Probably the first thing you should know about hay fever, is that "hay" is not the culprit at hand. This condition gets its particular name because grass usually sheds its pollen at the same time of the year that hay is harvested hence, the name "hay fever". Hay fever is usually caused by an allergic inflammation of your nose because of flower or grass pollen, dust, or animal fur. These particles immediately trigger a huge production of antibody immunoglobulin E that locks onto the mast cells and cause you to sneeze, have itching and watery eyes, swelling and inflammation of your nasal passage because of an increase in mucus production.
The intensity of hay fever symptoms usually varies from person to person. Supposing the person is more sensitive and has a lower immunity it is possible that he may also experience hives or a rash during hay fever. Both heredity and the environment play a big role in just how sever and how often a hay fever may be. Health studies have shown that around the world one in three people will be having an active allergy at any given time of the day, and that at least three individuals out of four are bound to develop an allergic reaction during the course of their lives.
An individual with hay fever may be extra moody, short tempered, and agitated because of the constant sneezing, watery eyes, and runny nose. They may also experience fatigue, insomnia, or irritability. It is important during this time that the person gets ample rest, re-cooperation, and the right medication whether entirely natural or otherwise. The symptoms of hay fever may also include having an itchy throat, and itchy nose, and blocked and runny nose. In more sever cases the individual may experience sweats, loss of smell and taste, headaches, and facial pain because of their blocked sinuses.
Some of the best home remedies for hay fever are mashing grapefruit and boiling it with lemon juice and honey for a three times a day sore throat cure, putting chamomile leaves in hot water and inhaling the steam twice a day for a blocked nose and head pain cure, drinking hot coffee to open your airways for easier breathing, or consuming twice a day a glass of water with 2 tablespoons of apple cider vinegar for overall healing. Garlic is also a powerful healer and is rather effective in treating hay fever if you are bold enough to use it. Including fresh garlic in your diet to be rid of hay fever sooner is definitely one of the best cures. But again, it is only for the bold, because not everyone feels the same way about the smell and taste.
One other cure for a blocked and itchy nose might be to use a Nasal Spray. These handy little items are entirely natural and help to clear out and dispel any dust particles. The nasal spray is a safe product for older children and is also okay for moms to use while pregnant. Another thing you could try is Loratadine. Loratadine is a simple use once a day relief tablet that has an active ingredient of loratadine which helps in preventing the effects of histamines.
As I suffer from the trouble of rheumatic and minor musculoskeletal pains, it proved extremely worse for my health. Besides, still I avoided the signs and symptoms of these disorders. Due to such reason, it proved extremely fatal for me and also hampered my professional responsibilities and duties. Due to these pain, I had to remain in my residence for a longer period of time, which hindered my organization to a significant extent. So, I decided to consult an experienced doctor to get freedom from these disorders.
After knowing the signs and symptoms of my disorder, the doctor prescribed me a medicine named algesal tube. As this medicine contains an active ingredient named diethylamine salicylate, so it can also be used to reduce the effects of lumbago, fibrositis, sciatica, bruises and strains and many others. While prescribing me this medicine, doctor told me to keep this medicine out of the reach of the small kids. As they might consume, that may prove problematic for me and my family. Along with this, he also told me that these medicines can only be consumed by us or children's above 6 years of age. After using this medicine, I understood that this medicine works in two ways such as an anti-inflammatory and a painkiller as well. So, it is highly preferred by me and many others in the entire world.
After putting the cream of algesal tube on the infected area, I attained a burning sensation and red rashes appeared within my entire body. This sensation distracts from brain and offers a relief from the feeling of pain from the infected part. After putting the cream, doctor advised me massage the cream with very gentle hands within the painful region. He prescribed me to use it, at-least 3 times a day. Besides, as I used numerous times, varied types of side-effects came into existence such as redness, irritation or rash. Along with this, the infected areas also becomes extremely sensitive to the rays of the sun. Not only this, he also advised me to store the medicine in a cool and dry place, so that it remains fresh for longer period of time.
