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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Serological studies were carried out in the time course of insulin-dependent diabetes mellitus in 419 children, among whom paired sera from 66 were studied in the very beginning of diabetes mellitus. By seroconversion in 83% of the children early in the disease, different, frequently mixed virus infections were diagnosed: Coxsackie B2, B3, B4 (46%), rubella (41%), influenza A, B, C (38%), parainfluenza types 1-3 (35%), mumps (23%), adenovirus infection (18%), HB virus infection (4.5%). Acute respiratory diseases preceded or coincided with the onset of diabetes in half of the children with diagnosed acute respiratory and enterovirus infections. No clinical signs of rubella, mumps, or hepatitis immediately before the onset of diabetes or early in the disease were found. A possible role of virus infection diagnosed early in diabetes, in the etiology of chronic insulitis, in provocation of its exacerbation, and manifestation of diabetes mellitus is discussed.
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PMID:[Antibodies to viruses in children with diabetes mellitus]. 631 65

The antibody responses to influenza vaccination of a group of adult diabetic patients were compared with responses in a healthy group of regular volunteer vaccinees. The initial and final geometric mean hemagglutination-inhibiting antibody titers were lower in the patient group, but the relative increase in titers was greater for each of the vaccine components. The percentage of fourfold rises in individual titers was greater in the diabetic group than in the control group. It was concluded that patients with diabetes mellitus responded normally to influenza vaccination. This was confirmed in an additional study. There was no significant difference in the antibody responses of patients treated with insulin or oral antidiabetic agents. There was no impairment of diabetic control as a result of influenza vaccination when this was evaluated by measuring the concentration of glycosylated hemoglobin, or by random blood glucose estimations. There was no significant change in the serum insulin level after immunization in patients on oral diabetic agents. It was concluded that influenza vaccination was safe and effective in adult diabetic patients.
Diabetes Care
PMID:Influenza immunization in adults with diabetes mellitus. 640 Jul 8

Staphylococcal pneumonia is rare, has a high mortality and morbidity rate, and occurs commonly during influenza epidemics (airborne) or during the course of right sided bacterial endocarditis in drug addicts (blood borne). In recent years, much emphasis has been given to the staphylococcal infections in intravenous drug abusers. This report describes ten patients with staphylococcal pneumonia resulting from soft tissue infection who were previously healthy and had no history of drug abuse. They were 12 to 45 years old. Eight were male patients. Soft tissue infection was community-acquired in nine and was most commonly located in the lower extremities. Three patients had diabetes. All presented with a clinical picture of acute pneumonia. Hemoptysis occurred in three. Chest roentgenogram showed multiple large or small round discrete densities in most of the patients. Lobar involvement was notably absent. Eight developed cavitary lesions in their lungs. The average length of hospital stay was 40 days. One patient died and six developed complications. Staphylococcal etiology should be suspected in patients with acute pneumonia who have soft tissue infection or have characteristic chest roentgenogram findings; antistaphylococcal agents should be included in the therapeutic regimens of such patients until the results of the cultures are known.
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PMID:Hematogenous staphylococcal pneumonia secondary to soft tissue infection. 746 Jun 48

