Friday, August 31, 2012

Chronic Pharyngitis: Role of Atypical Organisms: A Case Control Study from South India

Otolaryngology - Head and Neck Surgery (Aug 2012)

Naina P, Anandan S, Mathews SS, Job A, Albert RR

Background: Bacteria including Chlamydophila pneumoniae, Mycoplasma pneumoniae, and anaerobic bacteria such as Fusobacterium necrophorum have been implicated as etiological agents of chronic pharyngitis in Western literature. Because there are no data regarding this from India, the authors undertook this study.

Study Design  Prospective case-control study.

Setting  Tertiary-level medical college and hospital.MethodIn total, 343 consecutive adults with persistent throat pain and/or irritation (duration ≥3 months) were screened for known causes of pharyngitis by a thorough clinical and endoscopic examination. In 71 patients, the evaluation performed was unable to determine any cause, and these were considered cases. An enzyme-linked immunosorbent assay test to detect IgA and IgG antibodies to C pneumoniae and M pneumoniae was performed on 66 of these cases and 62 controls. The posterior pharyngeal swabs taken from both the cases and controls were subjected to aerobic and anaerobic culture.

Results  Individuals with chronic pharyngitis had a 3.43 times odds of being seropositive for C pneumoniae as compared with controls (P = .001; odds ratio = 3.43). Aerobic organisms and M pneumoniae did not seem to be significant etiological agents for chronic pharyngitis. On the contrary, isolation of Fusobacterium spp was found to be significantly more in controls as compared with cases.

ConclusionThis study suggests an association between IgA antibodies to C pneumoniae and chronic pharyngitis. Further studies using more specific tests combined with long-term follow-up are needed to confirm these findings.

Friday, August 24, 2012

The Red Puffy Ear Sign - A Clinical Sign to Diagnose a Rare Cause of Meningoencephalitis

Fortschritte der Neurologie-Psychiatrie (Jul 2012)

Prinz S, Dafotakis M, Schneider RK, Mühlenbruch G, Stopschinski BE 

We report on the case of a 63-year-old patient with a meningoencephalitis, presenting itself with headache and a general neuropsychological retardation. Additionally, a reddening and swelling of both auricles could be seen. Magnetic resonance imaging showed confluent, contrast-uptaking lesions. In the cerebrospinal fluid an aseptic lymphocytic pleocytosis was found. A biopsy of the ear revealed a chronic lymphoplasmacellular inflammatory reaction. We diagnosed a relapsing polychrondritis, an inflammatory disease of the cartilage, which can in rare cases affect the central nervous system. Typically, the patients complain about red swollen ears, the"red puffy ear sign". After initiation of steroid and azathioprin therapy the patient recovered fully.

Sexually transmitted infections of the oral cavity

 Der Hautarzt (Aug 2012)

Schöfer H

Various sexual practices like fellatio, cunnilingus, or anilingus (rimming) can cause both symptomatic and asymptomatic oral infections in both sexes. Clinically apparent lesions are found in primary, secondary, and tertiary syphilis, in acute HIV infection and the subsequent stage of immunodeficiency (opportunistic infections), as well as in herpes and human papilloma virus infections. Genital candidiasis also can be transmitted to the oral cavity. Depending on the infective agent transmitted, ulcerative, inflammatory or papillomatous lesions of the lips, tongue, mucous membranes and pharynx occur. Oropharyngeal infections with Neisseria gonorrhoeae or Chlamydia trachomatis (Serovar D-K) can cause pharyngitis and tonsillitis with sore throat, but are completely asymptomatic in most cases. Asymptomatic infections are an important, but frequently overlooked reservoir for new infections. Systemic treatment of oral STI's usually is the same as that for anogenital infections. It can be accompanied by symptomatic topical therapy. When the tonsils and other difficult to reach tissues are infected, higher doses and an antibiotic with good tissue penetration are recommended.

Friday, September 30, 2011

Human paranasal sinuses and selective brain cooling: A ventilation system activated by yawning?

Human paranasal sinuses and selective brain cooling: A ventilation system activated by yawning?
Medical Hypotheses
Volume 77, Issue 6 , Pages 970-973, December 2011

  • Andrew C. Gallup


    • Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, United States
    • Corresponding Author InformationCorresponding author. Tel.: +1 518 727 2473; fax: +1 609 258 7892.
  • Gary D. Hack


The function of the paranasal sinuses has been a controversial subject since the time of Galen, with many different theories advanced about their biological significance. For one, the paranasal sinuses have been regarded as warmers of respiratory air, when in actuality these structures appear to function in cooling the blood. In fact, human paranasal sinuses have been shown to have higher volumes in individuals living in warmer climates, and thus may be considered radiators of the brain. The literature suggests that the transfer of cool venous blood from the paranasal sinuses to the dura mater may provide a mechanism for the convection process of cooling produced by the evaporation of mucus within human sinuses. In turn, the dura mater may transmit these temperature changes, initiated by the cool venous blood from the heat-dissipating surfaces of the sinuses, to the cerebrospinal fluid compartments. Furthermore, it has recently been demonstrated in cadaveric dissections that the thin bony posterior wall of the maxillary sinus serves as an origin for both medial and lateral pterygoid muscle segments, an anatomic finding that had been previously underappreciated in the literature. The present authors hypothesize that the thin posterior wall of the maxillary sinus may flex during yawning, operating like a bellows pump, actively ventilating the sinus system, and thus facilitating brain cooling. Such a powered ventilation system has not previously been described in humans, although an analogous system has been reported in birds.