Moreover, these medicines need to be according to the prescription of the doctor. As, over use might cause varied disorders such as diverse types of allergies, not to be used in broken skin and many others. Not only this, he also advised me to keep out of the contact of the eyes and other sensitive regions. So, in order to attain the similar benefit, it is essential to obey all his advices and recommendations. If it is not maintained by us, then it might cause increase of the blood levels and due to toxicity of methotrexate excretion might decline. It might be extremely harmful both for your personal as well as professional life. So, we need to be extremely careful, before consuming these medicines as compared to others. Before stopping the medicine, one to need to consult with the doctor.
Today we are far too used to being lax with the hygiene of our homes, often neglecting it out of laziness or boredom. That however has to change we would never or very rarely ignore our own personal hygiene so things should really be no different when it comes to that of our residence. Hygiene goes a lot deeper than just the look, feel and smell of a place there is a lot more than meets the eye if we don't do a thorough job at cleaning and sanitizing the environment of our homes. Proper disinfection and cleaning are vital to keeping diseases and infections away from our homes as well as allergies and the like.
That being said even though hospitals and laboratories have to be perfectly clean and sterile in order to avoid the aforementioned problems our homes should be no different in many ways. Infection prevention is an important aspect of our lives when it comes to health and it is especially important if we have pets around the house. Pet hair, dead skin particles and more constitute a risk for respiratory issues and help provoke them, especially in asthmatics and other similar sufferers. What can be done to avoid that? Instead of sanitizing the entire home when you're done cleaning you should mostly address the high-risk areas around the house. So what can be done to sanitize your home and what should be done exactly?
Don't put it off for later
Like we mentioned earlier a lot of us would prefer to enjoy a nice quiet weekend rather than clean if the situation doesn't look that bad. That however has to be avoided since without proper motivation you simply won't get the job done right. Find a way and clean up on a regular basis as that way you'll have less to take care of in the long run.
Sanitation
After you are done cleaning your home there are a few areas that need to be sterilized especially during high risk times such as a flu epidemic or something similar. Begin by doing the following:
Fill up the kitchen sink with hot water mixed with one cup of bleach. Pick up all the utensils you use frequently and place them in the water for an hour. While that is going on wet a cloth into the mixture and wipe down all the surfaces of your kitchen to sanitize and destroy the germs as much as possible. Once the hour has passed take out all the utensils and wash them with hot water and soap and let them out to dry. Make sure you wash them well as to not have any problems with the bleach mixture later on.
Remove all covers from the beds and the pillows around the house. When you wash them add a teaspoon of bleach to the water and let it agitate for a bit before you add the covers in. Then use a disinfectant spray to deal with the mattresses and pillows.
Spray the vacuum filter with a disinfectant and use it to vacuum the carpets and rugs. For the floors you can add a cup of bleach to a bucket of hot water and then mop them up. Remember to open the windows to let some air in since bleach has a powerful scent.
Disinfect every surface from computer mice to door handles if possible to minimize the risks.
A bacterial cause accounts for 2%-10% of acute rhinosinusitis cases.
Nose and nasal cavities. Image source: Wikipedia, public domain.
Recommendations for Management of Acute Bacterial Sinusitis by the Infectious Diseases Society of America (IDSA):
Bacterial rather than viral rhinosinusitis should be diagnosed when any of the following occurs:
- persistent symptoms lasting at least 10 days, without improvement - symptoms or high fever and purulent nasal discharge or facial pain for 3–4 days at illness onset - worsening symptoms after an initial respiratory infection, lasting 5–6 days, has started to improve.
Empirical therapy should be started as soon as acute bacterial rhinosinusitis is diagnosed clinically.
Amoxicillin-clavulanate, instead of amoxicillin alone, is recommended for both children and adults.
Macrolides and trimethoprim-sulfamethoxazole are not recommended as empirical therapy, because of high rates of antimicrobial resistance.
Allergy sufferers who react to chocolate might be shocked to learn their allergy could be linked to something other than the cocoa bean: an allergy to cockroach.
An average of 8 insect parts are found in a chocolate bar and deemed safe, according to the FDA's guidelines.
"Most foods have natural contaminants in them, but there are levels which the FDA deems safe," said allergist Dr. Morton M. Teich. "Anything more than 60 insect pieces per 100 grams of chocolate is rejected by the FDA. "
Trace amounts of insect parts that are ground into the food and can affect people with allergies and asthma. Some side effects include migraines, cramps, itching or hives.
