized to receive empagliflozin 5, 10 or 25 mg once daily, placebo or open-label metformin for 12 weeks. The primary endpoint was change in haemoglobin A1c (HbA1c) after 12 weeks. RESULTS After 12 weeks' treatment, empagliflozin showed dose-dependent reductions in HbA1c from baseline [5 mg: -0.4%, 10 mg: -0.5%, 25 mg: -0.6%; all doses p < 0.0001 vs. placebo (+0.09%)]. Fasting plasma glucose (FPG) decreased with empagliflozin [5 mg: -1.29 mmol/l, 10 mg: -1.61 mmol/l, 25 mg: -1.72 mmol/l; all doses p < 0.0001 vs. placebo (+0.04 mmol/l)]. Body weight decreased in all empagliflozin groups (all doses p < 0.001 vs. placebo). The incidence of adverse events (AEs) was similar in the placebo (32.9%) and empagliflozin (29.1%) groups. The most frequently reported AEs on empagliflozin were pollakiuria (3.3% vs. 0% for placebo), thirst (3.3% vs. 0% for placebo) and nasopharyngitis (2.0% vs. 1.2% for placebo). AEs consistent with urinary tract infections (UTIs) were reported in four (1.6%) patients on empagliflozin vs. one (1.2%) on placebo. Genital infections were reported in five (2%) patients on empagliflozin vs. 0% on placebo. No UTIs or genital infections led to premature discontinuation. CONCLUSIONS In patients with type 2 diabetes, empagliflozin resulted in dose-dependent, clinically meaningful reductions in HbA1c and FPG, and reductions in body weight compared with placebo. Empagliflozin was well-tolerated with a favourable safety profile.
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Affiliation(s)
- E Ferrannini
- Department of Internal Medicine, University of Pisa, Pisa, Italy.
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Bartolini B, Chillemi G, Abbate I, Bruselles A, Rozera G, Castrignanò T, Paoletti D, Picardi E, Desideri A, Pesole G, Capobianchi MR. Assembly and characterization of pandemic influenza A H1N1 genome in nasopharyngeal swabs using high-throughput pyrosequencing. New Microbiol 2011; 34:391-397. [PMID: 22143812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/17/2011] [Indexed: 05/31/2023]
Abstract
De novo high-throughput pyrosequencing was used to detect and characterize 2009 pandemic influenza A (H1N1) virus directly in nasopharyngeal swabs in the context of the microbial community. Data were generated with a prior sequence independent amplification by 454 pyrosequencing on GS-FLX platform (Roche). Influenza A assembled reads allowed near full-length genome reconstruction with the simultaneous analysis of site-specific heterogeneity. The molecular approach applied proved to be a powerful tool to characterize the new pandemic H1N1 influenza virus in clinical samples. This approach could be of great value in identifying possibly new reassortants that may occur in the near future.
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Affiliation(s)
- Barbara Bartolini
- National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy
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Hashida K, Shiomori T, Hohchi N, Kitamura T, Udaka T, Suzuki H. [Survey of nasopharyngeal carriage of Haemophilus influenzae and Streptococcus pneumoniae in infants at day care centers]. Nihon Jibiinkoka Gakkai Kaiho 2006; 109:821-9. [PMID: 17233437 DOI: 10.3950/jibiinkoka.109.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Infants at day care centers tend to contract repetitive upper respiratory infections and prolonged otitis media. The increase in antimicrobial-resistant bacteria, particularly in infants, has given rise to a stubborn therapeutic problem. We studied the nasopharyngeal carriage and drug resistance to Haemophilus influenzae (H. influenzae) and Streptococcus pneumoniae (S. pneumoniae), the most common pathogens of upper respiratory infections, in infants at day care centers. Nasopharyngeal cultures of infants between the ages of 0 and 6 years were conducted at two day care centers in July 2004 ("summer"; n=183), and in February 2005 ("winter"; n=182). Isolated H. influenzae and S. pneumoniae were subjected to antibiotic susceptibility tests by broth microdilution. We also conducted an otolaryngological examination and a survey on past and life histories. H. influenzae in summer (38.3%) increased significantly in winter (57.7%). Beta-lactamase-negative and positive ampicillin-resistant H. influenzae (BLNAR+ BLPAR) in summer decreased significantly in winter. S. pneumoniae did not differ in summer (42.1%) or in winter (43.4%). Penicillin-resistant and intermediate S. pneumoniae (PRSP+PISP) was 41.3% in summer and decreased significantly to 19.0% in winter. BLNAR + BLPAR and PRSP + PISP differed with the