Asthma Homeopathic Remedies

The Big Asthma Lie

Through the help of skilled doctors who have been able to save the lives of up to 50 000 people all over the world, this product in the form of an E-book that contains 500 pages has all the information that you need to know about if you suffer from asthma or any health issues for your or your loved ones. It is going to make sure that you know about the truth that is hidden in the media of the prescription medication of asthma that cause you to feel tired all the time, no motivation, no life and no drive at all. These medications are killing you slowly and this guide is going dispell of all the information that harming your health. After purchasing this book which comes instantly after the successful transaction, you will be able to feel a lot better, feel and look younger, increase your drive in life, get rid of plaque buildup in arteries, reverse asthma and avid any cause of early death. You can finally enjoy the life that you have been dreaming about in this guide that contains all the information that you need to know about to get your health to its peak levels. Read more...

The Big Asthma Lie Summary

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Asthma further treatment

High dose nebulised fi2-bronchodilators (usually salbutamol but terbutaline is also used), steroids, and oxygen form the foundation of the therapy of acute asthma.There is now evidence that adding nebulised ipratropium bromide to maximal doses of fi2-bronchodilators is beneficial in severe acute asthma in children. As soon as the diagnosis has been made, the child should be given nebulised fi2-bronchodilator and ipratropium. The nebuliser should be driven by oxygen (4-6 l min) in all but the mildest of cases.This can be repeated every one to two hours until there is improvement. As an alternative to nebulised treatment 10-20 puffs of a bronchodilator from a metered dose inhaler can by given (one puff at a time) through a spacer but this cannot be supplemented with oxygen. In severe or life-threatening asthma half-hourly or even continuous nebulised bronchodilator may be needed until the child's condition stabilises. Corticosteroids expedite recovery from acute asthma. Although a oral...

Ciclesonide Asthma Copd [69

Ciclesonide, a new inhaled corticosteroid (ICS), is indicated for the prophylactic treatment of persistent asthma. ICS treatment is a widely accepted standard of care for maintenance therapy of chronic asthma, and the currently available agents include fluticasone propionate, budesonide, triamcinolone acetonide, flunisolide, and beclomethasone dipropionate. These agents exert their potent anti-inflammatory effects via modulation of the glucocorticoid receptor (GR). Although ICS drugs are generally safe and well tolerated compared with oral corticosteroids, many have measurable systemic exposures, and concerns over potential side effects resulting from it severely limit the dose at which they can be administered for long-term therapy. Systemic adverse effects associated with corticosteroids include HPA axis suppression, osteoporosis, abnormal glucose metabolism, cataracts, and glaucoma, some of which could potentially occur with the long-term use of high dose ICS. The key...

Background information on asthma and bronchiolitis

Acute exacerbation of asthma is the commonest reason for a child to be admitted to hospital in this country. Admissions for acute asthma in children aged 0-4 years increased seven-fold between 1970 and 1986 and admissions for children in the 5-14 age group tripled. In the early 1990s asthma represented 10-20 of all acute medical admissions in children but rates have fallen over the last 3-5 years. There were 24 deaths from asthma in children in England and Wales in 1998 (ONS). Consultations with General Practitioners for asthma have doubled in the last 15 years. These increases reflect a real increase in the prevalence of asthma in children. Except in the young infant, there is rarely any problem in making a diagnosis of acute asthma. An inhaled foreign body, bronchiolitis, croup and acute epiglottitis should be considered as alternative diagnoses. The classic features of acute asthma are cough, wheeze and breathlessness. An increase in these symptoms and difficulty in walking,...

Asthma

A condition of hyperreactivity of the tracheobronchial tree, in which a number of exogenous and endogenous stimuli can produce reversible airway obstruction. Histamine and the leukotrienes (LT) are thought to be the most active chemical mediators, whilst acetylcholine may contribute via a disturbance in autonomic balance. As obstruction worsens, increasingly smaller airways are affected. Expiration is prolonged, residual volume and functional residual capacity are increased, whilst vital capacity, inspiratory capacity and expiratory reserve volume are reduced.Widespread ventilation perfusion inequalities may occur to produce hypoxia, at a time when the work of breathing is considerably increased. In addition to bronchospasm, the pathological changes include oedema of the bronchial mucosa, secretion of mucus, and epithelial desquamation. The leukotrienes, which are arachidonic acid derivatives, are proinflammatory agents with actions that include airway smooth muscle contraction and...

Pathways Leading To Cardiorespiratory Arrest

Childhood most cardiac arrests are secondary to hypoxia, underlying causes including birth asphyxia, inhalation of foreign body, bronchiolitis, asthma, and pneumothorax. Respiratory arrest also occurs secondary to neurological dysfunction such as that caused by some poisons or during convulsions. Raised intracranial pressure (ICP) due to head injury or acute encephalopathy eventually leads to respiratory arrest, but severe neuronal damage has already been sustained before the arrest occurs. Asthma

Management of Refractory GERD Persistent Symptoms on PPI Twice Daily

Patients with atypical supraesophageal symptoms (ie, laryngitis, hoarseness, chronic cough, asthma) should be treated for at least 4 to 6 months on high dose PPI before declaring their atypical GERD symptoms refractory to therapy. There is a chapter on extraesophageal manifestations of GERD. In patients with predominantly persistent nocturnal symptoms, bedtime H2RAs should be added in the attempt to control nocturnal acid breakthrough. Studies from our laboratory have indicated that up to 80 of patients receiving PPI twice daily before meals have at least 60 continuous minutes of overnight intragastric pH 4 (nocturnal acid breakthrough) and addition of bed-

Preoperative abnormalities

Therapy in asthma can be aimed at blocking airway reflexes, relaxing smooth muscle, inhibiting the release of inflammatory mediators, and increasing beta adrenoceptor tone.An increasing appreciation of the role of the inflammatory component led to a change of emphasis in drug therapy for long term treatment (Barnes 1989, Guidelines for the Management ofAsthma in Adults 1990, Guidelines for the Management ofAsthma 1997). Bronchodilators are primarily indicated for short term relief of bronchospasm, acute asthma attacks, and the prevention of exercise-induced asthma.The main bronchodilators are, in decreasing order of effectiveness, beta2 adrenoceptor agonists, theophylline derivatives, and anticholinergics. For the chronic state, emphasis is now placed on the early introduction of regular inhaled anti-inflammatory drugs such as corticosteroids (beclometasone dipropionate or budesonide), sodium cromoglycate, and nedocromil sodium. Since their onset of action is slow, long term therapy...

Personality and Illness

Another major focus of behavioral medicine research is the relationship between personality factors and illness. Interest in this relationship dates back at least to the ancient Greeks, who classified people into one of four basic personality types (phlegmatic, melancholic, sanguine, and choleric) these personalities were presumed to be based on imbalances in bodily fluids, or humors. Early in this century, it was believed that certain diseases, such as hypertension, heart disease, cancer, asthma, ulcerative colitis, and ulcers, were psychosomatic mainly caused by personality. As research data have accumulated, however, it has become clear that the association between personality and illness is much more complex than first believed. Current research examines the impact on health of psychological constructs such as motivation, self-mastery, and self-confidence, as well as the impact of alcohol and substance abuse. Related factors under study include socioeconomic status, gender, and...

Supplemental Reading

Guidelines for methacholine and exercise challenge testing-1999. Am J Resp Crit Care Med 2000 161 309-29. Corrao WM, Braman SS, Irwin RS. Chronic cough as the sole presenting manifestation of bronchial asthma. N Engl J Med 1979 300 633-7. El-Serag HB, Lee P, Buchner A, et al. Lansoprazole treatment of patients with chronic idiopathic laryngitis a placebo controlled trial. Am J Gastroenterol 2001 96 979-83. Fass R, Fennerty MB, Hoffman JJ, et al. The clinical and economic value of a short course of omeprazole in patients with non-cardiac chest pain. Gastroenterology 1998 115 42-9. Harding SM, Richter JE, Guzzo MR, et al. Asthma and gastro-esophageal reflux acid suppression therapy improves asthma outcome. Am J Med 1996 100 395-405. Harding SM, Sontag SJ. Asthma and gastroesophageal reflux. Am J Gastroenterol 2000 95(Suppl) S23-32. Irwin RS, Carley FJ, French CL. Difficult-to-control asthma contributing factors and outcome of a systematic protocol. Chest 1993...

Adaptation to Cancer

Another example of behavioral medicine practice comes from studies of rehabilitation of patients with chronic obstructive pulmonary disease (COPD), which is a common ailment among smokers. It is currently the fourth leading cause of death in the United States. Chronic bronchitis, emphysema, and chronic asthma are the three diseases most commonly associated with COPD. The common denominator of these disorders is expiratory flow obstruction (difficulty exhaling air) caused by airway narrowing, although the cause of airflow obstruction is different in each. Exposure to cigarette smoke is the primary risk factor for each of these illnesses. There is no cure for COPD. in tobacco use among women in the latter part of this century. Medicines such as bronchodilators, cortico-steroids, and antibiotic therapy help symptoms, and long-term oxygen therapy has been shown to be beneficial in patients with severe hypoxemia. However, it is widely recognized that these measures cannot cure COPD. Much...