Chocolate isn't the only food product to blame for contamination, other foods like peanut butter, macaroni, fruit, cheese, popcorn, wheat and some cheese also contain this material. Allergists can help patients with cockroach allergies by giving them allergy shots with small amounts of the insect as well as removing chocolate from their diet.
First reported in 1943, allergists began skin testing for cockroaches in 1959. "Allergists are testing now because they're finding that asthma can be caused by cockroaches," said Teich, "I have patients whom we've tested for cockroach who really get reactions."
Teich says most of his patients are shocked at this information and swear off chocolate after discovering its contaminants. "Most of them say, 'I'm not going to eat that anymore!'" However if you think a simple switch of brands will keep you from safe from roaches, you're wrong-cockroaches and their droppings seem to be indigenous to the cocoa bean.
"To avoid [insects in your food], it's almost impossible," said Teich. "You probably would have to stop eating completely."
To consume foods without traces of insects, producers would have to use more pesticides, which Teich believes are much worse than eating a few insects. Some argue that the pricier chocolate brands take extra precautions in separating the bugs from the beans but there is no evidence that proves it.
Initial evaluation of chronic cough (defined as more than 8 weeks' duration in adults and 4 weeks in children) should include a chest radiography (CXR) in most adult patients.
Patients who are taking an angiotensin-converting enzyme inhibitor (ACEi) should switch to a medication from another drug class.
Differential diagnosis of cough, a simple mnemonic is GREAT BAD CAT TOM. Click here to enlarge the image: (GERD (reflux), Laryngopharyngeal Reflux (LPR), Rhinitis (both allergic and non-allergic) with post-nasal drip (upper airway cough syndrome), Embolism, e.g. PE in adults, Asthma, TB (tuberculosis), Bronchitis, pneumonia, pertussis, Aspiration, e.g foreign body in children, Drugs, e.g. ACE inhibitor, CF in children, Cardiogenic, e.g. mitral stenosis in adults, Achalasia in adults, Thyroid enlargement, e.g. goiter, "Thoughts" (psychogenic), Other causes, Malignancy, e.g. lung cancer in adults).
The most common causes of chronic cough in adults are:
- upper airway cough syndrome (post-nasal drip) - asthma - gastroesophageal reflux disease (GERD) - any combination of the above
If upper airway cough syndrome is suspected, a trial of a decongestant and an antihistamine is warranted.
The diagnosis of asthma can be confirmed with a clinical response to empiric therapy with inhaled bronchodilators or corticosteroids (spirometry is generally preferred though).
Empiric treatment for gastroesophageal reflux disease (GERD) should be initiated in lieu of testing for patients with chronic cough and reflux symptoms.
Patients should avoid exposure to cough-evoking irritants, such as cigarette smoke.
Further testing may be indicated if the cause of chronic cough is not identified and includes:
- high-resolution computed tomography (CT) of the chest - referral to a pulmonologist or an allergist
In children, a cough lasting longer than 4 weeks is considered chronic.
- respiratory tract infections ("bronchitis" and pneumonia) - asthma - rhinitis with post-nasal drip - gastroesophageal reflux disease (GERD) - aspirated foreign body is relatively rare but must not be missed
Evaluation of children with chronic cough should include chest radiography (CXR) and spirometry (if older than 5 years of age). Skin prick test for environmental allergies can also be indicated.
Tumor necrosis factor (TNF, cachexin or cachectin and formally known as tumor necrosis factor-alpha) is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. TNF induces apoptotic cell death, inflammation, and inhibits tumorogenesis and viral replication.
Tumor necrosis factor (TNF superfamily). Image source: Wikipedia, Protein Data Bank (PDB: 1TNF), public domain.
TNF inhibitors
TNF inhibition can be achieved with a monoclonal antibody such as infliximab (Remicade) or adalimumab (Humira), or with a circulating receptor fusion protein such as etanercept (Enbrel). The global market for TNF inhibitors in 2007 was $10 billion.
Infliximab (brand name Remicade) is a chimeric monoclonal antibody. Tthe term "chimeric" refers to the use of both mouse (murine) and human components of the drug i.e. murine binding Fab domains and human constant Fc domains. Remicade is administered by intravenous infusion, typically at 6-8 week intervals, and at a clinic or hospital. It cannot be administered orally (like all antibodies) because the digestive system would destroy the drug.