day care center. In otolaryngological examination, rhinosinusitis was commonest (28.4% in summer and 30.8% in winter), followed by allergic rhinitis (8.7% in summer and 6.0% in winter) and otitis media (8.2% in summer and 6.0% in winter). Tonsillitis was minor (0.5% in both seasons). Rhinosinusitis in winter was significantly higher in carriers of H. influenzae and/or S. pneumoniae than in non carriers (36.4% versus 16.0%). Breast-fed infants tended to have less otitis media than bottle-fed infants (38.2% versus 52.9%). H. influenzae and/or S. pneumoniae plateaued (75-80%) after 12 months in day care centers. These results suggest that infants attending day care centers are immediately colonized by H. influenzae and S. pneumoniae in the nasopharynx after entering the centers. Nasopharyngeal drug-resistant H. influenzae and S. pneumoniae varied during the seasons and between day care centers. Further prospective studies are needed to determine upper respiratory tract infection in infants at day care centers and to evaluate carriage, epidemiology, and the drug-resistance rates of these pathogens.
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Affiliation(s)
- Koichi Hashida
- Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
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12
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Ermolina LM. [Primary acute rheumatic fever in juveniles from an organized community]. Klin Med (Mosk) 2003; 81:25-30. [PMID: 14971152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
A closed population of juveniles was studied to follow-up manifestations of primary rheumatic fever. In line with other unfavourable factors, the onset of the disease within the first 6 months of the observation was due to cross streptococcal infection (foci of chronic nasopharyngeal infection were detected in 68.6% examinees, rheumatism debut after acute nasopharyngeal infection was in 91.0% patients). Persistence of streptococci was established in many blood counts in immunofluorescence reaction in 88.2% patients in acute disease, in more patients with lingering rheumatic process. Clinical manifestations include, aside from arthritis and rheumocarditis, frequent thyroid and gastrointestinal lesions. It is thought valid to raise the dose and duration of administration of penicillin in patients with primary rheumatic fever as it eradicates chronic infection foci, prevents recurrences, reduces the number of patients with a lingering course of the disease, with recurrences and valvular defects of the heart.
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13
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Denno DM, Frimpong E, Gregory M, Steele RW. Nasopharyngeal carriage and susceptibility patterns of Streptococcus pneumoniae in Kumasi, Ghana. West Afr J Med 2002; 21:233-6. [PMID: 12744576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
UNLABELLED Penicillin resistant Streptococcus pneunmoniae poses an increasing problem in paediatrics, particularly in less developed countries. Outside of South Africa, little is known about S. pneumoniae susceptibilities in Sub-Saharan Africa. The objective of this study was to determine the prevalence of pneumococcal colonization and antimicrobial susceptibility among children in urban Ghana. METHODS Nasopharyngeal pneumococcal colonization was examined in 311 children attending a polyclinic for sick children and an immunization clinic in Kumasi, Ghana. Isolates were tested for antibiotic susceptibility to penicillin, tetracycline, erythromycin, chloramphenicol, cefuroxime, cefotaxime, ceftriaxone, and trimethoprim-sulfamethoxazole. RESULTS Over half (51.4%) of subjects were colonized with S. pneumoniae and 17% of isolates were resistant to penicillin, all demonstrating intermediate resistance. S. pneumoniae strains were also frequently resistant to trimethoprim-sulfamethoxazole and tetracycline, less so to chloramphenicol and cefuroxime and were almost uniformly sensitive to cefotaxime, cefriaxone and erythromycin. CONCLUSIONS Our study shows a high rate of pneumococcal nasopharyngeal colonization and a concerning level of penicillin resistance although at a less alarming rate than seen in some other countries. Multiple antimicrobial resistance was also noted especially among drugs readily available and commonly used. These data impact treatment choices in pneumococcal disease. Vaccine may play an important role in disease limitation. An effort to curtail the misuse of antibiotics, by prescription and otherwise, may prevent further increases in resistance rates.
