21 February, 2009

Dr. Arthur Kornberg's comment on Penicillin

Dr. Arthur Kornberg and his family ---- from the book "For the love 
of enzymes: The odyssey of a Biochemist. Harvard University Press. 
1991.
synthesis of a infectious phagea virus of bacteria in 1967) wrote 
about penicillin.

---------------------------------------------------------------------------------
  Penicillin and other antibiotics are the most dramatic 
therapeutic advance in medicine in my lifetime. When I was a 
student and intern before the advent of antibiotics, the 
treatment of lobar pneumonia was discouraging ineffective. 
One out of four patients died. Subacute bacterial endocarditis 
was invariably fatal. Rheumatic fever and acute nephritis 
were prevent.        

Many people know that antibiotic therapy was not discovered 
at bedsides nor even in a clinical pharmacology laboratory. 
Bullrings in Spain have a statures of Alexander Fleming, 
who in 1929 noticed the inhibition of bacterial growth around 
penicillin mold contaminated his Petri plate.        

The apotheosis of Fleming gored bullfighters is exaggerated 
because the practical use of the penicillin mold was not 
discovered by Fleming. It took Ernst Chain, a biochemist, 
and Howard Florey, a pathologist, to apply this knowledge 
ten years later to isolate penicillin and demonstrated its 
clinical utility.        

   There is much more to the penicillin story than that. 
Basic inquiries and findings essential to Fleming's discovery 
started at least fifty years earlier. Fleming would never have 
made his observation without the agar Petri plate. But, more 
important, he would never have understood what he saw on 
the plate were it not for the firm foundations of bacteriology 
and immunology.       

One might assume that Chain and Florey undertook the 
isolation of penicillin because of its possible clinical potential. 
Not at all. With the encouragement of Florey, Chain started 
his research on penicillin only because he was curious about 
the dissolution of bacterial walls by enzymes such as lysozyme. 

He thought penicillin was an enzyme too and wanted to 
understand the mechanism of its action. He surprised to find 
that penicillin was a molecule small enough to pass readily 
through the pores of a dialysis membrane which stopped 
passage of molecules as large as enzymes. 

Penicillin was not enzyme at all. This discovery immediately 
presented the possibility that penicillin, as a low-molecular-
weight compound, could be administered as a drug to animals. 
With the technique of freeze-drying, which had just become 
available, Chain was able to concentrate and preserve 
penicillin and then to prove its therapeutic efficacy.       

  Why were Chain and Florey so quickly to test their very 
crude penicillin preparations for clinical efficacy?  Their 
prompt decision was likely conditioned by the discovery in 
the mid-1930s that sulfonamides inhibit microbes and yet are 
not toxic to animals. 

Thus, an agent could selectively interrupt growth of microbes 
without affecting the animal host, and this observation gave 
Chain and Florey the confidence to test their penicillin prepa-
rations in infected mice.       

It may also explain why Fleming, ten years earlier, believing 
that only the host immune system could combat infections, 
regarded chemotherapy as implausible and so failed to test 
his crude penicillin preparations for therapeutic value. 
I choose penicillin as an example of the importance of basic 
research because its history is so recent and dramatic.   
---------------------------------------------------------------------

Arthur Kornberg: For the love of enzymes: The Odyssey of a 
Biochemist. Harvard University Press. 1991.

Any questions:  write to Keiji Hagiwara, MD
                                      keijihagiwara@gmail.com

19 February, 2009

Haemophilus influenzae(2)

Photo )  Colonies of Haemophilus influenzae on the chocolate agar plate.
                 (Dr. Mizuno, Department  of Clinical Laboratory, Yamaguchi
                  University School of Medicine)


Photo )  Electron-microscopic graph of H. influenzae.
             The shape of this bacteria is round or rods like. Green colour was
             added later, not the real colour. 
             (Dr.Dennis Kunkel, Dennis Kunkel Microscopy, Inc, Kailua, HI)


Any questions:
             write to Keiji Hagiwara, MD
             Kami-Ube Pediatric Clinic,
             1) keijihagiwara@gmail.com   2) keiji-hagiwara@umin.ac.jp
           

10 February, 2009

Haemophilus influenzae (1)


Photo )  H. influenzae are observed inside of white blood cells.
               (Dr.Rebecca Buxton, Department of Pathology, University of Utah)
Photo ) H. influenzae in the sputum .
            (Dr. Rebecca Buxton, Department of Pathology, University of Utah)

~~~~~~~~~~~~~~~~~
Haemophilus influenzae
~~~~~~~~~~~~~~~~~

This bacteria( = Pfeiffer's bacilli) once thought to be a cause of  influenza(=Flu).

i) Microscopic findings: round or lods in shape, Gram stain(-)
                                       
ii)Type: divided into non-capsular type and capsular type.
             Capsular type:  Serovar (5 types; a, b, c, d, e, f )
                  ✭ type b is predominant, especially in acute meningitis and epiglottis.

iii) Type of diseases in childhood:
                   1) common cold: no data is  available.
                   2) otitis media:  non-capsular type is common.
                   3) acute epiglottis: very few in Japan.
                   4) bronchitis & pneumonia: non-capsular type is common.
                   5) meningitis: type b is dominant in Japan.