Etanercept (Enbrel) is a recombinant-DNA drug made by combining two proteins (a fusion protein). It links human soluble TNF receptor to the Fc component of human immunoglobulin G1 (IgG1). Etanercept is not a monoclonal antibody, it is a fusion proteton, thefefore, different from infliximab (Remicade) and adalimumab (Humira).
Etanercept (Enbrel) is a large dimeric molecule (see above), with a molecular weight of 150 kDa, that binds to TNFα. Monomeric version did not have sufficient biologic activity.
Etanercept is made from the combination of two naturally occurring TNF receptors linked to an Fc portion of an IgG1. The effect is an artificially engineered dimeric fusion protein.
Enbrel is injected subcutaneously, typically by the patient at home, using pre-filled 50 mg/ml syringes in late 2004 or a single-use 50 mg autoinjector "pen" was brought to market in 2006. Adalimumab. Image source: Wikipedia, public domain.
Adalimumab (brand name Humira) is the third TNF inhibitor, after infliximab and etanercept, to be approved in the United States.
Like infliximab and etanercept, adalimumab binds to TNFα, preventing it from activating TNF receptors. Adalimumab (Humira) was constructed fully from a human monoclonal antibody, while infliximab is a mouse-human chimeric antibody. Etanercept is a TNF receptor-IgG fusion protein.
Humira brand name is an abbreviation of "Human Monoclonal Antibody in Rheumatoid Arthritis." Adalimumab is marketed in both preloaded 0.8 ml syringes and preloaded pen devices (Humira Pen), both injected subcutaneously, typically by the patient at home.
Monoclonal anti–TNF-alpha-antibodies associated with increased risk of herpes zoster
The risk of bacterial infection is increased in patients treated with drugs that inhibit tumor necrosis factor-alpha (TNF-alpha). Little is known about the reactivation of latent viral infections during treatment with TNF-alpha inhibitors.
The study authors examined whether TNF-alpha inhibitors together as a class, or separately as either monoclonal anti–TNF- antibodies (adalimumab, infliximab) or a fusion protein (etanercept), are related to higher rates of herpes zoster in patients with rheumatoid arthritis.
Among 5040 patients in Germany receiving TNF- inhibitors or conventional DMARDs, 86 episodes of herpes zoster occurred in 82 patients:
- 39 occurrences could be attributed to treatment with anti–TNF- antibodies - 23 to etanercept - 24 to conventional DMARDs (used as controls)
A significantly increased risk was observed for treatment with the monoclonal antibodies although this risk was lower than the threshold for clinical significance. No significant associations were found for etanercept use or for anti–TNF-alpha treatment as a class.
The authors concluded that treatment with monoclonal anti–TNF-alpha antibodies may be associated with increased risk of herpes zoster.
The news outlets reported that the monoclonal anti–TNF- antibodies Humira, Kineret, and Remicade each increased shingles risk by 80%. Enbrel did not.
The circulating half-life of 25(OH)D is 2 weeks. This is the best test to determine vitamin D status.
A 25(OH)D level of less than 32 ng/mL is considered vitamin D insufficient because intestinal calcium absorption is optimized at levels above 32 ng/mL.
A 25(OH)D level of less than 15 or 20 ng/mL have been used to define vitamin D deficiency.
Parathyroid hormone levels start to rise at 25(OH)D levels below 31 ng/mL, which is another marker of vitamin D insufficiency. Although not always required for the diagnosis of vitamin D insufficiency, a serum PTH may be used to help establish the diagnosis of vitamin D insufficiency. Vitamin D is a steroid hormone and a component of a complex endocrine pathway sometimes called 'vitamin D endocrine system' (Medscape, 2012).
The word vitamin was originally derived from Funk's term "vital amine."
Calcifediol, also known as calcidiol, 25-hydroxycholecalciferol, or 25-hydroxyvitamin D (abbreviated 25(OH)D), is a prehormone which is produced by hydroxylation of vitamin D3 (cholecalciferol) in the liver.
Calcidiol.