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Affiliation(s)
- Donna M Denno
- Harborview Medical Center, MS 359774 325 Ninth Ave., Seattle, WA 98104-2499, USA
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Abstract
Allergic rhinitis (AR) is rarely found in isolation and needs to be considered in the context of systemic allergic disease associated with numerous comorbid disorders, including asthma, chronic middle ear effusions, sinusitis, lymphoid hypertrophy with obstructive sleep apnea, disordered sleep, and consequent behavioral and educational effects. The coexistence of AR and asthma is complex. First, the diagnosis of asthma may be confounded by symptoms of cough caused by rhinitis and postnasal drip. This may lead to either inaccurate diagnosis of asthma or inappropriate assessment of asthma severity with over treatment of the patient. The term "cough variant rhinitis" is therefore proposed to describe rhinitis that manifests itself primarily as cough that results from postnasal drip. AR, however, also has a causal role in asthma; it appears both to be responsible for exacerbating asthma and to have a role in its pathogenesis. Postnasal drip with nasopharyngeal inflammation leads to a number of other conditions. Thus sinusitis is a frequent extension of rhinitis and is one of the most frequently missed diagnoses in children. Allergen exposure in the nasopharynx with release of histamine and other mediators can cause Eustachian tube obstruction possibly leading to middle ear effusions. Chronic allergic inflammation of the upper airway causes lymphoid hypertrophy with prominence of adenoidal and tonsillar tissue. This may be associated with poor appetite, poor growth, and obstructive sleep apnea. AR is therefore part of a spectrum of allergic disorders that can profoundly affect the well being and quality of life of a child. Prospective cohort studies are required to assess the disease burden caused by AR in childhood and to further assess the potential educational impairment that may result. Because AR is part of a systemic disease process, its management requires a coordinated approach rather than a fragmented, organ-based approach.
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MESH Headings
- Asthma/diagnosis
- Asthma/epidemiology
- Child
- Child, Preschool
- Comorbidity
- Diagnosis, Differential
- Fatigue/epidemiology
- Humans
- Learning Disabilities/epidemiology
- Nasopharyngitis/epidemiology
- Otitis Media with Effusion/epidemiology
- Quality of Life
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Sinusitis/epidemiology
- Sleep Apnea, Obstructive/epidemiology
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Affiliation(s)
- G Lack
- Department of Pediatric Allergy and Immunology, St Mary's Hospital, London, UK
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White CB, Foshee WS. Upper respiratory tract infections in adolescents. Adolesc Med 2000; 11:225-49. [PMID: 10916122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
While upper respiratory tract infections (URTIs) cause much infectious morbidity in infants and young children, adolescents are not immune to infections. Adolescents experience two to four episodes of viral nasopharyngitis annually. In addition to group A streptococcus (GAS), pharyngitis may occur with other streptococci, Arcanobacterium haemolyticum, Epstein-Barr virus, Neisseria gonorrhoeae, and other pathogens. Uvulits, typically in association with GAS, occurs occasionally. Peritonsillar abscess is the most common deep neck space infection seen in adolescents, but retropharyngeal and parapharyngeal abscesses also occur, causing major morbidity. Adolescents experience fewer cases of otitis media than younger children. Rhinosinusitis occurs commonly in adolescents, occasionally leading to chronic sinusitis and serious sequelae such as osteomyelitis. This article reviews the major URTIs likely to be encountered by physicians caring for adolescents. For each entity there is a brief description of the epidemiology, morbidity, microbiology, clinical and laboratory features, treatment, and prevention.