Since their initial description in 1957, the interferons (IFNs) have been increasingly used to treat a wide array of diseases. Acute adverse effects, i.e. 'flu-like' syndromes, hypo- or hypertension, tachycardia, headache, myalgias and gastrointestinal disorders, occur within the first hour or day after starting treatment. They are seldom treatment-limiting and are easily manageable. Sub-acute and chronic effects develop after several days, usually within 2 and 4 weeks of therapy. The most typical is neurological toxicity, including fatigue/asthenia, and behavioural and cognitive changes. Such symptoms may seriously impair quality of life and result in treatment discontinuation. Seizures have seldom been described. Other infrequent central nervous system adverse effects include vertigo, cramp and oculomotor nerve paralysis. Distal paraesthesias and peripheral neuropathy have been reported. IFN-associated autoimmunity is quite rare but a matter of concern. Biological or clinical manifestations usually require several months to become apparent. Autoantibodies have been shown to develop in most patients but have been inconsistently associated with clinical symptoms of systemic lupus erythematosus, rheumatoid-like arthritis and thyroiditis. Both hypo- and hyperthyroidism have been described but are usually reversible. Other infrequent autoimmune reactions include diabetes, pemphigus and worsening of multiple sclerosis. Although several patients present with a pre-existing autoimmune disorder, no predisposing factor has been clearly established. While hypotension and tachycardia are the most frequent acute cardiovascular complications, a few additional cases of cardiac arrhythmias and myocardial ischaemia have been reported after a short course or several weeks of treatment. These latter complications do not appear to be dose-dependent or age-related. Isolated cases of congestive heart failure have also been described. Mild proteinuria has been observed in 15 to 25% of patients, but acute renal toxicity is uncommon. A transient rise in serum aminotransferase levels is frequently noted during the first stage of therapy, especially in patients receiving the highest dosages. Direct hepatotoxicity is extremely rare. Autoimmune hepatitis, which is ill-diagnosed as chronic viral hepatitis, and de novo induction of autoimmune hepatitis, account for the majority of liver diseases. Haematotoxicity is relatively common but mild to moderate, and develops gradually during the first weeks of treatment. Neutropenia is the most common haematological toxicity, but is usually not dose-limiting and resolves rapidly upon drug discontinuation. Myelosuppression, autoimmune and immune allergic haemolytic anaemias and thrombocytopenias have seldom been described. Cutaneous adverse effects comprised nonspecific erythema and hair loss and, less frequently, vasculitis, local ulcerations at the site of injection and exacerbation of psoriasis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical toxicity of the interferons. 751 63

Autoimmune (type 1) diabetes mellitus in mouse, rat, and humans shares several features, including T lymphocyte infiltration into pancreatic islets and a dependence on permissive class II major histocompatibility complex (MHC) alleles. We report here on an experimental model involving mice that express influenza hemagglutinin (HA) under the control of the insulin promoter and, at the same time, a transgenic class II MHC-restricted T cell receptor (TcR) specific for an HA peptide. These mice spontaneously develop islet infiltrates resembling those found in NOD mice and most animals become diabetic within 8 weeks of age. Because of the availability of a clonotypic TcR antibody, we can be confident that the Ins-HA transgene does not induce any measurable alterations in the vast majority of T cells with the transgenic TcR in primary and secondary lymphoid organs. Continuous export of large numbers of HA-specific lymphocytes from the thymus was not required for the manifestation of the disease since mice thymectomized at 3 days after birth still developed the disease albeit with smaller infiltrates.
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PMID:On the various manifestations of spontaneous autoimmune diabetes in rodent models. 752 72

Viral infection is assumed to trigger or exacerbate autoimmune responses against pancreatic beta cells leading to the development of insulin-dependent diabetes mellitus (IDDM). We therefore examined by polymerase chain reaction the presence of two candidate viruses, cytomegalovirus and Epstein-Barr virus, in IDDM pancreases. Pancreas tissues were obtained by biopsy under laparoscopy from 16 recent-onset IDDM patients: age 17-53 years; disease duration 0-7 months; six had flu-like symptoms before onset. Frozen sections were made and subjected to DNA amplification. DNA samples were prepared from the frozen sections and polymerase chain reaction was performed using primers specific to cytomegalovirus, Epstein-Barr virus and control gene for HLA-DP. Cytomegalovirus- and Epstein-Barr virus-infected cells were used for positive control. Southern blot analysis could detect cytomegalovirus DNA from as few as 2 x 10(-1) cytomegalovirus-infected cells and Epstein-Barr virus DNA from two Epstein-Barr virus-infected cells. This highly sensitive analysis, however, could not detect cytomegalovirus or Epstein-Barr virus genomes in pancreases of recent-onset IDDM. A single copy human gene (HLA-DP) was amplified from all IDDM pancreases indicating that DNA amplification was performed without inhibition. We conclude that cytomegalovirus or Epstein-Barr virus genomes are unlikely to exist in pancreas biopsy specimens of recent-onset IDDM patients.
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PMID:No detectable cytomegalovirus and Epstein-Barr virus genomes in the pancreas of recent-onset IDDM patients. 767 87