Asyia AhmadMD Faullin PaletskyMD and James C ReynoldsMD

Benign esophageal strictures are believed to develop as a result of chronic inflammation causing fibrous tissue formation and collagen deposition (Spechler, 1995). It is estimated that 65 to 70 of all benign strictures are peptic in origin and a result of chronic uncontrolled gastroesophageal reflux (a full list of other etiologies of esophageal strictures is listed in Table 17-1). Strictures become clinically apparent when patients complain of progressive dysphagia to solids. Heartburn, present in 75 of patients with peptic strictures, and chronic cough, regurgitation, and asthma can also be present. Symptoms may be subtle in which the patient slowly changes their eating habits or overt with recurrent food impactions.

Penicillium Chrysogenum On

Stachybotrys Chartarum Pictures

One of the early scientific papers published regarding the effects of mold spores on humans appeared in 1873 (Blackley). Charles Blackley, who was one of the early describers of pollen skin tests, wrote about his asthmatic responses to the inhalation of Penicillium species conidia (spores) (Licorish et al., 1985). It now appears that the literature is quite clear on the importance of the inhalation of fungal spores on respiratory disease in man. The Centers for Disease Control (CDC) recently published a statement for the record for the United States House of Representatives (Redd, 2002). In it they state, ''While there remain many unresolved scientific questions, we do know that exposure to high levels of mold causes some illnesses in susceptible people. Because molds can be harmful, it is important to maintain buildings, prevent water damage and mold growth, and clean up moldy materials.'' We have spent the last decade trying to understand the above concepts. It is our humble hope...

Anaesthetic problems

Bradykinins may or may not be secreted. Their possible effects include hypotension (Marsh et al 1987), secondary to both vasodilatation and increased capillary permeability, flushing, and bronchospasm (Miller et al 1980, Qumlivan & Roberts 1994).The bradykinin effects seem to be the most life threatening.

Peroxisome proliferatoractivator receptor gamma PPARg

Peroxisome proliferator-activated receptors (PPARs) are orphan receptors belonging to the steroids thyroid retinoid receptor super family of ligand-activated transcription factors. There are three PPAR isoforms (PPARa, -p, -g), each of which is differentially expressed and displays a distinct pattern of ligand specificity 50 . PPARs are implicated in several physiological processes, such as the regulation of lipoprotein, lipid metabolism and glucose homeostasis. Recent observations indicate that PPAR activators could reduce the inflammation induced in different inflammatory pathologies including asthma, hypertensive heart disease, hepatic inflammation and cerebral ischemia 51 . In vivo, PPARg agonists have been shown to modulate inflammatory responses in the brain and to reduce infract size following transient focal ischemia 52,53 . Cerebral ischemia is frequently accompanied by inflammation, which can worsen neuronal injury 54 . Activation of PPARg reduces inflammation and the...

Management options

Ideally, moderate and severe asthmatics should be counselled in the antenatal period and a plan set out for their management in labour. The prime aim of treatment is the maintenance of oxygenation. As asthmatics often play down their symptoms, direct questioning about their exercise tolerance and their current treatment, including steroids, is required for the antenatal record. Basic techniques for analgesia and anaesthesia are as for non-asthmatic mothers, bearing the above points in mind. Bronchospasm in labour may interfere with effective self-administration of Entonox. The woman should be fully alert and in control during her labour as much as possible, and therefore able to manage her asthma treatment with her inhalers. Epidural analgesia should be generally recommended. There is no contraindication to the standard treatments for an asthmatic attack in pregnancy or labour, including the use of inhaled or systemic steroids. It is important to remember that peak flow measurements...

Approach To The Child With Wheeze

Asthma and bronchiolitis are the two common causes of lower respiratory obstruction. Almost without exception, bronchiolitis is confined to the under one year olds and asthma is much more commonly diagnosed in the over ones. It is often difficult to assess the severity of an acute exacerbation of asthma. Important points in the history include the duration of symptoms, what treatment has already been given in this episode and the response to that treatment, and the course of previous attacks. Children who have previously required intravenous therapy, and particularly those who have required admission to an intensive care unit are at high risk of life-threatening episodes. Physical signs such as wheeze and respiratory rate are poor indicators of severity. Use of accessory muscles, recession and pulse rate are better guides. Pulsus paradoxus (the difference between systolic pressure on inspiration and expiration) is no longer considered a reliable sign to assess the severity of asthma...

Immediate hypersensitivity

This type of reaction is caused by reagin antibodies, which consist mainly of lgE, that react with allergens such as housedust mite, animal dander, or grass pollens. These reactions may occur in both the skin or the lung to produce asthma. Allergic reactions to insect stings can cause severe systemic effects anaphylaxis , which literally means without protection . Food proteins can also cause an immediate type of hypersensitivity reaction. The IgE molecule is attached to specific receptors on the surface of mast cells and when activated by linkage to specific allergen inflammatory mediators are released. This is an acute process, hence the name immediate hypersensitivity .

Anaphylaxis Definition

Anaphyalxis is the term used for hypersensitivity reactions that are typically mediated by immunoglobulin E (IgE). Anaphylactoid reactions are similar but do not depend on hypersensitivity. The initial management of both types of reaction is the same and therefore the term anaphyalxis will be used throughout this section (Joint Council of Allergy, Asthma and Immunology 1998)

Changes In Disease Notification

When investigating time trends of disease it is important to remember about the change in disease notification which may occur between ICD revisions. This impacts on how you retrieve data from national statistics. As mentioned in Chapter 4, most publishers of national statistics incorporate a correction factor to apply to the current data set. Another factor which should be considered is changes which are due to diagnostic fashion. For example, national statistics in the UK show that the incidence of asthma is increasing. However, it is not clear whether this is due to a true change in the incidence rate or to a change in the willingness to diagnose the disease.

Progress in the Development of Inhaled Long Acting P2Adrenoceptor Agonists

Long acting -adrenoceptor agonists are a highly precedented drug class used for the treatment of asthma and chronic obstructive pulmonary disease (COPD) 1,2 . There are currently two marketed long acting -adrenoceptor agonists, salmeterol 1 3 , and formoterol 2 4,5 , neither of which provides a once daily dosing regimen. Therefore, an opportunity may exist for a once daily agent both as a mono-therapy and as part of combination products, particularly with steroidal or muscarinic ligands. This review is not intended to cover the current state of potential combination therapies however, the final section of this review deals with an alternative paradigm of incorporating a second pharmacology within the same molecule as b2-adrenoceptor agonism. This concept is referred to as dual pharmacology 6 . Asthma is a chronic inflammatory disorder of the airways causing recurrent episodes of wheezing, breathlessness, chest tightness, and coughing 7 . These symptoms often occur at night or in the...

Mapping Differences In Rates

There are numerous examples of mapping in which the main purpose was to compare rates of disease between communities some of these were reviewed in Chapter 1 and all the atlases which have been published obviously fall into this category.6-11 Figure 7.3 shows the distribution of standardized mortality ratios for bronchitis, emphysema and asthma in Scotland between 1979 and 1983. It shows quite clearly that the highest mortality was found in the industrialized central belt of Scotland. The strength of this finding was somewhat surprising as it represented deaths 10 years after the passage of the second of the UK's Clean Air Acts. Figure 7.3. SMRs for bronchitis, emphysema and asthma in Scotland between 1979 and 1983. Redrawn from Williams et al. (1987)20 Figure 7.3. SMRs for bronchitis, emphysema and asthma in Scotland between 1979 and 1983. Redrawn from Williams et al. (1987)20

State Based Model for Management of Type II Diabetes

The Decision Systems Group at the Brigham & Women's Hospital, Boston, USA and the Clinical Knowledge Management Group at Partners HealthCare Systems, Inc. have developed a computational model that encompasses strategies for prevention, early diagnosis, and treatment of type II diabetes and associated complications. This effort is part of an on-going, enterprise-wide strategy to improve the quality, safety, and efficiency of provided care, by maximizing the use of new clinical information technology in key issues such as complex clinical workflows, usability, controlled terminology, knowledge management, and clinical decision support carried out by Partners HealthCare System. The proposed model is a disease state management system for the continuum of diabetes care that synergistically integrates patient care and education protocols at all levels of disease management, and supports the integration of evidence-based personalized care. Our approach could be easily adapted to...

Lselectintargeted therapies

Mal models of disease, few of these successes have translated to humans. Recently, pan-selectin antagonists have received attention for their ability to reduce leukocyte infiltration to diseased tissues by competing with selectins for ligand binding. Specifically, bimosiamose, developed by Kogan et al., a low molecular weight nonoligosac-charide selectin inhibitor, prevents P-, E-, and L-selectin-mediated adhesion in vitro 262, 263 . Additional in vivo studies suggest that bimosiamose does not inhibit leukocyte rolling but functions primarily by blocking E-selectin-mediated adhesion 264 . Recent limited clinical trials using bimosiamose have shown some promise. Specifically, patients with mild allergic asthma treated with inhaled bimosiamose had a 50 reduction in late asthmatic reactions following allergen challenge 265 . Similarly, psoriatic patients treated with bimosiamose, demonstrated reductions in epidermal thickness and lymphocyte infiltration 266 . In addition to pan-selectin...