Thursday, April 28, 2011

Influence of lipoproteins and fibrinogen on pathogenesis of sudden sensorineural hearing loss

a1 Department of Anesthesiology and Intensive Care, Clinical Hospital Center Zagreb, Zagreb, Croatia
a2 Department of Otorhinolaryngology, City Hospital Pakrac, Zagreb, Croatia
a3 University Clinic for Orthopedic Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia
a4 University Clinic for Otorhinolaryngology, Sestre Milosrdnice Clinical Hospital, Zagreb, Croatia
Aim: To evaluate the relationship between lipoproteins, fibrinogen and sudden sensorineural hearing loss in a Croatian population. Since pathological derangement of lipoproteins and fibrinogen could be one of the causes of sudden sensorineural hearing loss, we hypothesised that patients with sudden sensorineural hearing loss would have more abnormal fibrinogen and lipoprotein concentrations, compared with subjects with normal hearing.
Methods: Plasma concentrations of cholesterol, fibrinogen and triglycerides in patients with sudden sensorineural hearing loss were compared with those in a control group (i.e. subjects with normal hearing function).
Results: Patients with sudden sensorineural hearing loss had significantly higher plasma concentrations of cholesterol and low density lipoprotein cholesterol, compared with controls.
Conclusion: Higher cholesterol and low density lipoprotein cholesterol concentrations were found in patients with sudden sensorineural hearing loss, within a Croatian population. Cholesterol and low density lipoprotein cholesterol concentrations may be important factors in the pathogenesis of sudden sensorineural hearing loss, and should be assessed during the investigation of patients with this condition.
(Accepted June 15 2010)
(Online publication November 05 2010)
c1 Address for correspondence: Dr Goran Bicanic, University Clinic for Orthopedic Surgery, Clinical Hospital Center Zagreb, Salata 6-7, 10000 Zagreb, Croatia Fax: +385 1 4818810 E-mail:
Dr G Bicanic takes responsibility for the integrity of the content of the paper
Competing interests: None declared

Wednesday, April 27, 2011

Breakthrough In Allergic Asthma Treatments To Put Squeeze On Sneeze, UK

Breakthrough In Allergic Asthma Treatments To Put Squeeze On Sneeze, UK

A major breakthrough in creating effective new treatments for allergic asthma has been discovered by Asthma UK funded scientists at King's College London. 

The discovery is the culmination of over fifteen years of Asthma UK-funded research, and the findings are published today in the journal Nature Structural & Molecular Biology. 

The painstaking work conducted by a team of scientists led by Professor Brian Sutton at the MRC-Asthma UK Centre in Allergic Mechanisms of Asthma at King's College London, revealed the precise shape of an important molecule called IgE as it binds to receptor proteins on the surface of mast cells in the lungs. 

Scientists built up a picture of IgE's shape down to the location of each individual atom by firing X-rays at purified protein crystals and measuring how the rays were deflected. Using this technique they were also able to reveal how IgE moves and twists as it attaches to the receptor.

With further funding from Asthma UK, the team is now testing a library of small chemical compounds, looking for ones that have the potential to block the interaction between IgE and its receptor and prevent the development of asthma. 

There are hundreds of thousands of mast cells crawling through the lining of our lungs, each of which holds thousands of histamine-containing granules. In a person with allergic asthma, IgE molecules sit on the surface of these cells. Then, when the individual comes into contact with an allergen such as grass pollen, it sticks to the IgE, provoking the mast cells to release their granules. Histamine causes breathlessness, wheezing and other asthma symptoms by narrowing the airways and triggering inflammation

Although allergens from grass pollen, pets, house-dust mites and other sources all have different shapes, all of them trigger asthma and allergy symptoms by binding to IgE on mast cells. Hence, a drug that can prevent IgE from interacting with mast cells would help anyone with allergic asthma, no matter what triggers their allergy. 

The breakthrough is an essential step towards chemically-based drugs, such as those now being developed by Professor Sutton, which can be given in tablet form. 

Professor Brian Sutton from King's says: 'We are immensely proud of our achievement. Thousands of hours of work by my team, plus that of our collaborators, has brought us to an incredibly exciting point. 

'Armed with the precise structure of IgE bound to its receptor we stand a great chance of being able to create hugely effective new treatments for allergic asthma.' 

Dr Elaine Vickers, Research Relations Manager at Asthma UK, says: 'In the UK, 5.4 million people have asthma and almost 80% of them say they have allergies which affect their asthma control. 

'The impact of potential new treatments for allergic asthma resulting from this work could have an enormous impact on the quality of life of people across both the UK and the world.' 

Asthma UK 

Friday, January 21, 2011

Omalizumab: Anti-IgE Therapy in Allergy

Current Allergy and Asthma Reports (Jan 2011)

 Kopp MV 

Omalizumab is a humanized, monoclonal anti-IgE antibody that binds specifically to circulating IgE molecules, thus interrupting the allergic cascade. Omalizumab has been shown to be highly effective in treating children and adults with moderate to severe allergic asthma. Beyond this indication, the mode of action itself suggests that omalizumab is not only an antiasthmatic drug but also a promising therapeutic option for various allergic conditions, including allergic rhinitis, food allergy, urticaria, allergic bronchopulmonary aspergillosis, insect hypersensitivity, and atopic dermatitis. However, data from double-blind, placebo-controlled clinical trials are only available for allergic rhinitis and moderate to severe bronchial asthma. The aim of this review is to discuss the current clinical data as well as possible further indications of omalizumab treatment