Calcidiol is then converted in the kidneys into calcitriol (1,25-(OH)2D3), that is the active form of vitamin D.
Calcitriol, 1,25-dihydroxycholecalciferol.
Calcidiol can also be converted into 24-hydroxycalcidiol in the kidneys via 24-hydroxylation.
Twitter is a microblogging service where people answer the question "What are you doing?" via 140-character messages from their cellphone, laptop or desktop. The service can also be used to collect notes and ideas or to report from a medical conference. I have already explored the same communication channel while attending the NEJM Horizons Conference in October and the reports were generally met with approval by both the meeting participants and bloggers from around the world. This experience encouraged me to make the first attempt at using Twitter to post updates from the 2008 Annual Meeting of American College of Allergy, Asthma & Immunology (ACAAI). I attended the meeting to present our project AllergyCases.org to the program directors and fellows and to discuss 2 posters.
In order to make the Twitter postings (or "tweets") easily searchable, I included the hash tag "#ACAAI" with each tweet from the meeting. You can search Twitter for "#ACAAI" to find tagged updates from any participants who used Twitter to report from the ACAAI meeting.
The short updates from the workshop about treating severe asthma were posted in real time on Twitter at an interval of every 3-5 minutes. After the workshop, I used my cell phone and the mobile Twitter interface to discuss the asthma updates with several fellows during and after the ACAAI meeting.
The oldest post is at the bottom, the newest at the top:
#ACAAI Severe Asthma: AAF pts have more ER visits and hospitalizations for multiple reasons: poverty, obesity, no PCP, cockroach exposure... 7:04 PM Nov 8th from web
#ACAAI Severe Asthma: Theophylline pendulum may be swinging back -- useful again? 6:57 PM Nov 8th from web
#ACAAI Severe Asthma: No response to oral steroids? Consider GERD. 6:51 PM Nov 8th from web
#ACAAI Severe Asthma: Maximal dose of oral steroids beyond which there is no effect? 60 mg po qd. 6:51 PM Nov 8th from web
#ACAAI Severe Asthma: Older papers - methylprednisolone may "get into the lungs" better than prednisone - consider different steroid... 6:48 PM Nov 8th from web
#ACAAI Severe Asthma: Macrolides may be considered if nothing else helps. May have steroid-sparing effect. 6:47 PM Nov 8th from web
#ACAAI Severe Asthma: Clarithromycine tx for months is used in "infectious asthma" - studies ongoing. 6:45 PM Nov 8th from web
#ACAAI Severe Asthma: Monitor LFTs in Zileuton therapy. 6:44 PM Nov 8th from web
#ACAAI Severe Asthma: Zileuton is not the same as Singulair or Accolate. Works in a different way. 6:43 PM Nov 8th from web
#ACAAI Severe Asthma: Strategies for "SABA abuser" (Albuterol 18 x day), no response to ICS+LABA+LTRA? Consider zileuton and Xolair. 6:42 PM Nov 8th from web
#ACAAI Severe Asthma: FEV1 cutoff below which you don't use Xolair for fear they won't tolerate anaphylaxis? Some use 50-70% similar to SCIT 6:38 PM Nov 8th from web
#ACAAI Severe Asthma: Pts on Xolair tx - nasal polyps can get better. Nasal polyps are a heterogeneous disease like asthma. 6:32 PM Nov 8th from web
#ACAAI Severe Asthma: When do you give up on using Xolair? How long do you try? 4-6 months. 6:30 PM Nov 8th from web
#ACAAI Severe Asthma: There is no way to predict which patient will benefit from Xolair. 6:29 PM Nov 8th from web
#ACAAI Severe Asthma: Several attendees share experience with using Xolair in pts with IgE higher than 700. 6:28 PM Nov 8th from web
#ACAAI Severe Asthma: How do you monitor Xolair tx in pts with very high IgE? Monitor PFTs. Checking IgE levels is useless in these patients 6:26 PM Nov 8th from web