Secondary Assessment And Emergency Treatment

The secondary assessment takes place once vital functions have been assessed and the initial treatment of life threat to those vital functions has been started. It includes a medical history, a clinical examination and specific investigations. It differs from a standard medical history and examination in that it is designed to establish which emergency treatments might benefit the child. Time is limited and a focused approach is essential. At the end of secondary assessment, the practitioner should have a better understanding of the illness affecting the child and may have formulated a differential diagnosis. Emergency treatments will be appropriate at this stage - either to treat specific conditions (such as asthma) or processes (such as raised intracranial pressure). The establishment of a definite diagnosis is part of definitive care. Some children will present with an acute exacerbation of a known condition such as asthma or epilepsy. Such information is helpful in focusing...

Chronic Obstructive Pulmonary Diseases

Chronic obstructive pulmonary disease (COPD) refers to any disorder in which there is a long-term obstruction of airflow and a substantial reduction in pulmonary ventilation. The major COPDs are asthma, chronic bronchitis, and emphysema. In asthma, an allergen triggers the release of

Im worried that my daughter who is 40 will get osteoporosis How can she prevent this from happening to her

If your daughter is 40 and also has asthma or one of the autoimmune disorders that require treatment with steroids, she needs to be aware that steroids can cause significant bone loss. She should consult her clinician about taking a medication that will help her maintain her bone density.

Evidence that it works

Collaborative self care has been used to guide efforts to improve the quality of chronic illness care in many different healthcare settings and for many different chronic conditions including diabetes, heart failure, geriatric care, depression, and asthma. This approach gives patients the confidence and skills for self care and for getting what they need from the healthcare system (that is, becoming active, informed patients). Such effective support of patients is more likely to occur when the providers of care themselves have the information, training, resources, and time to deliver effective interventions (that is, are a well prepared, proactive practice team).

Endoscopic Therapy

In practice, 15 to 20 ofpatients will have either a relative or an absolute contraindication to therapy with a p-blocker, such as severe bradycardia, second or third degree atriovenous block, asthma, or congestive heart failure. In these patients, and in those who do not tolerate therapy with p-blockers, an alternative first line therapy for the prevention of variceal bleeding is endoscopic variceal band ligation (EVL). Studies have failed to show a consistent difference when comparing treatment with a p-blocker to EVL with regard to the prevention of variceal bleeding or mortality. Complications of EVL include superficial ulcers, transient retrosternal chest discomfort, dysphagia, and, rarely, distal esophageal stricture. In the past, endoscopic sclerotherapy was also used, as it too reduces both rebleeding and death, but due to the significant morbidity and mortality associated with endoscopic sclerotherapy, as well as a higher efficacy rate for EVL, endoscopic sclerotherapy is now...

The Berberry botanical family Berberidaceae

Containing this alkaloid were widely used in Japanese folk medicine for the treatment of whooping cough, asthma, pharynx tumours, uterine bleeding and diabetes. Berbamine was extracted from Berberis poiretil Echneid, a plant which grows in China163. This alkaloid shows actions of anti-arhythmia, anti-myocardial ischemia and antithrombosis.

Early DP antagonists and their related analogs

BW A868C (2) is one of the early DP antagonists reported in the literature. It binds the DP receptor with a Kd value of 1.45 nM (Kd was determined using human platelets) 28 . S-5751 (3) was the first DP antagonist reported to be under evaluation in clinical trials for rhinitis and asthma 29 . S-5751 demonstrated binding IC50 value of 1.9 nM in 3H -PGD2 binding assays using human platelet membranes. It also inhibited PGD2-induced cAMP formation in human platelets with an IC50 of 0.9 nM 30 . Several other DP antagonists, structurally similar to 3, were described in the literature. Compound 4 had a binding IC50 value of 130 nM and an IC50 value of 70 nM in a functional assay 31 .

Information on Potential Exposure to Environmental Agents

Information on exposures to environmental agents can be used in evaluating the risk to health represented by noninfectious diseases, injuries, and certain infectious diseases. For example, measurement of airborne particulates is useful in assessing risks related to certain pulmonary disorders (e.g., asthma and lung cancer). Information on vectors that may carry agents of infectious disease (e.g., ticks as vectors for Lyme disease and Rocky Mountain spotted fever, mosquitoes as vectors for viral encephalitides, and raccoons as vectors for rabies) is important in evaluating the risk of infection. Information on exposures to known risks supports the development and implementation of rational public health interventions (e.g., ATSDR's Hazardous Substances Emergency Events Surveillance System provides information on the public health consequences associated with the release of hazardous substances) (CDC 1994e). In addition, information on exposures provides the basis for issuing alerts to...

Are the Symptoms Truly Caused by ADHD

Such stressors, especially when more than one is present, may be the primary cause of the child's apparent ADHD impairments, or they may simply be exacerbating ADHD impairments that have been present since birth. The incidence of unemployment, marital conflict, substance abuse, and frequent changes of residence is elevated among individuals with ADHD. The presence of environmental stressors, even if they are many and severe, does not rule out a diagnosis of ADHD any more than such stressors would rule out a diagnosis of asthma.

Reports of Health Events

System were used by states to institute intervention programs for occupational asthma. As a result, investigations of workplaces where occupational asthma cases have occurred have identified substantial numbers of symptomatic coworkers and inadequacies in engineering controls and work practices. These findings have led to preventive measures by the Office for Safety and Health Administration, health departments, and employers (Reilly et al. 1994). The National Nosocomial Infections Surveillance System receives reports from a selected group of hospitals on the incidence and characteristics of hospital-acquired infections data from this system have been instrumental in alerting health authorities to the emergence of antibiotic-resistant strains of bacteria, which in turn has led to the development of specific recommendations regarding use of antibiotics (CDC 1996d).

Genetically complex disorders

In atopic eczema, matters are equally complicated. Environmental factors may well be responsible for the recent rise in its prevalence as the gene pool within the population is not likely to have changed greatly, but a genetic component is obvious too, even though affected children can be born to clinically normal parents. Within each family, atopic disorders tend to run true to type, so that, in some, most affected members will have eczema, in others, respiratory allergy predominates. The inheritance of atopic eczema probably involves genes that predispose to the state of atopy, and others that determine whether it is asthma, eczema, or hay fever that develops. One plausible gene for the inheritance of atopy encodes for the p subunit of the high affinity IgE receptor, and lies on chromosome 11q13. However several groups have failed to confirm earlier reports of this linkage, and a gene linked to atopic eczema has recently been found on chromosome 3q21.

Differential Diagnosis

Lactose intolerance is the most common form of food intolerance worldwide and may coexist with other GI conditions as well as food allergy. A complete medical history is often helpful because most patients with a history of food allergy have a family history of atopy, and may have a personal history of other allergic conditions, such as asthma and dermatitis. A history of latex allergy should alert the practitioner to the large number of fruits that can cross-react with latex. Similarly, the oral allergy syndrome occurs in response to inhalant plant allergens, but cross-reactivity with fruit, nut, and certain vegetable antigens is common. Finally, it is well recognized that exercise and medications such as aspirin may act as cofactors in allergic reactions to various types of antigens.

Skin Anomalies Pathological Noninfective

Classically this condition is the end-result of intense, chronic pruritus that results from repetitive rubbing or scratching. The skin responds by thickening and the increase in skin markings is referred to as lichenification. This occurs mostly in individuals with a history of allergies, eczema, hay fever or asthma. They have sensitive and easily irritated skin.

Correlation Between Levels of Correctly Spliced RNA and Disease Severity

The level of correctly spliced transcripts in patients with mild disease varies with a large range of 4-50 , whereas severe disease is caused by lower levels of correct transcripts (0-3 ). Some carriers of CFTR mutations (which probably have high level of correct transcripts, of over 50 ) may have increased susceptibility to certain pulmonary diseases, such as asthma.

Review of Key Concepts

Resistance also varies with the diameter of the airway. Bronchoconstriction increases resistance and reduces airflow bronchodilation increases airflow. Asthma and anaphylaxis can cause fatal bronchoconstriction. 3. The chronic obstructive pulmonary diseases (COPDs) are asthma, chronic bronchitis, and emphysema. Asthma is an allergic disease while the others are usually caused by tobacco smoke. Chronic bronchitis entails congestion of the airway with thick mucus, and susceptibility to respiratory infection. Emphysema entails destruction of

Should Everyone Be Tested

CFTR gene into cultures of cells derived from a CF patient in which the gene was crippled and correct the defect in ion transport. Of course there is a huge difference between fixing cells in a test tube and treating humans, but hope is high. There are more than a dozen research projects under way in which the goal is to develop techniques to get normal CF genes into the lung tissue of affected children. Most focus on using relatively benign viruses that are known to penetrate human lung cells as bio-missiles to carry a payload of normal CFTR genes to the target organ. Some progress has been made. A decade from now there may well be an easy way to treat the disease, quite possibly with a gene inhaler, a DNA spray that works much like the little pumps that persons with asthma use to deliver preset doses of medicine to their airways. But the discovery of the gene has also created sometimes vitriolic debate about genetic testing.

