Determination of enteroviruses, hepatitis A virus, bacteriophages and Escherichia coli in Adriatic Sea mussels.

The aim of the present study was to evaluate the incidence of enteric viruses in mussels and to verify the possibility of using phages as indirect indicators of mussel viral contamination. Mussels (36 samples) collected from three different areas of the Adriatic Sea were analysed to determine the following parameters: Escherichia coli, somatic coliphage (T6 phage), F-Plus (MS2 phage), B40-8 (phage of Bacteroides fragilis), enteroviruses and hepatitis A virus. Most of the results of the bacteriological analysis (most probable number (MPN) ml-1) were in accordance with the bacteriological limits established by European law, with the exception of seven samples. The bacteriophage analyses were always negative for F-Plus and B40-8, with the exception of a few samples, whereas the somatic coliphages were generally between 0 and 20 MPN g-1, with the exception of two samples (110 MPN g-1). The virological analysis showed five samples positive for the presence of enteroviruses and 13 for the presence of hepatitis A virus (in three samples both viruses were present). Most of these samples presented acceptable bacteriological parameters and the bacteriophages were absent or their value was generally very low. The results show that the detection of E. coli and phages does not seem to be a good indicator of viral contamination.

Out-patient management of asthma & COPD.

Carefully document smoking history and other environmental exposures such as may occur in the work place. Also seek possible "triggers" such as household pets, ASA NSAIDs, and Beta Blockers. Laboratory evaluation should include a chest x-ray, ECG and Spirometry. If FEV1, sec less than 1 liter obtain ABGs. Treatment can be initiated with ipratroprium and prn use of Beta agonists. Theophyline may be useful. Corticosteroids may be effective in approximately 20% of subjects with stable COPD (nonasthmatic) and should be tried if symptom relief unsatisfactory and strongly urged before initiation of chronic O2 therapy. The role of inhaled steroids in COPD has not been adequately studied. Chronic O2 therapy in appropriate subjects may prolong life. Antibiotics are commonly prescribed for acute exacerbations of COPD, but without good supporting data. Corticosteroids, however, for acute exacerbations of COPD have been shown to be effective.

Occult pulmonary hemorrhage in anticoagulated patients.

Evidence for severe intrapulmonary bleeding was obtained in 3 anticoagulated patients who presented with pulmonary infiltrates. The diagnosis of pulmonary hemorrhage was based on findings of markedly elevated quantities of stainable hemosiderin and hemoglobin in alveolar macrophages retrieved by bronchopulmonary lavage. In 2 of the patients, roentgenographic abnormalities regressed after anticoagulation was reversed. The third patient died and massive bilateral pulmonary hemorrhage was found at autopsy. The syndrome of occult pulmonary hemorrhage was characterized clinically by dyspnea, unexplained acute anemia, and infiltrates with an alveolar pattern on chest roentgenogram. Hemoptysis was conspicuously absent. Bronchopulmonary lavage and quantification of alveolar macrophage hemosiderin content may be useful in identifying intrapulmonary bleeding occurring in an otherwise occult manner. Recognition of pulmonary hemorrage in anticoagulated patients is important because reversal of anticoagulation can be life saving.