#ACAAI Severe Asthma: Xolair and IgE of 4k? Classic wisdom: Xolair will not bind enough IgE to be effective. Some pts still respond however 6:25 PM Nov 8th from web
#ACAAI Severe Asthma: Xolair use in pts with very high IgE (4-5 k)? Anecdotal evidence: it may help. Use the highest dose calculated for 700 6:23 PM Nov 8th from web
#ACAAI Severe Asthma: Treat GERD, if no response for a month, try doubling the dose. Don't give up if no response at the lower dose. 6:19 PM Nov 8th from web
#ACAAI Severe Asthma: GERD - Beta agonists and theophylline relax GE sphincter which may exacerbate GERD and make asthma worse. 6:18 PM Nov 8th from web
#ACAAI Severe Asthma: Obesity - Losing weight (diet or surgery) changes metacholine sensitivity. Losing wt improves asthma in obese pts. 6:15 PM Nov 8th from web
#ACAAI Severe Asthma: What is behind the connection between obesity and asthma? Can diet play a role? 6:12 PM Nov 8th from web
#ACAAI Severe Asthma: Workshop shifts to Q&A brought by the participants. 6:11 PM Nov 8th from web
#ACAAI Severe Asthma: With genetics, we may be able to tailor-make the therapy to individual patients rather than blindly follow guidelines. 6:10 PM Nov 8th from web
#ACAAI Severe Asthma: Vit D deficiency could be a risk factor of asthma but there is not enough data to make a final conclusion. 6:07 PM Nov 8th from web
#ACAAI Severe Asthma: Ciclesonide is the new ICS. Activated by esterase in target tissues. Less suppression of HPA than other ICS - FP/BUD 6:05 PM Nov 8th from web
#ACAAI Severe Asthma: Xolair decreases hospitalizations in pts on moderate dose ICS. 6:04 PM Nov 8th from web
#ACAAI Severe Asthma: Omega-3 FA, fish oil may be beneficial in children. 6:02 PM Nov 8th from web
#ACAAI Severe Asthma: Lactose is added or removed from DPIs, check contents of each inhaler. 6:00 PM Nov 8th from web
#ACAAI Severe Asthma: Consider lactose sensitivity in pts who don't respond to Advair or Symbicort. Check contents of each inhaler. 5:59 PM Nov 8th from web
#ACAAI Severe Asthma: Consider GERD if asthmatic pts don't respond to medications. 5:58 PM Nov 8th from web
#ACAAI Severe Asthma: Asthma in 30% pts of pts with chronic asthma. 5:57 PM Nov 8th from web
#ACAAI Severe Asthma: Sinusitis in 75% of pts with moderate asthma. 5:57 PM Nov 8th from web
#ACAAI Severe Asthma: Link between sinusitis and asthma. 5:56 PM Nov 8th from web
#ACAAI Severe Asthma: Treat co-morbid conditions - rhinitis, sinusitis, GERD - "One airway disease" 5:55 PM Nov 8th from web
#ACAAI Severe Asthma: Some pts may have airway irritation from the delivery system, e.g. dry powder inhalants. Listen to pts... 5:53 PM Nov 8th from web
#ACAAI Severe Asthma: A subpopulation of patients may benefit from erythromycin or other ABx. 5:52 PM Nov 8th from web
#ACAAI Severe Asthma: Is asthma an infectious disease? 5:50 PM Nov 8th from web
#ACAAI "Some asthmatics don't respond to ICS, so why try them at all?" but this is not what the guidelines say with their stepwise approach. 5:49 PM Nov 8th from web
#ACAAI Since 1976: Asthma is a heterogeneous disease, but this is not reflected in the guidelines. 5:47 PM Nov 8th from web
#ACAAI Attending the workshop Treating the severe asthmatic patient. 5:45 PM Nov 8th from web
#ACAAI As far as I know, this will be the first ACAAI meeting reflected on Twitter.
#ACAAI The #ACAAI tag means you will be able to find the tagged posts on Twitter Search http://search.twitter.com/
#ACAAI Going to the annual ACAAI meeting. I have 2 posters and 1 website presentation. Will be updating Twitter with the tag #ACAAI
I have used Opera Mobile browser for years but a newcomer among mobile browsers called Skyfire is much better for streaming video. In fact, Skyfire is so good that you can watch almost any video you are able to see on your desktop computer -- videos from CNN, NBC Nightly News, TV episodes on Hulu.com, etc.