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Affiliation(s)
- C B White
- Department of Pediatrics, Medical College of Georgia, Augusta, Georgia 30912, USA
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Abstract
The terminology used to describe upper respiratory tract infections (URTIs) in children can be based on the symptomatic picture, the aetiological agents or anatomical features involved, or classical disease descriptions. However, there is a lack of precision in the epidemiology and nosology of nasopharyngitis and acute otitis media (AOM) in children. Moreover, there are differences between European countries in diagnostic and therapeutic measures. The aim of this broad survey was to record all items potentially relating to URTIs in children and, therefore, to refine the classification of nasopharyngitis and AOM, as well as to clearly define their medical and economic consequences as observed in normal medical practice. Specifically, the objectives can be summarised as follows: to define nasopharyngitis as a clear-cut entity and thus provide a standard for clinical trials; to identify different definitions of AOM and compare them with Paradise's algorithm; to establish a profile of patients at risk of recurrences; to assess therapeutic habits; and to determine the cost of illness. The survey involved 328 European physicians (general practitioners, paediatricians, ear, nose and throat specialists), who recorded spontaneous medical visits of 2007 children presenting with a first episode of nasopharyngitis or AOM during November and December 1996. These children were then followed up until April 1997 so that any recurrent episodes could be recorded. A parent questionnaire focusing on burden of illness for the family was also included. Demographic characteristics at inclusion and the first data on the multifactorial correspondence analysis for nasopharyngitis at inclusion are available and have been presented.
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Affiliation(s)
- W Elies
- ENT Clinic, Municipal Hospital, Bielefeld, Germany
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Nieto Sánchez T, Bolivar Almagro M, Almagro Nievas D. [An outbreak of acute respiratory infection in a public school of a rural town]. Aten Primaria 1993; 11:501-2. [PMID: 8518363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Kostiukova NN, Tumanian AA, Babich EM, Tatarnikov VM, Sipacheva NB. [The role and place of serologic research in the system of epidemiologic surveillance of meningococcal infection]. Zh Mikrobiol Epidemiol Immunobiol 1988:36-41. [PMID: 3146192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The results of serological surveys, carried out with a view to the detection of capsular meningococcal polysaccharides in the passive hemagglutination (PHA) test and covering 1,289 patients with systemic meningococcal infection, 221 patients with bacteriologically confirmed meningococcal nasopharyngitis, 2,820 persons in organized groups of children and adults with different epidemiological situation (including 650 carriers) and 4,050 residents of 8 cities with different morbidity levels, were analyzed. The patients, the carriers and the members of organized groups underwent multiple surveys. As shown in this study, the confirmation of the meningococcal etiology of the systemic forms of meningococcal infection (meningitis, meningococcemia) in all cases with the exception of children under 1 year of age, as well as the determination of the groups of meningococci, could be achieved in the PHA test twice as frequently, i.e. in 60-70% of cases, as with the use of the bacteriological method. The same regularities were observed in nasopharyngitis. The conclusion was made on the possibility of using the PHA test for more exact determination of the group of meningococci, prevailing at the initial stage of diseases, this determination playing an essential role in the epidemiological surveillance. The data obtained as the result of serological surveys in organized groups may lead to conclusions on the circulation of meningococci and their group composition, thus showing the necessity of profound epidemiological study with ensuring epidemic-control measures. The selective serological study of some hundreds of donor sera is not expedient in big cities, as it provides no data on the circulation of meningococci there.(ABSTRACT TRUNCATED AT 250 WORDS)
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Usmanov MK, Glinianova LM. [Meningococcal infection in the Uzbek SSR]. Zh Mikrobiol Epidemiol Immunobiol 1982:30-4. [PMID: 6214912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The epidemiological characteristics of meningococcal infection in Uzbekistan during the period of 8 years since its last epidemic rise in 1972 is presented. Differences in the intensity of the epidemic process among the urban and rural population due to a considerable isolation of most of the rural populated localities from the district centers and the low population density in the republic have been established. The seasonal distribution of the infection had a winter-spring character in urban areas and a spring character in rural areas. 63.4% of all cases were children under 14 years. In cities a high morbidity level among adolescents and young people was determined mainly by visitors from rural areas. A high epidemiological importance of healthy carriers, predominantly schoolchildren and young people was established. The immunological studies of humoral immunity in different groups of the population indicate that the process of immunization was more rapid in cities.
