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Many chronic illnesses that affect the working population can cause losses in productivity. The extent to which these productivity losses can be reduced by pharmacological treatment is of particular interest to employers, who bear the productivity costs and subsidize the cost of employees' health care. In the past several years, the effects of pharmaceuticals on productivity losses have been tested in numerous studies, including randomized, double-blind, placebo-controlled trials. In this article, we summarize and critically review these studies and, where appropriate, provide quantitative overviews. The evidence is very good for about a dozen drug classes that pharmaceuticals reduce productivity losses caused by respiratory illnesses (ie, asthma, allergic disorders, bronchitis, upper respiratory infections, and influenza) diabetes, depression, dysmenorrhea, and migraine. We also discuss the calculation of productivity costs, reductions in which may partially or completely offset the costs of treatment. This information should be helpful to occupational physicians who are increasingly providing recommendations on employer benefit plan designs and pharmaceutical benefits.
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PMID:Pharmaceuticals and worker productivity loss: a critical review of the literature. 1280 14

Disseminated herpes simplex virus (HSV) infection usually manifests in the immunocompromised. However, anecdotal examples of visceral HSV disease and viremia have complicated type I diabetes. A case of a 53-year-old type I diabetic patient with bowel obstruction one week subsequent to bronchitis is reported. At laparotomy, a perforated segment of ileum was associated with an adhesive peritoneal band. HSV cytopathic atypia and HSV immunohistochemical staining were confined to fibrocytes and mesothelial cells without involvement of the epithelium. Dissemination of symptomatic HSV pneumonia was verified by histology, immunohistochemistry, in situ hybridization, polymerase chain reaction and direct fluorescence antibody. Intravenous acyclovir resolved symptoms. This is a novel documentation of HSV complicating ileal adhesive band disease. Furthermore, this case indicates that the HSV cytopathic effect is not unique to the epithelium. Disseminated infection can manifest in myofibrocytes and mesothelium, distinguishing it from standard epithelial atypia of localized HSV infection.
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PMID:Herpes simplex virus type II infection of ileum mesothelium: a case report and review of the literature. 1599 70

Strychnos potatorum Linn. seeds are used in the Indian traditional system of medicine for the treatment of hepatopathy, nephropathy, gonorrhoea, leucorrhoea, gastropathy, bronchitis, chronic diarrhoea, strangury, renal and vesicle calculi, diabetes and eye diseases. The present study describes the hepatoprotective and antioxidant activities of the seed powder (SPP) and aqueous extract (SPE) of Strychnos potatorum seeds against CCl4-induced acute hepatic injury. Hepatic injury was achieved by injecting 3 ml/kg, s.c. of CCl4 in equal proportion with olive oil. Both SPP and SPE at the doses 100 and 200 mg/kg, p.o. offered significant (p < 0.001) hepatoprotective action by reducing the serum marker enzymes like serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT). They also reduced the elevated levels of ALP and serum bilirubin. Reduced enzymic and nonenzymic antioxidant levels and elevated lipid peroxide levels were restored to normal by administration of SPP and SPE. Histopathological studies further confirmed the hepatoprotective activity of SPP and SPE when compared with the CCl4 treated control groups. The results obtained were compared with Silymarin (50 mg/kg, p.o.), the standard drug. In conclusion, SPE (200 mg/kg, p.o.) showed significant hepatoprotective activity similar to that of the standard drug, Silymarin (50 mg/kg, p.o.).
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PMID:Studies on hepatoprotective and antioxidant actions of Strychnos potatorum Linn. seeds on CCl4-induced acute hepatic injury in experimental rats. 1638 23