Post Hypoxic Myoclonus in Rodents

Myoclonus is a medical term used to describe brief, very rapid, sudden, shock-like involuntary jerking movements that involve small muscles or the whole body (Fahn, 1986). Myoclonus is manifested in a wide variety of neuropatho-logical conditions affecting the central nervous system. Myoclonus can be classified based on anatomic distribution, pattern of contractions, pathophysiology, or etiology. One of the most disabling forms of myoclonus is known as post-hypoxic myoclonus, which is caused by brain damage resulting from a prolonged oxygen deprivation during cardiac arrest or anesthesia accidents during surgical operations. In addition, asthmatic attacks, airway obstruction, and drug intoxication can also trigger post-hypoxic myoclonus.

Ian P Hall Amanda P Wheatley and Jane C Dewar 1 Introduction

Both the P2- and P3-adrenergic receptors (P2-AR and P3-AR) are known to be polymorphic, and disease-related associations have been described for polymorphisms in both receptors. Therefore, the arginine-glycine 16 (Arg-Gly 16) variant of the P2-AR has been associated with nocturnal falls in FEV1 (forced expiratory volume in 1 s) in asthmatic subjects and with bronchodilator subsensitivity (1-4). The glutamine-glutamate 27 (Gln-Glu 27) P2-AR polymorphism was shown to be associated with reduced IgE levels in one study of asthmatic families (5), although in random populations this effect was not observed (6). Both these polymorphisms have functional effects. The glycine 16 variant produces increased receptor downregulation following agonist stimulation in both transformed and nontransformed cell systems, whereas the glutamate 27 variant reduces agonist-induced receptor downregulation (7,8). Two other rarer P2-AR variants have been identified at codon 34 (valine-methionine) and at codon...

Approach to Patients Complaining of ARF

Evaluation of food allergies have recently been published as a medical position statement by the American Gastroenterological Association (Sampson et al, 2001). It is essential to obtain a careful history correlating symptoms with specific foods. Most immediate hypersensitivity reactions to food include a set of symptoms that consistently occur minutes to hours after ingesting certain foods. In some individuals, other factors, such as medications or exercise, may modulate the reaction to a specific food. Specificity of the reaction does not always imply a food allergy because patients with anaphylactoid reactions or lactose intolerance report defined reactions to specific foods. However, the nature of the reaction will help differentiate lactose intolerance (gas, bloating, diarrhea) from an allergy to cow's milk protein (often urticaria, swelling of the lips and oral mucosa, and or asthmatic symptoms occur in addition to GI symptoms).

Materials And Methods

A total of 4865 patients with arsenical dermatosis (ASD) were thoroughly examined for clinical features in 300 rural areas. The field survey was initiated in 1983. It included clinical investigation, collection of tube well water samples, nails, hairs and skin scales of patients. The cases of mild complications, such as asthmatic bronchitis, received treatment in the field. However, serious cases with complications, such as ascetic jaundice, were admitted to the hospital of the Calcutta School of Tropical Medicine (CSTM), India, between 1983 and 1987 (Saha, 1984 Saha, 1995). After 1994 a collaborative study was done with the School of Environmental Studies (SOES) of Jadavpur University. In this institution arsenic content has been measured by flow injection hydride generation, atomic absorption spectrometry (FIHGAAS) (Samanta et al., 1994). Even after working for 17 years, we feel we have only seen the tip of the ice-berg.

Caesarean section under general anaesthesia

NSAIDs are contraindicated in women with severe pre-eclampsia because of their effect on platelet function and should also be used with caution in asthmatics. The potentially adverse effect of NSAIDs on renal function should be considered in women who are hypovolaemic and in those who have compromised renal function.

Critical illness myopathy

Classic weakness of limb and sometimes respiratory muscles develops in patients following use of high dose intravenous glucocorticoids as well as neuromuscular blocking agents, aminoglycosides, or other combinations of steroids, neuromuscular blockers and antibiotics. This disorder may develop within days of treatment with high dose methylprednisone for a severe asthmatic attack, or may follow admission to the intensive care unit after surgery requiring a general anesthetic. Critical illness myopathy may also develop in some patients who have become septic or malnourished, and may not be related to use of steroids or neuromuscular blocking agents. Recovery if it occurs usually happens within days to months after removal of the offending drug.

Anaphylactic Reactions

Because it is often difficult to prevent accidental exposure to food antigens, patients with a history of an anaphylac-tic reaction should be instructed to carry an epinephrine-containing syringe for emergency administration. As reactions may be biphasic in nature, patients must be instructed to go to a local emergency facility even after control of the initial symptoms. Individuals who are at increased risk of anaphylaxis include those with a past history of anaphylaxis, those with reactions with respiratory symptoms, those with episodes due the ingestion of peanuts, tree nuts, fish or seafood, and those taking p-blockers or angiotensin converting enzyme inhibitor therapy. Antihistamines, ketotifen, oral cromolyn, leukotriene antagonists and corticosteroids may modify symptoms to food allergens but apart from first generation histamine receptor antagonists, their efficacy in food allergic conditions is largely unproven. Realizing that there are limited studies available from which to...

Regulation of stimulation

Many alkaloids are generally known to have stimulating properties, such as caffeine, cathine, theobromine and theophylline. These alkaloids are considered in many different medical applications. Theophylline also has similar possible clinical applications. This alkaloid has a high level of purines, and because of this it can act as a relaxant. It has also been used in the prevention of bronchospasms.

Poisoning Emergency Treatment Drug elimination

Activated charcoal has a surface area of 1000 m g and is capable of binding a number of poisonous substances without being systemically absorbed. It is now widely used in cases of poisoning. However, there are some substances which it will not absorb. These include alcohol and iron. Repeated doses of activated charcoal are useful in some types of poisoning because they promote drug reabsorption from the circulation back into the bowel and interrupt enterohepatic cycling. These types include aspirin, barbiturates, and theophylline.

The Coffee botanical family Rubiaceae

Madder) botanical family (Rubiaceae Juss.) (Table 15) consists of more than 400 genera and over 6000 species. It grows in the tropics and the sub-tropics. Plants belonging to this family include trees, bushes and liane. The Coffee plant family contains two major purines of adenine- guanine-derived alkaloids, the so-called purine alkaloids . Purine is a nitrogenous base of nucleotide, which consists of just purine and pentose sugar (D-ribose or 2 deoxy-D-ribose). Typical purine alkaloids are caffeine, theophylline and theo-bromine. The same or similar purine alkaloids occur also in other plant families,

Preoperative Cardiac and Pulmonary Evaluation

Pulmonary evaluation in patients with chronic obstructive pulmonary disease includes chest x-ray, spirometry and baseline arterial blood gases. Patients with significant pulmonary insufficiency such as an FEV1 50 , may benefit from preoperative bronchodilator therapy, or a short course of steroids prior to surgery.

Bronchiolitis emergency treatment

As there is no specific treatment for bronchiolitis, management is supportive. Humidified oxygen is delivered into a headbox at a rate that will maintain Sao2 above 92 , and intravenous or nasogastric fluids are commenced if required. Pulse oximetry is helpful in assessing the severity of hypoxemia. Because of the risk of apnoea, small infants and those with severe disease should be attached to oxygen saturation and respiratory monitors. Antibiotics, bronchodilators and steroids are of no value. The precise role of the nebulised antiviral agent ribavirin is unclear and its use should be reserved for children with pre-existing lung disease, those with impaired immunity and infants with congenital heart disease. Mechanical ventilation is required in 2 of infants admitted to hospital, either because of recurrent apnoea, exhaustion, or hypercapnia and hypoxaemia secondary to severe small airways obstruction. All intubated infants must have continuous Sao2 and CO2 monitoring....

Application of Chinese Medicinal Herbs

Contraindication to the symptoms Contraindication to the symptoms refers to the use of an herb for diseases or symptoms inappropriate to the indications of the herb. For example, Herba Ephedrae (Ma Huang) has the function of inducing diaphoresis and relieving asthma. Its indications include invasion of Wind-Cold, exterior and excess symptoms, and cough due to obstruction of the Lung-Qi. Thus, for patients with spontaneous sweating due to Qi deficiency or cough due to the Lung deficiency, Herba Ephedrae (Ma Huang) is prohibited.

Pollen Food Allergy Syndrome

The oral allergy syndrome or pollen-food allergy syndrome results from various plant proteins that cross-react with certain inhalant antigens, particularly birch, ragweed, and mug-wort (Sloane and Sheffer, 2001). Exposure to the cross-reacting foods may lead to pruritis, tingling and or swelling of the tongue, lips, palate, or oropharynx, and, occasionally, to bronchospasm or more systemic reactions. Foods that cross-react with birch include raw potatoes, carrots, celery, apples, pears, hazelnuts, and kiwi. Those individuals that are allergic to ragweed may react to fresh melons and to bananas. It is important to educate patients with inhalant allergies about potential cross-reacting foods.

