Short courses of antibiotics for children and adults with bronchiectasis (Review)

BackgroundBronchiectasis is an important cause of respiratory morbidity in both developing and developed countries. Antibiotics are considered standard therapy in the treatment of this condition but it is unknown whether short courses (four weeks or less) are efficacious.ObjectivesTo determine whether short courses of antibiotics (i.e. less than or equal to four weeks) for treatment of acute and stable state bronchiectasis, in adults and children, are efficacious when compared to placebo or usual care.Search methodsThe Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, OLDMEDLINE, CINAHL, AMED and PsycINFO and handsearching of respiratory journals and meeting abstracts were performed by the Cochrane Airways Group up to February 2011.Selection criteriaOnly randomised controlled trials were considered. Adults and children with bronchiectasis (defined clinically or radiologically) were included. Patients with cystic fibrosis were excluded.Data collection and analysisTwo review authors independently reviewed the titles, abstracts and citations to assess eligibility for inclusion. Only one study fulfilled the inclusion criteria and thus meta-analysis could not be performed.Main resultsThe single eligible study showed a small benefit, when compared to placebo, of four weeks of inhaled antibiotic therapy in adults with bronchiectasis and pseudomonas in their sputum. There were no studies in children and no studies on oral or intravenous antibiotics.Authors\u27 conclusionsThere is insufficient evidence in the current literature to make reasonable conclusions about the efficacy of short course antibiotics in the management of adults and children with bronchiectasis. Until further evidence is available, adherence to current treatment guidelines is recommended

Fun time, finite time: Temporal and emotional dimensions of grandtravel experiences

Grandtravel, a growing but under-researched aspect of family tourism, appears to be a rich site for exploring temporal and emotional dimensions of tourism. This interpretive study draws on interviews with grandparents and grandchildren in Denmark and New Zealand to explore the meanings, emotions and experiences associated with grandtravel. In both contexts, we suggest that this particular form of family holiday contributed to individual and intergenerational wellbeing. Specifically, we characterise grandtravel as offering fun time, finite time and also legacy time. Each time was associated with particular affective flows including joy; loss and acceptance; and hope and confidence. These affective flows fostered playmate, poignant and continuing bonds between grandparents and grandchildren, contributing to their wellbeing in multiple ways.acceptedVersionPeer reviewe

Whom should we screen for Cushing syndrome? The Endocrine Society practice guideline recommendations 2008 revisited

CONTEXT: Cushing syndrome (CS) is a rare and serious disease with high mortality. Patients are often diagnosed late in the course of the disease. OBJECTIVE: This work investigated whether defined patient populations should be screened outside the at-risk populations defined in current guidelines. METHODS: As part of the prospective German Cushing registry, we studied 377 patients with suspected CS. The chief complaint for CS referral was documented. Using urinary free cortisol, late-night salivary cortisol, and the 1-mg dexamethasone suppression test as well as long-term clinical observation, CS was confirmed in 93 patients and ruled out for the remaining 284. RESULTS: Patients were referred for 18 key symptoms, of which 5 were more common in patients with CS than in those in whom CS was ruled out: osteoporosis (8% vs 2%; P = .02), adrenal incidentaloma (17% vs 8%, P = 0.01), metabolic syndrome (11% vs 4%; P = .02), myopathy (10% vs 2%; P < .001), and presence of multiple symptoms (16% vs 1%; P < .001). Obesity was more common in patients in whom CS was ruled out (30% vs 4%, P < .001), but recent weight gain was prominent in those with CS. A total of 68 of 93 patients with CS (73%) had typical chief complaints, as did 106 of 284 of patients with ruled-out CS status (37%) according to the Endocrine Society practice guideline 2008. CONCLUSION: The 2008 Endocrine Society Practice guideline for screening and diagnosis of CS defined at-risk populations that should undergo testing. These recommendations are still valid in 2022

Unveiling 4500 years of environmental dynamics and human activity at Songo Mnara, Tanzania

Coastal East Africa has undergone massive transformations through the Late Holocene, with a combination of changes in sea level, increasing human settlement, and ensuing use of coastal resources. A comprehensive multi-proxy analysis, including pollen, phytolith, charcoal, stratigraphy, particle size, and geochemical data from sedimentary cores extracted from mangrove ecosystems combined with soils from archaeological contexts, provided valuable insights into vegetation dynamics, environmental changes, and human interactions within the mangrove ecosystem of Songo Mnara Island, Tanzania over the last 2590 BCE (4540 cal yr BP). The bottommost layers indicate a lack of vegetation, as deduced from the presence of coral rags and high calcium and carbonate content, possibly due to high mid-Holocene sea-level. Evidence of mangrove taxa suggests a decrease in sea level, enabling the establishment of mangroves from around 2590 BCE. A brief period of sea-level rise occurred between 90 BCE and 320 CE before sea-level fell until 1570 CE. Significant evidence of human activity is recorded from around 1400 CE indicated by increased charcoal, crop phytoliths, and evidence of marine resource utilisation. The timing of this human-environment interaction is also linked to the time of lower sea level. However, there was evidence suggesting human abandonment of the island from around 1500 CE. This coincided with a subsequent rise in sea levels and potentially prolonged drought conditions spanning from 1570 to 1700 CE. These factors likely contributed to a shortage of food resources in the area, impacting both agricultural practices due to the scarcity of natural freshwater and the accessibility of marine food resources. From 1700 CE to the present, fluctuations in sea level have been observed, with a signal of recent sea-level rise in tandem with shifts in mangrove, terrestrial herbaceous taxa and fire activity. The low sedimentation rates within mangrove areas suggest that the mangroves on Songo Mnara Island may not keep pace with the current rate of sea-level rise