Rapidly growing mycobacteria (RGM) have emerged as important human pathogens that can cause a variety of diseases. Thirty isolates of the pathogenic RGM were recovered from patients who attended King Chulalongkorn Memorial Hospital during 1997 and 2003. There were 16 isolates of Mycobacterium chelonae, ten isolates of M. fortuitum and four isolates of M. abscessus. Clinical data was available in only nine patients (five males and four females) including six M. chelonae, two M. abscessus, and one M. fortuitum. The mean age was 37 years (range: 13-62 years). The associated conditions were present in five patients including two diabetes, one HIV infection, one pregnancy, one SLE and one chronic renal failure. A wide spectrum of clinical features was observed. These included two chronic pulmonary infections, two post-traumatic wound infections, two disseminated infections, one lymphadenitis, one keratitis and respiratory colonization. AFB staining was positive in six patients (66.67%). The MIC of one M. chelonae and one M. abscessus were determined by Epsilon test. For M. chelonae, the MIC of clarithromycin, amikacin, ciprofloxacin, sulfamethoxazole and imipenem were 0.25, 2.0, 1.00, > 64, and 0.54 microg/ml, respectively. For M. abscessus, the MIC of clarithromycin, amikacin, ciprofloxacin, tetracycline and sulfamethoxazole were 0.016, 0.016, 0.038, > 16 and 0.002 microg/ml, respectively. Six of eight patients (75%) were initially treated with four first-line antituberculous drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) before obtaining the culture result. Of these, three patients with pulmonary and disseminated infections improved after a prolonged course of these combinations. The patients improved after switching to specific anti-RGM antibiotics. One patient died after 10 months of therapy of four anti-tuberculous drugs. One patient with post-traumatic wound infection was cured with surgical debridement and dicloxacillin. One patient improved after treatment as acute bronchitis with oral amoxicillin. An extensive review of the literature of RGM infections in Thailand is also presented.
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PMID:Rapidly growing mycobacteria in King Chulalongkorn Memorial Hospital and review of the literature in Thailand. 1640 50

The quality of doctor-patient communication is critical for the practice of medicine. Studies show that effective communication results in patient satisfaction and improved compliance. To better understand one aspect of this complex phenomenon we estimated the ability of people to comprehend 11 commonly used medical terms. We used multiple choice questions in a telephone survey of 1167 Icelanders aged 16-75 years. Results (% of participants with correct answers): Gastroesophageal reflux (72), emphysema (25), steroids (40), one tablet twice a day (79), side effects (67), bronchitis (68), white blood cells (56), erythrocyte sedimentation rate (33), diabetes mellitus (72), antibiotics (87), chronic obstructive pulmonary disease (42). Variables associated with better comprehension were: Female gender (better in 7/10 questions), university degree (10/10) and high income (9/10). Decision tree analysis showed that education had the most impact. The youngest participants (age 16-24) had the worst outcome in seven out of 10 questions. The results define certain medical terms that require more careful explanation than others. They also indicate that those of young age, low socioeconomic status and less educated require more help in understanding medical terms. Interestingly, 21% of participants failed to understand a very simple medication order, emphasizing the importance of explaining these in detail. The data may also have implications for informed consent. A larger study exploring the public comprehension of multiple medical terms should be considered.
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PMID:[Public comprehension of medical terminology.]. 1681 14

Syncope is a transient, self-limiting loss of consciousness usually leading to a fall. The onset of syncope is relatively rapid and the subsequent recovery is spontaneous, complete and usually prompt. As syncope is a symptom, the aim of the diagnostic work-up is to assess whether there is a syncope or another "nonsyncopal" condition, whether there are clinical features suggesting the diagnosis, whether the patient has an increased risk for mortality or recurrent episodes, and whether the patient must be admitted to hospital. The diagnostic work-up is given for two cases: a 68-year-old male with insulin-dependent diabetes experienced his first syncope after lunch. The clinical judgment suggested a neurocardiogenic syncope. The initial evaluation consisting of history, physical examination and twelve-lead ECG evidenced that the patient received several drugs for arterial hypertension so that an orthostatic hypotension had to be ruled out. The twelve-lead ECG showed a left bundle branch block suggesting an arrhythmic syncope and the need for additional diagnostics: an echocardiography mainly to assess the left ventricular function which was normal, and a 24-h long-term ECG to rule out arrhythmias which were not observed. The patient gets an explanation of his risk and the reassurance about his excellent prognosis and some preventive lifestyle modifications such as sufficient volume intake. The second case is a sick 58-year-old male with tracheal cough und aggravating breathing who had a syncope on his way to the toilette. The cause of the syncope was related to a bronchitis with high fever. The patient received a causative treatment and recovered completely.
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PMID:[Syncope]. 1718 Jun 54