Reduction Of Dpdt And Treatment Of Hypertension

Esmolol is an ultra-short-acting beta blocker, and because the infusion can be abruptly discontinued if necessary, it is especially useful in patients starting with relatively normal blood pressures in whom one still wants to achieve a reduction in dp dt. Esmolol may also be preferable when there is uncertainly about the safety and tolerance of beta blockers, such as in patients with a history of obstructive pulmonary disease who may be at risk for bronchospasm. However, esmolol is not a very potent beta blocker, so once the safety of therapy has been established, it may be preferable to switch over to a more effective but cardioselective beta blocker, such as intravenous metoprolol. Esmolol is administered as a 0.5 mg kg intravenous bolus followed by continuous infusion at 50 g kg min and titrated up to 200 g kg min. When contraindications exist to the use of beta blockers (e.g., sinus bradycardia, atrioventricular block, congestive heart failure, or bronchospasm), one should...

Regulation of schizonticide activity

The alkaloids ephedrine, ergotamine, ergometrine and yohimbine are used in many forms. Products like Dorex or Endrine contain ephedrine as their major component. They are used for many purposes, including treating nasal cold symptoms or in bronchial asthma. More than 25 different drugs containing ephedrine have been developed today. Stimulant drugs are often based on caffeine, cathine, theobromine and theophylline. Caffeine is a component of more than 300 different drugs. It is also a minor component in many other pharmaceuticals. Analgen or Panax are examples of caffeine-based drugs. Cathine is found in drugs such as Amorphan or Recatol. They have an anorectic influence of the liver. More than 25 different drugs have been developed from theobromine, for example Atrofed and Seominal. These drugs serve many clinical purposes including treating asthma and Angina pectoris. Moreover, 200 different drugs have been developed from theophylline. Theochron and Euphyllin are examples....

Cladosporium Herbarum Nasal Problems Mexico

September 20) but also during the time of year Alternaria spore counts are high (July through October) (Reed, 1985). Cladosporium herbarum has been shown to be a potential cause of allergic asthma and rhinitis (Malling, 1990). Cladosporium, Alternaria, Penicillium, Aspergillus, and Mucor were reported to be the commonest allergenic fungi (Furuuchi and Baba, 1986 Malling et al., 1985). Cladosporium is believed to be the most common one causing mold allergy (Malling et al., 1985). However, the most prevalent airborne fungi are not necessarily the most potent allergens, at least as determined by prick testing (Terracina and Rogers, 1982). Spores of Alternaria alternata and those of the closely related genera Stemphylium and Ulocladium are considered to be the most important mold allergens in the United States (Hoffman, 1984 O'Hollaren et al., 1991 Reed, 1985). Penicillium exposure was a risk factor for asthma, while Aspergillus exposure was a risk factor for atopy (a genetic trait of...

Andreas Vesalius On The Fabric Of The Human Body

Vesalius With Cadaver

The patronage of a king, pope, or wealthy nobleman might allow a scientist to continue his research, but such patrons were often difficult and demanding patients. Charles V suffered from gout, asthma, and a variety of vague complaints exacerbated by his predilection for quack remedies. Moreover, kings often loaned their physicians to other royal courts. Thus, when Henry II of France was injured while jousting, Vesalius and the French surgeon Ambroise Pare were among the medical consultants. Using the heads of four recently decapitated criminals, Pare and Vesalius carried out experiments to ascertain the nature of the injuries. They correctly predicted that the wound would be fatal. According to a doubtful, but persistent tradition, Vesalius went on a pilgrimage to the Holy Land to extricate himself from the Emperor's service, or as a penance for initiating a premature autopsy. Vesalius may have used the excuse of a pilgrimage to explore the possibility of returning to a professorship...

Anaphylactoid or Pseudoallergic

Anaphylactoid or pseudoallergic reactions to food result from foods that mimic the effects of mast cell degranulation but do not involve IgE antibodies. Strawberries and shellfish may cause this type of ARF. Certain food ingredients, including additives such as salicylates, benzoates, and tartrazine, induce pseudoallergic reactions. As with true food allergy, patients exhibiting such reactions should be instructed to avoid the offending food substance if identifiable. Pharmacological reactions to food or food additives represent a relatively common type of ARF, although most of these reactions cause symptoms outside of the GI tract. Histamine found in certain cheeses or in scrombroid fish, such as tuna, can cause headaches and diffuse erythema of the skin. Certain individuals develop migraine headaches to various foodstuffs, including those rich in amines. Sulfites, tartrazine and monosodium glutamate (MSG) have all been associated with asthma, and MSG can cause a characteristic...

Focal Biliary Fibrosis Cirrhosis

Many gastroenterologists will also think about going on to secondary prevention of bleeding varices with nonselective p-blockers, such as propranolol, to decrease splanchnic pressure and cardiac output (Shashidhar et al, 1999). The respirologist caring for the patient needs to be consulted before starting this therapy to ensure it will not interfere with other therapy, such as the use of bronchodilators for lung disease. Some centers would avoid the use of p-blockers except in those cases where bleeding cannot be controlled by banding, such as patients with gastric varices or portal hypertensive gastropathy. Should the drug need to be stopped at some point, the risk for rebleeding appears to return to baseline risk. Primary prevention of variceal bleeding in CF has not been well studied. Gastorenterologists who consider either p-blockers or banding must take into account the severity of the pulmonary disease, other medications the patient may be on, and the risk for general...

Drug Lore And Dietetics

The use of tea illustrates the overlap between foods and drugs. For about six thousand years, the Chinese have been making a beverage from the leaves of the tea shrub. Tea contains small amounts of nutrients, but it is rich in physiologically active alkaloids, including caffeine, theobromine, and theophylline. Perhaps the most important health aspect of tea drinking in the ancient world, and in many regions of the world even today, was the use of vigorously boiling water. In general, the boundary between medical prescriptions and dietary prescriptions was not as sharply defined in many ancient traditional systems as it is in modern Western medicine. Yet, modern medicine is once again focusing on the role of diet as an aid to good health, disease prevention, and longevity. The three classes of drugs vegetable, animal, and mineral were said to correspond to heaven, man, and earth. Animal organs were highly regarded as sources of remarkable ''vital principles,'' such as tiger liver for...

Mast Cells in Acne Inflammation

Human Inflammation Cells Pcr

Increasing attention has been directed towards interactions between components of the nervous system and multiple target cells of the immune system. Communication between nerves and MCs is a prototypic demonstration of such neuroimmune interactions. Several studies have demonstrated that MCs are often found in close contact with nerves and that there may be a functional interaction between mast cells and the nervous system 28 . In addition, recent evidence suggests that SP is an important mediator in intimate nerve-mast cell cross talk 29 . When organ-cultured normal facial skins were exposed to SP uniformly degranulated MCs adjacent the sebaceous glands were observed at the electron microscopic level. Venules around the sebaceous glands of specimens stimulated with SP showed expression of ELAM-1 on the endo-thelia after subsequent culture. Furthermore, preincuba-tion of explants with the SP analogue or with cromolyn sodium, one of the MC inhibitors, abrogated the ability of SP to...

Hypokalemia Diagnostic Approach

Approach Hypokalemia

That, during some conditions (eg, ketoaci-dosis), transcellular shifts and potassium depletion exist simultaneously. Spurious hypokalemia results when blood specimens from leukemia patients are allowed to stand at room temperature this results in leukocyte uptake of potassium from serum and artifactual hypokalemia. Patients with spurious hypokalemia do not have clinical manifestations of hypo-kalemia, as their in vivo serum potassium values are normal. Theophylline poisoning prevents cAMP breakdown (see Fig. 3-3). Barium poisoning from the ingestion of soluble barium salts results in severe hypokalemia by blocking channels for exit of potassium from cells. Episodes of hypokalemic periodic paralysis can be precipitated by rest after exercise, carbohydrate meal, stress, or administration of insulin. Hypokalemic periodic paralysis can be inherited as an autosomal-dominant disease or acquired by patients with thyrotoxicosis, especially Chinese males. Therapy of megaloblastic anemia is...

GERD and Airway Disease

Airway manifestations of GERD are now recognized as a significant component of the disease spectrum. Patients with pulmonary or laryngeal disease caused or exacerbated by GERD are much more likely to respond to surgical than medical therapy. Confirming a link between GERD and airway symptoms, such as coughing, sore throat, hoarseness, and asthma with diagnostic testing, however, is difficult. Thus, these patients, as a group, have the highest chance of improvement, and at the same time failure, with surgical therapy. Successful intervention is most likely dependent on picking those patients in whom reflux is the culprit. One problem is that the exact mechanism by which reflux causes respiratory symptoms is unclear and is likely due to several different mechanisms. Aspiration is one obvious and likely common mechanism of airway injury. Vagal nerve stimulation may induce bronchospasm or potentiate the bronchomotor response to other triggers. Although acidic refluxate likely plays a role...

