Bacteremic pneumonia before and after withdrawal of 13-valent pneumococcal conjugate vaccine from a public vaccination program in Spain: a case-control study

The objective of this study is to compare the incidence and epidemiology of bacteremic community-acquired pneumonia (CAP) in the setting of changes in 13-valent pneumococcal conjugate vaccine (PCV13) coverage. In the region of Madrid, universal immunization with the PCV13 started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. We performed a multicenter surveillance and case-control study from 2009-2014. Cases were hospitalized children with bacteremic CAP. Controls were children selected 1:1 from next-admitted with negative blood cultures and typical, presumed bacterial CAP. Annual incidence of bacteremic CAP declined from 7.9/100 000 children (95% CI 5.1-11.1) in 2009 to 2.1/100 000 children (95% CI 1.1-4.1) in 2012. In 2014, 2 years after PCV13 was withdrawn from the universal vaccination program, the incidence of bacteremic CAP increased to 5.4/100 000 children (95% CI 3.5-8.4). We enrolled 113 cases and 113 controls. Streptococcus pneumoniae caused most of bloodstream infections (78%). Empyema was associated with bacteremia (P = .003, OR 3.6; 95% CI 1.4-8.9). Simple parapneumonic effusion was not associated with bacteremia. Incomplete PCV immunization was not a risk factor for bacteremic pneumonia.

Multicenter Randomized Controlled Trial of Withdrawal of Inhaled Corticosteroids in Cystic Fibrosis

Rationale: Lung inflammation and injury is critical in cystic fibrosis. An ideal antiinflammatory agent has not been identified but inhaled corticosteroids are widely used despite lack of evidence.

Objectives: To test the safety of withdrawal of inhaled corticosteroids with the hypothesis this would not be associated with an earlier onset of acute chest exacerbations.

Methods: Multicenter randomized double-blind placebo-controlled trial in 18 pediatric and adult UK centers. Eligibility criteria included age > 6.0 yr, FEV1 ? 40% predicted, and corticosteroid use > 3 mo. During the 2-mo run-in period, all patients received fluticasone; they then took either fluticasone or placebo for 6 mo.

Measurements and Main Results: Fluticasone group: n = 84, median age 14.6 yr, mean (SD) FEV1 76% (18); placebo group: n = 87, median age 15.8 yr, mean (SD) FEV1 76% (18). There was no difference in time to first exacerbation (primary outcome) with hazard ratio (95% confidence interval) of 1.07 (0.68 to 1.70) for fluticasone versus placebo. There was no effect of age, atopy, corticosteroid dose, FEV1, or Pseudomonas aeruginosa status. There was no change in lung function or differences in antibiotic or rescue bronchodilator use. Fewer patients in the fluticasone group withdrew from the study due to lung-related adverse events (9 vs. 15%); with a relative risk (95% confidence interval) of 0.59 (0.23–1.48) fluticasone versus placebo.

Conclusions: In this study population (applicable to 40% of patients with cystic fibrosis in the UK), it appears safe to consider stopping inhaled corticosteroids. Potential advantages will be to reduce the drug burden on patients, reduce adverse effects, and make financial savings.

Characterization of a high-density, direct-current reflex discharge plasma source operating in Ar and N-2

The characterization of a direct current, low-pressure, and high-density reflex discharge plasma source operating in argon and in nitrogen, over a range of pressures 1.0-10(-2) mbar, discharge currents 20-200 mA, and magnetic fields 0-120 G, and its parametric characterization is presented. Both external parameters, such as the breakdown potential and the discharge voltage-current characteristic, and internal parameters, like the charge carrier's temperature and density, plasma potential, floating potential, and electron energy distribution function, were measured. The electron energy distribution functions are bi-Maxwellian, but some structure is observed in these functions in nitrogen plasmas. There is experimental evidence for the existence of three groups of electrons within this reflex discharge plasma. Due to the enhanced hollow cathode effect by the magnetic trapping of electrons, the density of the cold group of electrons is as high as 10(18) m(-3), and the temperature is as low as a few tenths of an electron volt. The bulk plasma density scales with the dissipated power. Another important feature of this reflex plasma source is its high degree of uniformity, while the discharge bulk region is free of electric field. (C) 2002 American Institute of Physics.

High-density and low electron temperature direct current reflex plasma source

A new type of direct current, high-density, and low electron temperature reflex plasma source, obtained as a hybrid between a modified hollow-cathode discharge and a Penning ionization gauge discharge is presented. The plasma source was tested in argon, nitrogen, and oxygen over a range pressure of 1.0-10(-3) mbar, discharge currents 20-200 mA, and magnetic field 0-120 Gauss. Both external parameters, such as breakdown potential and the discharge voltage-current characteristic, and its internal parameters, like the electron energy distribution function, electron and ion densities, and electron temperature, were measured. Due to the enhanced hollow-cathode effect by the magnetic trapping of electrons, the density of the bulk plasma is as high as 10(18) m(-3), and the electron temperature is as low as a few tenths of electron volts. The plasma density scales with the dissipated power. Another important feature of this reflex plasma source is its high degree of uniformity, while the discharge bulk region is free of an electric field. (C) 2004 American Institute of Physics.

Are there clinical features of a sensitized cough reflex?

Cough reflex hypersensitization is a key feature in patients with troublesome cough. The clinical consequence of this hypersensitive state is typified by bouts of coughing often triggered by low threshold stimuli encountered by the patient during normal daily activities including exposure to aerosols, scents and odours, a change in air temperature and when talking or laughing. These features are often perceived by cough patients to be the most disruptive aspect of their condition and undoubtedly contribute to impaired quality of life. Patients with troublesome cough may describe a range of additional symptoms and sensations including an 'urge to cough' or the feeling of an 'itch' at the back of the throat, or a choking sensation and occasionally chest pain or breathlessness. It is uncertain if these features arise due to the processes responsible for cough reflex sensitization or as a direct consequence of the underlying cough aetiology. In an attempt to understand the clinical features of a sensitized cough reflex, the spectrum of symptoms typically described by cough patients will be reviewed and possible underlying mechanisms considered. Since an intact cough reflex is crucial to airway protection, anti-tussive treatment that attenuates the hypersensitive cough state rather than abolishing the cough reflex completely would be preferable. Identifying such agents remains a clinical, scientific and pharmacological challenge. (c) 2008 Elsevier Ltd. All rights reserved.