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Lecointre F, Marandas P, Micheau C, Lacombe H, Schwaab G, Cachin Y. [Tuberculosis of the mucosa of the naso-pharynx. A clinical study of 37 cases seen at the Gustave-Roussy Institute between 1961 and 1978 (author's transl)]. Ann Otolaryngol Chir Cervicofac 1980; 97:423-33. [PMID: 7436234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The authors report a series of 37 cases presenting with tuberculosis of the mucosa of the upper naso-pharynx. The localization broke down as: 5 cases of tuberculosis of naso-sinuses, 6 of the buccal cavity, 3 of the cavum, 10 of the oro-pharynx, 1 of the hypopharynx, and 12 of the larynx. -- The male-female ratio was unequal (2:1 M:F) -- The mean age was 52.5 years -- Most patients were European. The 3 rhinopharyngeal cases were in North Africans. -- Macroscopically the lesions were of a malignant character in 70%. -- There was palpable lymphadenopathy in 56% of patients. The most commonly involved chain was the jugulo-carotid, especially the subdigastric group. -- There was tuberculosis in the entourage in 20/37 cases. CXR was normal in 17 cases. On hospitalisation active T.b. was discovered in 15 cases. -- Biopsy confirmed a definitive diagnosis in every case. -- All patients were treated medically. There were no cases of resistant organisms. The results were excellent.
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Sharma V, Sharma R, Purohit BK. A longitudinal study of morbidity in children up to 5 years in an urban community. Indian J Med Res 1979; 69:457-66. [PMID: 447384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Favorova LA, Sokova IN, Ivanova LM, Gimpelevich SD, Chernyshova TF. [Incidence of meningococcal infection in the RSFSR]. Zh Mikrobiol Epidemiol Immunobiol 1978:60-7. [PMID: 154278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The authors present characteristics of meningococcus infection epidemic process in case of sporadic cases and under epidemic conditions (1965--1976). A scheme of epidemiological analysis suggested by the authors permitted to differentiate and to record the incidence of various clinical forms of meningococcus infection, to present data on the age, seasonal characteristics, focality, etc. Comparison of intensive morbidity indices for 10 years, both at the individual administration territories and in the Republic as a whole demonstrated morbidity level of 1.5--2.0 to be one of prognostic signs of the beginning epidemic. The main features differentiating the sporadic and epidemic morbidity periods were revealed. The presence of group diseases, a greater percentage of children among those who fell ill, and marked signs of seasonality and territorial difference characterized the period of rise caused by meningococcus of serological group A.
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Demina AA, Pokrovskiĭ VI, Deviatkina NP, Kuz'menko SV, Semina NA. [Role of meningococcal carrier state in formation of the immunologic structure of a collective with regard to that agent]. Zh Mikrobiol Epidemiol Immunobiol 1976:126-31. [PMID: 983585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The authors present the results of the immuno-epidemiological studies of two collective bodies -- over 2000 persons in all -- equal by age composition and physical load, who were under the same sanitary-hygienic conditions. Observations were carried out from the time of formation of these collective bodies in November and were continued for a period of 6 months; they differed by the epidemic situation in respect to the meningococcus infection, i.e. cases of this disease and carriers were present in the first, and carriers only in the second group. The collective bodies were subjected to complete bacteriological examination (at the time of formation and in 3 and 6 months); blood was studied for the presence of antibodies to the complex meningococcus antigens of groups A, B and C (in the passive hemagglutination test.) There proved to be a marked increase in the percentage of positive tests with the A- and C-antibodies in both collective bodies and an increase in the number of positive tests with B-antibodies only in the collective body with no meningococcus cases. Since in the first collective body the percentage of generalized meningococcus infection cases was insignificant (about 0.85%) and there were no cases in the second collective body, a conclusion could be drawn that changes in the immunological indices among persons in these groups were caused by carrier state. Thus, the effect of meningococcus carrier state on the formation of immunological indices of collective bodies was revealed.
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Kulik ZD, Kolotilova LV, Davydova IS, Kurilenko EI, Mal'kovskaia EM. [Meningococcal nasopharyngitis]. Zh Ushn Nos Gorl Bolezn 1974; 0:44-5. [PMID: 4421355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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