This is how I use Skyfire to watch immunology lectures on my Windows-based mobile phone (MotoQ 9c):
3. Click on any of the lectures to stream the slides and the talk in Adobe Flash format.
Skyfire Mobile Browser Demo
Skyfire is a mobile web browser for Windows Mobile and Symbian S60 v3. As of November 2008, it is available for users with American or Canadian phone numbers.
It is the first browser software for Windows Mobile which can view Adobe Flash content and streaming video.
Skyfire works similar to Opera Mini, in that the webpage is fully rendered by a server separate from the mobile device, similar to the operation of a thin client. The output is sent as images annotated with interactive items such as links and text-fields.
Features such as Adobe Flash, Silverlight and QuickTime are usable without additional plug-ins on the device, and can be easily updated server-side without the need to update the client.
A 56-yo male with severe asthma and cirrhosis due to hepatitis C takes milk thistle (Silybum marianum) for his liver disease. He is on maximal asthma therapy including ICS plus LABA, LTRA and prednisone 5 mg po qd. His pulmonologist is wondering if his milk thistle intake has anything do to with his difficult to control asthma.
What is milk thistle?
Thistle is the common name of a group of flowering plants characterized by leaves with sharp prickles on the margins. Prickles often occur all over the plant and are an adaptation to protect the plant against herbivorous animals, discouraging them from feeding on the plant.
The national flower of Scotland is Scots Thistle possibly stemming from the story that a Viking attacker stepped on one at night and cried out, so alerting the defenders of a Scottish castle.
Milk thistles are thistles of the genus Silybum Adans., flowering plants of the daisy family. They are native to the Mediterranean regions of Europe, North Africa and the Middle East. Health uses, mainly for chronic liver disease, have been traditionally claimed for the plant.
What is the therapeutic use of milk thistle?
Milk thistle has been used medicinally for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. The active compound in milk thistle is silymarin, a mixture of at least 4 flavonolignans. The terms "milk thistle" and "silymarin" are often used interchangeably. Silymarin is typically administered orally in amount ranging from 200-500mg per day.
Uses based on scientific evidence rated by grade:
Chronic hepatitis
Several studies of oral milk thistle reported improvements in LFTs. Most studies were small and poorly designed. Grade B
Cirrhosis
In several studies from Europe milk thistle improved LFTs and decreased death rate. Grade B
Acute viral hepatitis
Not recommended. Grade C
Amanita phalloides mushroom poisoning
Milk thistle has been used traditionally to treat Amanita phalloides mushroom poisoning. Not recommended. Grade C
Key to grades
A Strong scientific evidence for this use B Good scientific evidence for this use C Unclear scientific evidence for this use D Fair scientific evidence against this use
According to AHRQ, clinical efficacy of milk thistle is not clearly established. Interpretation of the evidence is hampered by poor study methods and/or poor quality of reporting in publications. Possible benefit has been shown for improvement in LFTs. Milk thistle is associated with few, and generally minor, adverse effects.
Synonyms for milk thistle
Bull thistle, cardo blanco, Cardui mariae fructus, Cardui mariae herba, emetic root, flavonolignans, heal thistle, holy thistle, isosilibinin, isosilybin, lady's thistle, Marian thistle, mariana mariana, Mary thistle, mild thistle, milk ipecac, pig leaves, royal thistle, silybin, silybinin, Silybum marianum, snake milk, St. Mary's thistle, thisylin, wild artichoke.
Does milk thistle affect the respiratory status of patients with asthma?
Pubmed search does not show any studies which have formally evaluated the effect of milk thistle on the respiratory system of patients with asthma or COPD but a significant effect appears unlikely.
HEENT: Pale boggy turbinates with 75% obstruction of the nasal cavity Chest: CTA (B) Extremities: severe arthritis of both hands, and a R hand weakness secondary to remote stroke.
A hand with arthritic changes. Image source: Cicadas, a Creative Commons license.
A yellow jacket wasp with a typical narrow waist (left) and a honey bee with a fat hairy "fuzzy" body (right). Image source: Wikipedia 1, 2, GNU Free Documentation License.
Steve Parsow managed Parsow's Fashion for Men, an upscale clothing company at Regency Court that his father founded 50 years ago.
He was mowing the lawn when a swarm of bees attacked his leg. He was stung 12-15 times, sending him into anaphylactic shock, and killing him at the age of 48.