Hypokalemia Treatment

Hypokalemic Treatment

Treatment of hypokalemia estimation of potassium deficit. In the absence of stimuli that alter intracellular-extracellular potassium distribution, a decrease in the serum potassium concentration from 3.5 to 3.0 mEq L corresponds to a 5 reduction ( 175 mEq) in total body potassium stores. A decline from 3.0 to 2.0 mEq L signifies an additional 200 to 400-mEq deficit. Factors such as the rapidity of the fall in serum potassium and the presence or absence of symptoms dictate the aggressiveness of replacement therapy. In general, hypokalemia due to intracellular shifts can be managed by treating the underlying condition (hyperinsulinemia, theophylline intoxication). Hypokalemic periodic paralysis and hypokalemia associated with myocardial infarction (secondary to endogenous -adrenergic agonist release) are best managed by potassium supplementation 19 .

Pharmacologic Management

There should be no peritoneal signs, blood pressures must be 90 60 mm Hg, and pulse 60 beats min. Contraindications to neostigmine use include recent use of p-blockers, bradycardia, hypotension, acidosis, recent myocardial infarction, renal failure, acute bronchospasm, and signs of bowel perforation. Mechanical obstruction must first be excluded by a Gastrografin study. Atropine must be available. Neostigmine is given intravenously at a dose of 2.5 mg in 100 mL saline infused over 5 minutes with electrocardiographic monitoring in the ICU. Neostigmine is effective and rapid decompression can be expected after a single dose. Median time to clinical response varies from 4 to 30 minutes as measured by time to pass flatus or stool. An abdominal film is obtained in 60 minutes to assess radiographic response. A second dose may be required and should be given 3 hours following the first dose. Side effects include postural hypotension, symptomatic bradycardia requiring atropine, abdominal...

Blood Pressure Management

For patients with massive cerebral infarction, induced hypertension is relatively contraindicated, as this may exacerbate cerebral edema. However, the clinician must also be wary of reducing the blood pressure too aggressively, as relative hypotension may induce a reflexive increase in the CBF by cerebral vasodilation and thereby exacerbate cerebral edema. Multiple intravenous antihypertensive agents are available for use, the most common being beta-blockers, calcium channel blockers, and nitrates. Labetolol is typically well tolerated, and may be protective against cardiac ischemia. However, it may also exacerbate asthma COPD and may be ineffective in treating refractory, severe hypertension. Nicardipine is a recommended alternative it is a potent vasodilator that is well tolerated, but more costly. It does have negative inotropic effects and may cause left ventricular dysfunction. Nitroprusside should be used with great caution, as it can cause cerebral vasodila-tion and impair...

Latex Food Allergy Syndrome

Latex-food allergy syndrome, also referred to as the latex-fruit syndrome, is a specific form of food allergy in which food antigens cross-react with various latex antigens (Blanco, 2003). Natural rubber latex contains over 200 proteins, 10 of which bind IgE Hevea brasiliensis latex protein allergens (HEV b 1 to 10) and cross-react with a variety of food antigens including kiwi (HEV b 5), potato and tomato (HEV b 7), and avocado, chestnut, and banana (HEV b 6). In latex-sensitive individuals exposure to these foods can result in the same symptoms as if exposed to latex ranging from pruritis, eczema, oral-facial swelling, asthma, GI complaints, and anaphylaxis. A large number of studies from around the world indicate that the natural rubber latex allergy is increasing in prevalence and that the frequency of associated food allergy varies from 21 to 58 (Blanco, 2003). Worldwide, banana, avocado, chestnut and kiwi are the most common causes of food-induced symptoms associated with latex...

Diagnosis Of Essential Tremor

Time, along with family history information should be collected. Caffeine, cigarettes, and several medications, including lithium, prednisone, thyroxine, asthma inhalers, valproate, and selective serotonin re-uptake inhibitors, can exacerbate enhanced physiological tremor, which can resemble ET. Therefore, a complete inventory of all current medications (including inhalers), as well as caffeine and smoking habits, is important in order to exclude these as the cause of tremor or as contributors to tremor. Patients with tremor may also have disorders other than ET. These patients may have symptoms of these disorders at presentation. Thus, patients with hyperthyroidism may complain of diarrhea, weight loss, and heat intolerance and patients with PD may note a loss of normal facial expression, a change in normal arm swing, and slowness or stiffness, and patients with dystonia may notice pain or spasms in affected limbs.

Table 1 Relative Contraindications to Outpatient Surgery

Procedures with an anticipated significant blood loss Procedures associated with significant postoperative pain Procedures necessitating extended postoperative I.V. therapy ASA class IV (or III if the systemic disease is not under control, as with unstable angina, asthma, diabetes mellitus, and morbid obesity) Known coagulation problems, including the use of anticoagulants Inadequate abillity or understanding on the part of caretakers with respect to requirements for postoperative care

Churg Strauss syndrome

A syndrome of asthma, allergic rhinitis, pulmonary and systemic small-vessel vasculitis and extravascular granulomas. Reid et al (1999) reported organ systems involvement as follows lungs (48 ), heart (44 ), kidney (48 ), nervous system (78 ),skin (48 ),bowel (30 ), joints (57 ), and muscle (57 ).The presence of severe gastrointestinal disease or myocardial involvement is associated with a poor prognosis (Guillevin et al 1999). It has sometimes been associated with the new leukotriene antagonists used for asthma. However, it is thought that the disease is unmasked when these drugs replace corticosteroids for treatment, rather than being the cause of it (Churg & Churg 1998, Stirling & Chung 1999).

Pulmonary Pathophysiology

Asthma And Fibrosis

3.8.3 Asthma Asthma is a chronic disease which affects 5 million children in the United States. In asthma, the airways become overreactive with increased mucus production, swelling, and muscle contraction. Because of the decreased size of the bronchi and bronchioles, flow of air is restricted and both inspiration and expiration become more difficult. Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease of the lung and airways. COPD can include asthma, chronic bronchitis, chronic emphysema, or some combination of these conditions. The disease is characterized by a gradual loss of lung function. The most significant risk factor for COPD is cigarette smoking. Other documented causes of COPD include occupational dusts and chemicals. Genetic factors can also play a significant role in some forms of this disease. Figure 3.12 shows the volume versus time curve for a normal lung compared to that for a patient with fibrosis, asthma, and emphysema. In the patients with...

Ear Nose and Throat Disease

GERD may be associated with a number of ENT syndromes, including recurrent hoarseness, throat clearing, sore throat, and globus, and signs, such as laryngitis, vocal cord granulomas, ulcers, leukoplakia, sinusitis, and even laryngeal cancer. These patients are usually diagnosed by our ENT colleagues based upon symptoms and signs of inflammation involving the posterior third of the vocal cords and interarytenoid areas, which are both in close proximity to the upper esophageal sphincter. However, the specificity of these findings has recently been questioned our study in 100 healthy volunteers without ENT complaints found signs associated with reflux laryngitis in 86 of these subjects (Hicks et al, 2002). In these individuals, other causes could usually be found, including smoking, alcohol, excessive voice use, allergies, or asthma.

Quinolinones 8hydroxycarbostyril

Indacaterol, 3 (QAB-149) is currently being developed as a once daily b2-adrenoceptor agonist for the treatment of COPD and asthma 9 . Indacaterol contains the familiar quinolinone head group that appears in the marketed short-acting p2-adrenoceptor agonist, procaterol, 4. This 8-hydroxycarbostyril moiety is known to have a high affinity for the -adrenoceptor and has been postulated to give potential slow offset properties to ligands to drive duration of action 10 . A recently published patent suggests that the maleate salt of indacaterol is highly crystalline, stable, and may be the preferred form of this compound for development and clinical use 11 . Data have recently been disclosed on the pharmacological profile of indacaterol. Using guinea-pig tissue preparations, potency data were generated in guinea-pig atria (EC50 21.6 mM) vs. guinea-pig trachea (EC50 45 nM), suggesting that the compound has selectivity over the -adrenoceptor. Further studies using guinea-pig trachea tissue...

The Role Of Disease Mapping In Health Boards

For instance a study in Barcelona looked at the onset of an epidemic of asthma by time and by geographical clustering and was able to identify the unloading of soybean in the city's harbour as the cause of the asthma epidemic days.2 In another study, plotting the residential addresses of cases of lung cancer was one technique by which an association was demonstrated between residential proximity to a steel foundry and lung cancer.3 (Lung cancer is one of the very few cancers which is caused primarily by a single factor, namely tobacco smoking. It is estimated that tobacco smoking causes 80-85 of lung cancer cases.)

Conclusion Of Medicinal Chemistry

The interest in the pharmaceutical industry to develop long-acting -adrenoceptor agonists with improved duration of action over salmeterol and formoterol is intense. The coming years will be pivotal as data for the most promising compounds will become available from clinical studies. There remains a continuing need for quality inhaled medicines for the treatment of asthma and COPD and it is a challenge to the industry to supply improved agents. 38 A. D. Brown, J. S. Bryans, M. E. Bunnage, P. A. Glossop, C. A. L. Lane, R. A. Lewthwaite, S. J. Mantell and C. Perros-Huguet, Discovery of Novel Inhaled Long-Acting Beta-2 Agonists for Asthma & COPD, Poster P14, 13th RSC-SCI Medicinal Chemistry Symposium, September 4-7, 2005, Churchill College, Cambridge, UK.