Diabetes mellitus is often identified as an independent risk factor for developing lower respiratory tract infections. Pulmonary infections, such as those caused by Mycobacterum tuberculosis, mucor, Staphylococcus aureus, and gram-negative bacteria may occur with an increased frequency whereas infections due to Streptococcus pneumoniae, Legionella, and influenza may be associated with increased morbidity and mortality. The predisposition to lower respiratory tract infections may represent alterations in pulmonary host defenses at several levels. The purpose of this article is to review the spectrum of pulmonary infections encountered in the diabetic patient, focusing on predisposing defects in pulmonary host defense, highlighting characteristic clinical features, and discussing diagnostic approaches, therapeutic interventions, and prophylaxis in this patient population.
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PMID:Pulmonary complications of diabetes mellitus. Pneumonia. 776 21

Influenza vaccination policies of 28 European countries were compared with those of the US Immunization Practices Advisory Committee. Twenty-four of 28 (86%) European countries had immunization policies for influenza. European and US recommendations were in complete agreement concerning immunization of those with heart and lung disease. Within Europe there was 81-86% agreement concerning immunization of the elderly, irrespective of their health status, and patients with diabetes, renal dysfunction and immunosuppression, and 71% agreement concerning those in residential care and occupational groups that can transmit influenza to high-risk patients. Unlike the US, 62-71% of European countries did not target those with haemoglobinopathies, children and teenagers taking salicylates or household members of those at high risk. Few recommendations were endorsed by relevant medical or patient organizations. The observed variation in vaccination policies in Europe and North America possibly reflect uncertainties concerning risks from influenza and benefits from vaccination, and differences in public health systems and attitudes towards preventive medicine.
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PMID:Influenza immunization policies in Europe and the United States. 779 32

Recent additions to the immunization schedule include acellular pertussis vaccine, and hepatitis B vaccine for all infants and selected adolescents. The third dose of OPV is recommended at 6 months of age and the first dose of MMR vaccine at 12 to 15 months. A new vaccine against Haemophilus influenzae type b has been licensed. Children aged 6 months and older with asthma, diabetes, or heart disease should receive influenza vaccine. Children aged 2 years and older with asplenia, immunosuppression, and nephrotic syndrome may be candidates for pneumococcal immunization.
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PMID:Childhood immunization guidelines: current and future. 785 58

Influenza is a major cause of debilitating illness and premature death in the United States, particularly among persons aged > or = 65 years and those with chronic conditions such as lung or heart disease, diabetes, and cancer. Medicare reimbursement for excess hospitalizations during influenza epidemics ranges from $750 million to $1 billion (1). In May 1993, influenza vaccination became a covered Medicare benefit after its potential cost-effectiveness was established by the Medicare Influenza Vaccine Demonstration (2). During the fall of 1993, the Health Care Financing Administration (HCFA) initiated an information campaign to promote use of the influenza vaccination benefit, implemented simplified billing procedures, and improved electronic billing capabilities. However, reports during the 1993-94 influenza season suggested problems experienced by state and local health departments in implementing the new benefit. To characterize public influenza vaccination programs and problems with implementing this benefit, in the spring of 1994, CDC collected information from all 63 state and local health departments receiving federal immunization grants. This report summarizes the reports from these programs.
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PMID:Implementation of the Medicare influenza vaccination benefit--United States, 1993. 793 12


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