Immediately after being stung, Mr. Parsow seemed fine, then his hand began to swell. The family called 911 and gave him Benadryl, but by the time the paramedics arrived, he "slipped into unconsciousness and lost his pulse."
His wife, Debra, said he had no known allergy to bee stings, but a local doctor says it's unlikely someone would die from that number of stings without an allergy or some other underlying condition.
"Just shut him down, "says his brother David. He says he watched as doctors used shock paddles and tried to revive his younger brother in the ER. "It's already been how many minutes? They told us from the start there wasn't a beat. They could not get a beat."
The 48 year old Mr. Parsow was healthy and was running 6 miles a day every day at 4 AM. There are over 50 reported deaths per year due to insect stings in the U.S. The most common stinging insects are bees and wasps. They can cause severe allergic reactions including anaphylaxis and anaphylactic shock.
Mind map of insect venom allergy. See more mind maps from AllergyCases.org.
An 8-year-old boy complains of abdominal pain, nausea, vomiting, lack of appetite and weight loss for 6 months. Past medical history includes allergic rhinitis and conjunctivitis and skin prick testing positive for house dust mite.
A retrospective study sponsored by the American Lung Association has found no evidence of depression or suicide linked to montelukast.
The study findings will be published in an upcoming issue of the Journal of Allergy and Clinical Immunology.
Leukotriene Receptor Antagonists (LTRA)
Antagonists of the CysLT1 receptor (LTRA) are efficacious as controller therapy in asthma and montelukast is FDA-approved for treatment of seasonal allergic rhinitis.
Mast cells quickly generate different mediators from the metabolism of arachidonic acid: leukotrienes and prostglandins (LTC4, LTB4, PGD2). These substances are produced within minutes of IgE-receptor crosslinking on the surface of mast cells.
Eicosanoids are signaling molecules made by oxygenation of 20-carbon essential fatty acids. There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).
Mast cell mediators including (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX). See more Allergy and Immunology mind maps here.
A 65-year-old female has a history of frequent UTIs for the last year. Serum immunoglobulins showed low levels of IgG 515 mg/dL (reference range 700 to 1600), IgM 30 (reference range 40 to 230), IgA 50 (reference range 70 to 400).
What is the reason for the low levels of immunoglobulins?
"It was a murder mystery playing out in major cities across the country and perplexing scientists. Thousands of people were dying from strokes and heart attacks within 24 hours of a spike in microscopic pollution -- tiny particles that spew from the exhaust of diesel trucks, buses and coal-burning factories.
Northwestern researchers have discovered that this microscopic air pollution spurs hyperclotting of the blood. The study found that lungs inflamed by the pollution secrete a substance, interleukin-6, which causes an increased tendency for blood to coagulate or clot.
In the study in mice, researchers observed a 15-fold increase in interleukin-6 24 hours after the mice were exposed to the pollution. In people, interleukin-6 also raises the levels of a substance called CRP, which is correlated with death from cardiovascular disease.
Among the metropolitan areas, Los Angeles has the most year-round particle pollution. Chicago ranks 11; New York, 17 and Washington D.C., 20.
The level of particulate matter in the air in Chicago is 20 micrograms/m3. The level of particulate matter in Beijing is 260 micrograms/m3 — 13 times as much as Chicago.
The risk of dying from a heart attack or ischemic stroke jumps a whopping 30 percent with each additional 10 micrograms of pollution."
An 18-month old boy is here for a follow-up of atopic dermatitis. He was last seen at the clinic 3 months ago and at that time his mother described his symptoms as "8" - the lesions were affecting his face, elbows, the areas behind the ears and knees, and the pubis. He was prescribed Elidel (pimecrolimus) and hydrocortisone 1% for the face BID, and Elidel and triamcinolone 0.1% (Kenalog) for the body BID. The symptoms improved significantly and the mother downshifted local therapy to triamcinolone 0.1% daily a month ago. She also stopped Singulair. Two weeks ago, the skin lesions re-occurred, including new ones on the face and back.
I was not asked for permission to use the post but since it is based on Flickr (Creative Commons license) and Wikipedia (public domain), I am not inclined to make a big deal about it.
