Globally, pneumonia is the leading cause of death among children and also results in significant morbidity. The most common treatment options include anti-pyretics and antibiotics. Other treatments include vitamins and over-the-counter cough syrup. This overview presents a summary of the results of previous Cochrane reviews on the treatment of community acquired pneumonia (CAP) in children. The Cochrane Database of Systematic Reviews was searched for all systematic reviews examining the treatment of pediatric pneumonia or lower respiratory tract infections. All reviews that were under the heading “pneumonia” on the Cochrane Acute Respiratory Infections (ARI) Group's Topic List and the ARI group were consulted. Data were extracted and entered into tables; data were synthesized using qualitative and quantitative methods. Eight reviews and one protocol were identified and data were available from seven reviews. Azithromycin and amoxicillin-clavulanate appeared to be equivalent for CAP in developed countries. In comparing beta-lactams, one small low-quality trial showed a higher cure rate with amoxicillin-clavulanate than with amoxicillin. In comparing macrolides, the efficacy of azithromycin, clarithromycin, and erythromycin appeared to be equal. Azithromycin was better tolerated than was amoxicillin-clavulanate. For CAP in developing countries, the failure rate was lower for amoxicillin than for co-trimoxazole. Initial therapy with oral or parenteral antibiotics were equivalent in children with non-severe pneumonia. A 3-day course of amoxicillin or of co-trimoxazole had an equivalent clinical cure rate, treatment failure rate and relapse rate when compared to a 5-day course. Inconsistent outcomes were shown in studies of vitamin A for therapy of non-measles pneumonia. There were insufficient children in the studies of over-the-counter medications for cough in children with pneumonia to reach meaningful conclusions. Although thousands of children have been enrolled in trials of CAP treatments, limited conclusions can be reached about the ideal treatment, route and duration in developed or developing countries and for children of various ages. The primary reason for this is the multitude of interventions studied in diverse populations. Another major problem is that the diagnosis of pneumonia was often clinical rather than radiographic—often by necessity in developing countries. Even when pneumonia was diagnosed radiographically, differentiating viral from bacterial pneumonia was often not practical. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Allmanlakare forskrec mindre antibiotika men utnyttjade CRP-test mer : Diagnos–forskrivningsstudier for aren 2000–2005 [General practitioners prescribed less antibiotics but used the CRP test more. Diagnosis-prescription studies in 2000-2005]

Allmanlakare forskrec mindre antibiotika men utnyttjade CRP-test mer : Diagnos–forskrivningsstudier for aren 2000–2005 [General practitioners prescribed less antibiotics but used the CRP test more. Diagnosis-prescription studies in 2000-2005]

The aim of this study is to present diagnostic patterns, diagnostics used and antibiotic treatment in relation to guidelines in 3 repeated diagnosis-prescription studies conducted simultaneously in general practice in 5 Swedish counties, during 1 week in November 2000, 2002 and 2005. General practitioners (GPs) at the participating health centres were asked to complete a form for all patients with symptoms of an infectious disease. During the studied periods a total of 15,371 consultations was registered. Consultations with GPs diagnosed as respiratory tract infection (RTI), especially consultations for sore throat, decreased considerably between y 2000 and 2005. The percentage of patients allocated an RTI diagnosis and prescribed an antibiotic declined significantly from 54% to 49% and the decline was most pronounced among children. Penicillin V remained the dominant antibiotic prescribed throughout the study periods. For lower urinary tract infections there was a significant change in choice of prescribed antibiotics with an increase for pivmecillinam and nitrofurantoin and a decrease for trimethoprim, in accordance with recommendations. The results indicate a quite close adherence to current guidelines, with changes in the pattern of consultations as well as in the management of infectious diseases in general practice in Sweden.

The purpose of this study was to examine the meaning of lived experiences after an acute myocardial infarction (AMI) and being a partner to an afflicted woman, as it is narrated during rehabilitation. Nine women and their partners narrated their experiences three and twelve months after AMI. The interview texts were transcribed and then interpreted, using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The result showed that their experiences of the illness contained two themes: ‘rehabilitation needed’ and ‘loss of freedom’ which contains eight sub-themes; ‘adapting to it’, ‘struggling against it’, ‘living as normally as possible’, ‘having insight into how it can be’, ‘feeling guilty and ashamed about being weak’, ‘withholding feelings’, ‘feeling useless’, and ‘feeling fatigued and losing strength’. After further interpretation, the themes gave a deeper meaning of living with AMI and how it affects women and their partners. The women conceded that they felt distressed and vulnerable but struggled against the fear the illness means. The partner’s role appears to be one of trying to adapt to the women’s experiences of the illness. That the women withheld their feelings and did not talk about them indicates a lack of communication between the couples. As coronary care nurses often come very close both to the afflicted persons and the relatives they fill an important function in each patient’s recovery. The nurses could help and prepare the patients and their relatives to understand better such feelings and reactions as could appear after discharge from hospital.

Insulin is an important growth factor in man and mammals. In the present investigation, we have studied the incorporation of (35S)-sulfate into growth plate proteoglycans in normal, diabetic, insulin-treated diabetic, and marasmic rats. We found that diabetes leads to an all-but-total stop in the synthesis of sulfated glycosaminoglycans. The glycosaminoglycan chains actually synthesized were shorter than in normal rats. The proteoglycan monomers were smaller and did not form large aggregates in vitro. Marasmic rats and insulin-treated diabetic rats were intermediate between normal and diabetic rats with respect to sulfate uptake by cartilage, incorporation of cartilage sulfate into glycosaminoglycans, and the chain length of glycosaminoglycans. We conclude that insulin and nutrition play important but different roles in the biosynthesis of growth plate proteoglycans and thus for the longitudinal growth of skeletal bones.

The inhibition by retinoic acid (vitamin A acid) of the proteoglycan biosynthesis in human and rabbit corneal fibroblast cultures has been studied. A stepwise increase in the concentration of retinoic acid in the medium from 10−9 to 10−6 m leads to a gradual decrease in the incorporation of [3H]glucosamine. At a concentration of 10−7m retinoic acid the synthesis of each of the individual glycosaminoglycans was inhibited to about the same extent. In rabbit corneal organ cultures no clearcut effect of short time (2 hr) incubation with 10−7 m-retinoic acid was observed.

Proteoglycan subunits (PGS) were isolated from bovine articular cartilage of calves and from cows, 18 months and 8 years old respectively. From the latter cartilage of osteoarthrotic and of non-osteoarthrotic sites was taken. PGS were characterized by gel-chromatography on Sepharose 2B columns and subjected to digestion with chondroitinase ABC and with papain. The isolated keratan sulphate-protein cores obtained from chondroitinase digestion were characterized on Sepharose 4B and the chondroitin sulphate chains on Sephadex G-200 gels. A larger molecular size of PGS was found in calf cartilage than in the other samples. This was attributed to the larger molecular size of chondroitin, whereas no change was observed in the keratan sulphate-protein cores. No change was observed in molecular size of PGS, isolated chondroitin sulphates or keratan sulphate-protein cores in osteoarthrosis in comparison with non-osteoarthrotic cartilage from the same joint or from younger adult animals.

A number of proteins and proteoglycans were chromatographed on a Sepharose 4B column at various ionic strengths and after application of various amounts of samples. Kav was negligibly affected by the chromatographic conditions. When Kav was plotted against Stokes′ radius, it was found that molecules with different frictional ratios followed relationships. These results are discussed in relation to the effects of molecular asymmetry. Physical parameters for Sepharose 4B and 6B gels were calculated from chromatography of two protein mixtures.