The objective of this study was to assess the frequency and characteristics of false-positive results for tumor markers after curative gastrectomy for gastric cancer. Carcinoembryonic antigen and/or carbohydrate antigen 19-9 were periodically assessed for 168 patients who underwent curative gastrectomy. Cancer recurrence was observed for 17 (10.1%) patients and 151 (89.9%) were disease-free during the mean follow-up period of 23.1 months after the operation. The frequency of false-positive findings for tumor markers after gastrectomy was 14.3% (24/168) for all followed-up patients. Three different patterns of marker elevation were observed in the false-positive group. A false-positive finding for these markers was observed for patients with early-stage cancer and for those with chronic benign diseases, for example bronchitis, liver dysfunction, diabetes mellitus, and renal dysfunction. For most patients with false-positive findings for a marker a spontaneous decrease in the tumor marker was observed 1-2 months after the marker was first observed at a high level after the operation. Surgeons and oncologists should therefore keep in mind the high frequency of false-positive findings for tumor markers after curative gastrectomy for gastric cancer.
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PMID:False-positive findings for tumor markers after curative gastrectomy for gastric cancer. 1747 95

In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0-17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.
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PMID:[Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. 1751 53

In the article some merits and some limitations of inhaled insulin (Exubera produced by Pfizer) in the treatment of adult patients with type 1 or 2 diabetes were presented. Up till now about 3500 volunteers usually in short-term study periods (6 months) were examined. Some patients were observed in the course of treatment even 4-7 years. Inhaled insulin was well tolerated by patients and they accepted with satisfaction this new form of drug. Main adverse events were a small decrease in the forced expiratory volume at 1 s (FEV1) and a small decline in carbon monoxide diffusion capacity with no clinical significance a well as a mild or moderate cough occurring temporally. Inhaled insulin is contraindicated in smokers and patients with bronchial asthma, bronchitis and pulmonary emphysema. Despite the approval of inhaled insulin for use in adult patients with type 1 or 2 diabetes in the United States and European Union in January 2006, Pfizer designed Real World Trial to estimate the costleffectiveness of this drug and the effect of the availability of Exubera as a treatment options for glycemic control.
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PMID:[Perspectives of inhaled insulin treatment]. 1772 16

Fennel (Foeniculum vulgare Mill.) is a widespread perennial umbeliferous (Apiaceae) herb, traditionally used for medicinal purposes and human consumption. It is highly recommended for diabetes, bronchitis and chronic coughs, and for the treatment of kidney stones; some of those chronic diseases are related to the production of radical species involved in the oxidative stress. Therefore, the antioxidant potential of this herb might explain some of their empirical uses in folk medicine. This is the first time that a systematic study on different parts of fennel is performed, in order to understand differences in the antioxidant potential of shoots, leaves, steams, and inflorescences, particularly related to their composition in antioxidant compounds such as vitamins (ascorbic acid and tocopherols) and phenolics. The shoots seems to have the highest radical-scavenging activity and lipid peroxidation inhibition capacity (EC(50) values<1.4 mg/ml), which is in agreement with the highest content in phenolics (65.85+/-0.74 mg/g) and ascorbic acid (570.89+/-0.01 microg/g) found in this part. The shoots also revealed high concentration of tocopherols (34.54+/-1.28 microg/g) and were the only part with flavonoids.
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PMID:Systematic evaluation of the antioxidant potential of different parts of Foeniculumvulgare Mill. from Portugal. 1959 97


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