Answers and Explanations

X 181.8 grams of anhydrous theophylline Since the anhydrous theophylline has 0.4 unbound water, it is only 99.6 pure. While the differences between 184.5 and 181.1 or 181.8 do not appear significant, the principle of correcting for either waters of hydration or unbound water is important. Drugs such as magnesium sulfate, theophylline, citric acid, and iron salts often have waters of hydration. The pharmacist must ascertain which form is present in a given formula. Other drugs such as morphine may have absorbed water, thus changing its strength. (4 7.22)

Laughing Gas Ether And Surgical Anesthesia

Laughing Gas Surgical Operation

The ingenious discoveries of the first pneumatic chemists provided new opportunities for quacks and charlatans. Conscientious experimentalists could not compete with charlatans promising miraculous cures for asthma, catarrh, consumption, and cancer through the inhalation of oxygen, hydrogen, and other ''factitious airs.'' Some physicians, however, attempted to find legitimate medical uses for the new gases. Fascinated by pneumatic chemistry, Thomas Beddoes (1760-1808) persuaded his friends Thomas Wedgwood (1771-1805) and James Watt (1736-1819) to help him establish the Pneumatic Institute, a hospital in which the inhalation of factitious airs was used in the treatment of lung disease. Many scientists, including Humphry Davy, were intrigued by his work. While suffering from toothache in 1795, Davy began inhaling nitrous oxide. In addition to feeling giddy, relaxed, and cheerful, Davy noted that the pain caused by his wisdom teeth had almost disappeared. Soon after the exhilaration wore...

Systemic Mastocytosis

In the 23 to 43 of patients with systemic mastocytosis, the diarrhea is mild to moderate in the majority, with 90 having a stool volume 1 L d. In systemic mastocytosis, the primary cause of the most troubling diarrhea is gastric hypersecretion owing to hyperhistaminemia therefore, it has a pathogenesis similar to that seen in patients with Zollinger-Ellison syndrome. However, villous atrophy and a secretory component, perhaps owing to prostaglandins,may be important diarrheal factors in some patients with systemic mastocytosis. The diarrhea in these patients is usually controlled by a combination of Hi and H2 receptor antagonists. The mast cell membrane-stabilizing drug cromolyn sodium (disodium chromoglycate) has been reported to be useful to treat diarrhea and other GI symptoms in a small number of patients with systemic mastocytosis. In patients with the malignant forms of mastocytosis, treatment with interferon alpha-2b, as well as chemotherapy and corticosteroids, has been used...

Role of Lselectin in disease

Airway inflammation involving intense influx of leukocytes is a prominent factor in the development of chronic airway hyperresponsiveness found in asthma. Leukocyte endothelial interactions in the lung vascular bed have been considered to be regulated differently from that of the systemic circulation due to the presence of a highly interconnected vascular bed in which the diameter of the vessels are often smaller than that of the leukocytes 239 . Because of this, it was thought that specialized adhesion molecules such as the selectins were not required for leukocyte recruitment to the lung. However, multiple studies have demonstrated a role for each of the selectins in this process. Specifically, L-selectin has been shown to support leukocyte rolling on inflamed and non-inflamed lung vessels 240-242 . Furthermore, Nishio et al. 242 found that in vivo administration of fucoidin, an L-selectin competitor, reduced the number of leukocytes rolling on pulmonary arte-rioles in a...

Medicine In The Roman World

Dioscoride

Pliny's Natural History provides an invaluable, far-ranging, if unsystematic survey of science, medicine, agriculture, industry, and the arts of the late republic and early empire. In lauding the virtues of Rome's traditional herbal remedies, Pliny claimed that everything had been created for the sake of man, making the whole world an apothecary shop for those who understood nature's simple prescriptions, such as wound dressings made of wine, vinegar, eggs, honey, powdered earthworms, and pig dung, and ferns used in the treatment of parasitic worms. Among the remedies suggested by Pliny are some that contain pharmacologically active components, such as ephedron for asthma, cough, and hemorrhage.

Potassium Depletion Is Least Likely To Occur In A Patient Using Edecrin

Which of the following bronchodilators act by inhibiting phosphodiesterase I. dyphylline (Lufyllin) II. salmeterol (Serevent) IH. nedocromil sodium (Tilade) 145. Cromolyn sodium (Intal, Nasalcrom, Opti-crom) is a drug that is (A) effective in acute asthmatic attacks 160. An advantage of salmeterol (Serevent) over isoproterenol (Isuprel) in the treatment of bronchial asthma is that salmeterol (A) It should only be used in the treatment of an acute asthmatic attack. (B) It should not be used in a patient who is currently using a theophylline product. (D) If used in conjunction with a bron-chodilator administered by inhalation, the bronchodilator should be used first. (E) The aerosol form is also useful in the treatment of status asthmaticus.

Eliminatiton Half Life Of Sodium Chloride

Poison Tree Poem Analysis

How many mg of aminophylline should be given as a loading dose if a theophylline plasma level of 10 mg L is desired in a 55-year-old male patient weighing 70 kg His volume of distribution has been calculated to be 35 liters. Assume that aminophylline consists of 85 theophylline and 15 ethylenediamine.

Premenstrual Syndrome Treatment Interventions

Premenstrual Dysphoric Disorder (PMDD), formerly Late Luteal Phase Dysphoric Disorder (LLPDD) Terms that refer to that small percentage of women who have premenstrual syndrome with primarily emotional symptoms severe enough to affect their ability to function at home or in the workplace. Premenstrual Exacerbation Aggravation of such chronic conditions such as asthma, depression, anxiety, eating disorders, substance abuse, headaches, allergies, seizures, or herpes during the premenstrual phase.

Figure

Extrarenal potassium homeostasis insulin and catecholamines. Schematic representation of the cellular mechanisms by which insulin and -adrenergic stimulation promote potassium uptake by extrarenal tissues. Insulin binding to its receptor results in hyperpo-larization of cell membranes (1), which facilitates potassium uptake. After binding to its receptor, insulin also activates Na+-K+-ATPase pumps, resulting in cellular uptake of potassium (2). The second messenger that mediates this effect has not yet been identified. Catecholamines stimulate cellular potassium uptake via the adrenergic receptor (I2R). The generation of cyclic adenosine monophosphate (3', 5' cAMP) activates Na+-K+-ATPase pumps (3), causing an influx of potassium in exchange for sodium 10 . By inhibiting the degradation of cyclic AMP, theophylline potentiates catecholamine-stimulated potassium uptake, resulting in hypokalemia (4).

Figure 420

Acute Mg replacement for life-threatening events such as seizures or potentially lethal cardiac arrhythmias has been described 8-12,19 . Acute increases in the level of serum Mg can cause nausea, vomiting, cutaneous flushing, muscular weakness, and hyporeflexia. As Mg levels increase above 6 mg dL (2.5 mmol L), electrocardio-graphic changes are followed, in sequence, by hyporeflexia, respiratory paralysis, and cardiac arrest. Mg should be administered with caution in patients with renal failure. In the event of an emergency the acute Mg load should be followed by an intravenous (IV) infusion, providing no more than 1200 mg (50 mmol) of Mg on the first day. This treatment can be followed by another 2 to 5 days of Mg repletion in the same dosage, which is used in less urgent situations. Continuous IV infusion of Mg is preferred to both intramuscular (which is painful) and oral (which causes diarrhea) administration. A continuous infusion avoids the higher urinary fractional excretion of...

The Conundrum

The literature suggests that the majority of patients with extraesophageal GERD do not have the classic symptoms of heartburn or acid regurgitation. For example, reflux symptoms are absent in 40 to 60 of asthmatics, in 57 to 94 of patients with ear, nose, and throat (ENT) complaints, and in 43 to 75 of patients with chronic cough in whom GERD is suspected to be causing their symptoms (Richter, 2000). In contrast, studies find that 80 to 90 of patients with acid reflux-related chest pain have associated classic reflux symptoms (Hewson et al, 1991). Obviously, the silent reflux of this syndrome contributes to difficulties in making this diagnosis. If true, physicians must consider GERD in the differential diagnosis of these problems either early, when classic symptoms are present, or when alternative diagnoses have been excluded.

Therapeutic Trials

The use of therapeutic trials to identify patients with true GERD-related extraesophageal complaints is ideal in clinical practice, but it is impractical for large clinical trials of drug efficacy. Reliable predictors of response to therapy are needed unfortunately, these are not available, and therefore we have little means of enriching our study populations with patients who have true GERD-related extraesophageal symptoms. This key issue probably accounts for the variable treatment results seen with both aggressive medical and surgical antireflux regimens, and it makes scientific evidence-based algorithms for treating these patients very difficult. For example, asthma studies with PPIs by Harding and Sontag (2000) have found only inconsistent results in the improvement of asthma after aggressive treatment of GERD. Furthermore, whereas a surgical study by So and colleagues (1998) found that 93 of patients with classic reflux symptoms responded to antireflux surgery, only 56 of...