                        is available.

Any questions:  write to Keiji Hagiwara, MD
                         E-mail: keijihagiwara@gmail.com

31 January, 2009

Adenovirus infection in child (3 year old)


Dr. Linda Stannard, Department of Medical Microbiology, University of Cape Town.
------------------------------------------------------
A case of acute tonsillitis due to adenovirus.
------------------------------------------------------

||||||| 3-year-old.
||||||| November 10th. at noon, came to Clinic.
||||||| BT:39.1 ℃. No cough & running nose.
||||||| Tonsil and pharynx were reddish.
||||||| ------- Rapid adenovirus test(+)
||||||| Rx) 1. acetaminophen suppository 200mg(3/4)
||||||| at high fever.
||||||| 11th. high fever and sore throat.
||||||| 12th. high fever.
||||||| 13th. high fever.
||||||| 14th. Morning ~ noon, no fever. raised at night 38.5℃.
||||||| 15th. no fever.


Any questions: write to Keiji Hagiwara, MD
keijihagiwara@gmail.com

Tamifu dry syrup for influenza virus type A infection in child

------- A case record of 5-year-old girl ---------
January 12th: at noon, notice the fever, cough and running nose.
came to Clinic at late evening. BT:39.5℃.
Rapid influenza Test(A+).
prescribed Tamiflu dry syrup, anti-cough drug & acetaminophen fine granules.

13th: at noon, fever up to 40.3℃.
14th; no fever.
15th; no fever.
16th; slight fever 37.6℃


Any questions: write to Keiji Hagiwara, MD
keijihagiwara@gmail.com

24 January, 2009

Tamiflu: a drug for influenza A & B virus infection

The cost of this drug is relatively high. One capsule is 31 points (=310 yen) by
public insurance price. Taking 2 capsules/day for 5 consecutive days cost
3,100 yen (patient pay 30% of it, 930 yen in drug store since 70% is covered by
insurance).

February 2001, Tamiflu (Trade name from Roche, Oseltamivir) was covered by
Public Health insurance in Japan. It is the main reason why Tamiflu are so
much prescribed in Japan.


Tamiflu capsule











Tamiflu Dry syrup for child.











~~~~~~~~~~~~~~~~~~~~~~~~~
1) Tamiflu and abnormal behavior:
~~~~~~~~~~~~~~~~~~~~~~~~~
The abnormal neurological symptoms(abnormal behavior) in children were noted
who took Tamiflu. Mass media picked up the typical case; a teenager who diagnosed
as influenza A infection by rapid antigen test and prescribed this drug by a practitioner.
After several hours taking Tamiflu, he/she jumped into the ground from the 10th's
mansion floor.

But the real causal relationship is remain obscure, since in some cases, influenza
virus infection itself cause the neurological complications, such as febrile convulsion
in infant (frequent), hallucination in children(sometimes) and acute encephalopathy
(rare) or hemorrhagic shock encephalopathy(very rare).

Before this drug was available in Japan, I also experienced the abnormal behavior
cases. For instance, 10 year old boy had high fever at morning and rest at bed.
Afternoon, he suddenly raised up the bed and rush to the outdoor. He lived in the
countryside and small river along in his house. So he run and jumped into the river.
The local doctor referred the boy to the University hospital. He was semi comatose
state at admission.The Electroencephalograph and Cerebral spinal fluid were normal.
Next morning, his consciousness returned to normal.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2) do not prescribed to one year old or younger ;
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This recommendation is based the mouse experiment by the researchers of Hoffmann
La Loche announced that there are abnormally high CSF concentration of Tamiflu
in young rats.


Any questions: write to Keiji Hagiwara, MD
keijihagiwara@gmail.com

Amantadine for influenza A virus infection





Amantadine tablets(50mg)









In 1966, Amantadine was approved By FDA for the treatment for influenza A infection 
in USA. Accidentally, the patients with Parkinson disease who took this drug improved
the tremor symptom.  thereafter also approved.  In Japan, this drug was first approved for 
the treatment for Parkinson disease and then for influenza A virus infection.