Pulmonary Disease

Bronchial asthma, chronic bronchitis, chronic obstructive pulmonary disease, obesity, history of smoking, and recent upper respiratory infection are the most common medical conditions which may influence pulmonary function in the perioperative period. An estimated 4.5 of the population may suffer some form of reactive airway disease 116 . If these medical conditions are identified in the preoperative history, a thorough evaluation of the patient's pulmonary function should ensure. As with other medical conditions, a careful history may help separate patients with these medical conditions into low and high risk groups, especially since the degree of preoperative respiratory dyspnea closely correlates with postoperative mortality 117 . Using a simple grading scale, the patients' preoperative pulmonary function can be estimated (Table 2.4). If the physical examination of asthmatic patients reveals expiratory wheezing, conventional wisdom dictates that potentially reversible bronchospasm...

Respiratory

Peak flow if asthma suspected, chest X-ray (selective), arterial blood gases (selective), oxygen Children with a history of asthma or with wheeze and significant respiratory distress, depressed peak flow and or hypoxia should receive nebulised fi2 agonists and ipratropium driven with oxygen. Infants are likely to have bronchiolitis and require only oxygen.

Abdominal Hernias

A hernia, meaning sprouting forth , is an outpouch-ing of a visceral organ or a part of organ through an opening that it does not normally transverse. When hernias are associated with the abdomen, they may occur through the inguinal canal, lumbar trigone of Petit, femoral canal, or umbilicus. Nerve damage and weakening of the muscles, as a postsurgical complication, may lead to herniation. A variety of other situations such as pregnancy, constipation, peritoneal dialysis, ascites, and asthma may predispose an individual to herniation. Each hernia consists of a sac, usually a di-verticulum of the parietal peritoneum that invests the hernial contents, and a protruded tissue or organ with its coverings. The proximal tapered end of the sac that marks the site of herniation is known as the neck of the hernial sac. Although the ratio of the length of the inguinal canal to the circumference of the hernial sac may define the clinical picture best, this parameter cannot be the sole determinant...

Emergency treatment

Then consider tension pneumothorax and massive haemothorax and consider flail segment and open pneumothorax If evidence of tension pneumothorax then perform immediate needle decompression and follow up with chest drain If evidence of massive haemothorax then consider simultaneous chest drain and blood volume replacement If wheeze or crackles then consider asthma, bronchiolitis, pneumonia, and heart failure but remember inhaled foreign body as a possible cause If evidence of acute severe asthma then consider inhaled or intravenous -agonists and consider intravenous steroids and aminophylline Continue the primary assessment

Costbenefit Issues

The most important risks inherent to iodinated contrast administration are allergic reaction and injury to the kidneys. Patients with a history of prior allergic reaction to iodinated contrast material, asthma or other allergies are at increased risk. The decision to perform contrast enhanced CT is dependent on the severity of the prior reaction and feasibility of appropriate antiallergic premedication. Patients with elevated creatinine, diabetes mellitus, renal transplant, multiple myeloma, nephrotoxic medication, and severe chronic heart failure are at risk for renal failure after contrast injection. Hydration, reduced dose of contrast material, and use of isoosmolar contrast agents are options to reduce nephrotoxicity in this vulnerable patient population. However, alternative methods, particularly MR imaging, should be considered if available and no contraindications exist.

Data Quality

It is commonly believed that although the death certificate is probably not all that accurate, it is accurate enough for epidemiological research. However, the evidence for this belief is not reassuring. Early work about cerebrovascular disease found only 65 agreement between necropsy and death certification in New Haven, USA.10 And the findings were replicated in a study in Edinburgh in the late 1970s.1112 More recent scrutiny of the quality of death certification does not alter the picture. There is evidence that diseases are misrepresented on the death certificate. For instance deaths from asthma and chronic obstruction pulmonary disease are mistakenly classified as each other.13 The discrepancy between the death certificate and necropsy information seems to be around 12 14 to 18 .15

Emotions and health

Emotion can be involved in any medical condition. For example, a broken leg can lead to anger and frustration, anxiety, fear, sadness, and so on. Or it may be that one's emotional condition was a precipitating factor in whatever led to the leg being broken in the first place. But the most problematic circumstance comes with the idea of psychosomatic disorders, in which the disorder is clearly physical (migraine, skin rashes, indigestion, peptic ulcers, asthma, genito-urinary conditions, and so on) but the causative factors seem to be emotional. The emotion most commonly implicated is anxiety. The extent of the emotional is hard to determine, one view being that all illness has an emotional component, causa-tively. For example, long-term stresses may well have a deleterious impact on the efficacy of the immune system and thus leave a person more vulnerable to infection.

Efficiency

Modification of the Host by Opening Tight Junctions Epithelial cell tight junctions (zonulae occludens) are collar-like structures composed of a diverse number of proteins that separate the apical and basolateral domains of the lumenal columnar epithelial cells. As well as functioning as a restrictive barrier to mixing of apical and basolateral membrane components, these intercellular junctions limit the transepithelial transport of solutes across the epithelium. A number of disease states have been shown to alter tight junction permeability (e.g., asthma) and reagents to increase the permeability of the junction are available. The key to successful disruption of tight junctions to allow Ad access to basolateral epithelial cell surfaces will be to use a reagent that opens tight junctions sufficiently for Ad to pass through but that is rapidly reversible to limit the passage of other lumenal contents (e.g., bacteria) or serosal fluid into the airway lumen.

Breathlessness

General supportive measures should be considered in all cases. Face masks may be uncomfortable or intrusive at this time, but oxygen therapy may help some patients (even in the absence of hypoxia) who are breathless at rest. Nebulised 0.9 saline is useful if a patient has a dry cough or sticky secretions but should be avoided if bronchospasm is present.

Anesthesia

The medieval prototype of the ''sleep apple'' that appears in the story of Snow White usually contained opium, mandrake, henbane, hemlock, wine, and musk. Usually, the user was expected to inhale the fumes of the apple rather than eating it. The ''soporific sponges'' recommended by medieval surgeons contained similar mixtures. By the sixteenth century, surgeons were describing old favorites like mandrake as poisonous drugs that lulled the senses and made men cowards. In Shakespeare's Antony and Cleopatra, Cleopatra safely used mandrake to sleep away the hours before Antony's return. Shakespeare alludes to various soporific agents, such as poppy, mandragora, and ''drowsy syrups,'' but these agents were unreliable at best. In the real world, surgeons found that drugged patients who slept like the dead during surgery often failed to awaken afterwards. Opium retained its favored status long after mandrake was discarded. Eminent physicians like Thomas Sydenham (1624-1689) and John Hunter...

Interactions

Absorption of ciprofloxacin can be reduced if it is taken at the same time as dairy products, antacid or iron preparations ciprofloxacin should be dosed at least four hours apart from these products. Quinolones can inhibit the cytochrome P450 system, and thus interact with a number of different drugs. Some of these interactions can be potentially serious for example, ciprofloxacin can cause an increase in theophylline levels, potentially leading to toxicity.

Figure 1111

Risk factors for development of amphotericin B (AmB) nephrotoxic-ity. Nephrotoxicity of AmB is a major problem associated with clinical use of this important drug. Disturbances in both glomerular and tubule function are well described. The nephrotoxic effect of AmB is initially a distal tubule phenomenon, characterized by a loss of urine concentration, distal renal tubule acidosis, and wasting of potassium and magnesium, but it also causes renal vasoconstriction leading to renal ischemia. Initially, the drug binds to membrane sterols in the renal vasculature and epithelial cells, altering its membrane permeability. AmB-induced vasoconstriction and ischemia to very vulnerable sections of the nephron, such as medullary thick ascending limb, enhance the cell death produced by direct toxic action of AmB on those cells. This explains the salutary effect on AmB nephrotoxicity of salt loading, furosemide, theophylline, or calcium channel blockers, all of which improve renal blood flow or...

Figure 1122

Els, a consensus is developing to the effect that contrast-associated nephropathy involves combined toxic and hypoxic insults to the kidney 35 . The initial glomerular vasoconstriction that follows the injection of radiocontrast medium induces the liberation of both vasoconstrictor (endothelin, vasopressin) and vasodilator (prostaglandin E2 PGE2 , adenosine, atrionatiuretic factor ANP ) substances. The net effect is reduced oxygen delivery to tubule cells, especially those in the thick ascending limb of Henle. Because of the systemic hypoxemia, raised blood viscosity, inhibition of sodium-potassium-activated ATPase and the increased osmotic load to the distal tubule at a time of reduced oxygen delivery, the demand for oxygen increases, resulting in cellular hypoxia and, eventually cell death. Additional factors that contribute to the acute renal dysfunction of contrast-associated nephropathy are the tubule obstruction that results from increased secretion of Tamm-Horsfall proteins and...

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