Amantadine granules(10%).
Trade name: Symmetrel fine granules











Dosage of Amantasine
-----------------------------------------------------------------------------------------
1~9 year ---------- 5mg/kg/day(max.150mg). in 1 or 2 divided doses.
10 year older (body weight 40kg> )  -------  200mg/day. 1 or 2 div.
-----------------------------------------------------------------------------------------

8-year-old boy of influenza A virus infection, treated with Symmetrel.  


Any questions:  write to Keiji Hagiwara MD.
                                      keijihagiwara@gmail.com

Relenza: inhalation drug for influenza virus A & B infection

Relenza (Trade name from GlaxoSmithKline, common name = Zanamivir hydrate) is a 
inhalation drug for influenza virus A or B infection.   Here, show a case of influenza 
virus A infection and the use of it. It seems excellent effect in this case.






inhalation drugs.











A case record of influenza A
18 year old, male
Red arrow indicate the intake of drugs.







-----------------------------------------------------------------------
Jan 19th;  started fever at night
Jan 20th;  came to Clinic.
                 Rapid test for influenza: A(+)B(-)
                 Rp) 1. Relenza 
                             inhale 2 times at morning & evening.
                 2. Anti-cough tablets  9 tab.
                                  div. 3
                 3. Acetoaminophen(200mg) 2 tab.
                                  at one time,
Jan 21th;  fever fell down.
----------------------------------------------------------------------

Any questions: write to Keiji Hagiwara, M.D.
                                          keijihagiwara@gmail.com

Measles & Rubella vaccine











Measles & Rubella combined vaccine.



of mumps virus. So, Measles-Rubella combined vaccine is used.

The schedule of MR vaccine in Japan.

1) 1st dose : 1 year or older
2) Second dose: 5~7 year old

What is Measles ? see ----- http://keiji-hagiwara.blogspot.com/2008/08/measles.html


Any questions: write to Keiji Hagiwara, MD
keijihagiwara@gmail.com

22 January, 2009

Haemophilus influenzae type-b vaccine

Haemophilus influenzae type b vaccine , Now available in Japan.
This vaccine is imported from French company"Sanofi Pasteur".

As the name implies, this bacteria (former name=Pfeiffer's bacillus)
was thought to be causative microbe of Flu(influenza) at the time
of Spanish Flu era.

1) Preventable diseases: Infections due to Haemophilus influenzae
type b , such as purulent meningitis, pneumonia and epiglottis.
2) Inactivated component vaccine.
3) Age : 2 month old and after. 3 times at 3~8 weeks interval.
4) Cost: no public expenditure. 7,500 Yen.


What is H. influenzae?
----- see 2) http://keiji-hagiwara.blogspot.com/2009/02/haemophilus-influenzae2.html


Any questions: Keiji Hagiwara, MD
Kami-Ube Pediatric Clinic
Ube 755-0097, Japan.
E-mail: keijihagiwara@gmail.com
Tel: 0836-29-1155
Fax:0836-29-1156

13 January, 2009

A cat


Photo 1)
    In August, 2007 one day, my son picked up a little cat, 
    who crying in a park, and bought to home.  
    The age was around 2~3 month old.
Photo 2)
Photo 3)


Photo 4)  On the top of kitchen. She have a good appetite
                 But dislike exercise.   
                 Accidentally ! 
                 She put into his head to the small basket.


09 January, 2009

Chrismas Camellia ( Camellia SAZANQUA )



The flowers of Christmas Camellia(= Camellia SAZANQUA) are blooming in 
my house. This plants grow in south of Japan, Taiwan, china and Indonesia.


02 January, 2009

first shrine visit of New Year(2)

--------------------------------------
First shrine visit of New Year(2)
--------------------------------------
Photo 5)
photo 6)Photo 7) Omikuji ; 
               a small paper strip in which described 
               the prediction of one's future, such as health, 
               disease, fortune, romance, human relationship, 
               business, childbirth, travel and more -------

Photo 8) Omikuji ; 
              if the prediction is bad, it's paper strip is bind 
              to the tree or board.

photo 9)

First shrine visit of the New Year(1)

-------------------------------------------------
First shrine visit of the New Year(初詣)
-------------------------------------------------

During the first~third January, we Japanese visit to 
Shrine for worship. People pray to God for their 
wishes and good future.

I am not so religious, but, Today I went to the Shrine.


Photo 1)   琴崎八幡宮
Photo 2) a line of worshiper
Photo 3) a line of worshiper
Photo 4)