By Q. Basir. Iona College.
In vitro studies suggest there is some cross-reaction between the major allergens in fire ant venom and the winged Hymenoptera venoms suhagra 100 mg sale erectile dysfunction pump implant video. The clinical significance of this observation is still unclear; there appears to be limited clinical application discount suhagra online american express impotence and prostate cancer. Individuals allergic to bees and vespids do not appear to be at major risk for fire ant reactions purchase suhagra cheap erectile dysfunction in diabetes ayurvedic view, and similarly, fire ant allergic individuals are not at major risk for reactions from the winged Hymenoptera. Anaphylaxis from the sting of the harvester ant, another nonwinged Hymenoptera present in the southwestern United States, has been described ( 58). Specific IgE antibodies have been detected with direct skin tests and leukocyte histamine release using harvester ant venom. In summary, hypersensitivity reactions to ants, especially fire ants, have become clinically important. Fire ant venom has been analyzed, and many of the antigens are cross-reactive among the species. Fire ant whole-body extract has also been characterized and is known to contain venom antigens. Fire ant allergy will likely become a more important clinical problem as the ants spread, as the human population grows in the southern United States, and as the land is cultivated to favor their habitation. Natural history of insect sting allergy: relationship of severity of symptoms of initial sting anaphylaxis to re-sting reactions. Clinical and immunologic features and subsequent course of patients with severe insect sting anaphylaxis. Stinging insect allergy: detection and clinical significance of venom IgE antibodies. Diagnosis of IgE-mediated Hymenoptera sensitivity by venom induced histamine release. Insect-sting challenge in 324 subjects with a previous anaphylactic reaction: current criteria for insect-venom hypersensitivity do not predict the occurrence and severity of anaphylaxis. Lack of reproducibility of a single negative sting challenge response in the assessment of anaphylactic risk in patient with suspected yellow jacket hypersensitivity. Comparison of biochemical and immunologic properties of venoms from the four hornet species. Comparison of the allergenicity and antigenicity of yellow jacket and hornet venoms. Comparison of the allergenicity and antigenicity of Polistes venom and other vespid venoms. Clinical correlations of the venom specific IgG antibody level during maintenance venom immunotherapy. Should routine measures of serum venom specified IgG be a standard of practice in patients receiving venom immunotherapy? Long-term protection after stopping venom immunotherapy: results of restings in 200 patients. In-hospital sting challenge in insect venom-allergic patients after stopping venom immunotherapy. Duration of venom immunotherapy: relationship to the severity of symptoms of initial insect sting anaphylaxis. Further observations on discontinuation of venom immunotherapy: comparisons of patients stopped because of a fall in serum venom specific IgE to insignificant levels with patients stopped prematurely by self-choice. Expanding habitat of the imported fire ant (Solenopsis invicta): a public health concern. Harvester ant sensitivity: in vitro and in vivo studies using whole body extracts and venom. For the clinician, this requires a broad knowledge of the many clinical forms of urticaria and an even more extensive familiarity with the creative ways that medications and treatment can be applied. Meanwhile, clinicians should formulate a rational approach to the care of patients with these conditions. Individual lesions typically resolve within 24 hours and leave no residual skin changes. This description does not cover all forms of urticaria, but it includes the features necessary for diagnosis in most clinical situations. Angioedema is frequently associated with urticaria, but the two may occur independently. Angioedema is similar to urticaria, except that it occurs in deeper tissues and is often asymmetric. Because there are fewer mast cells and sensory nerve endings in these deeper tissues, pruritus is less common with angioedema, which more typically involves a tingling or burning sensation. In this review, angioedema and urticaria are discussed jointly except where specified. Although it is said to afflict 10% to 20% of the population at some time during life, it is most common in young adults ( 1). Chronic urticaria occurs more frequently in middle-aged persons, especially women. If patients have chronic urticaria for more than 6 months, 40% will continue to have recurrent wheals 10 years later ( 4). It is possible that the true prevalence of urticaria is higher than reported owing to many acute, self-limited episodes that do not come to medical attention. Acute urticaria is arbitrarily defined as persisting for less than 6 weeks, whereas chronic urticaria refers to episodes lasting more than 6 to 8 weeks. When considering chronic urticaria, an etiologic agent or precipitating cause such as a physical urticaria is established in up to 30% of patients who are thoroughly evaluated ( 5). Because of the sometimes extreme discomfort and cosmetic problems associated with chronic urticaria, a thorough evaluation to search for etiologic factors is recommended. This evaluation should rely primarily on the history and physical examination and response to therapy; limited laboratory evaluation may be indicated (see Fig. This algorithm suggests a potential method for evaluating and treating chronic urticaria. Empiric treatment should generally follow the cumulative, sequential use of the medications shown. Avoidance of aspirin, nonsteroidal antiinflammatory drugs, and angiotensin-converting enzyme inhibitors is essential. Corticosteroids may be useful for a brief time during the initial treatment until the severity of the urticaria is controlled. Erythema and edema are mimicked by intracutaneous injection of histamine, causing localized pruritus, a major characteristic of urticaria. The hypothesis that histamine is the central mediator of urticaria is bolstered by (a) the cutaneous response to injected histamine; (b) the frequent clinical response of various forms of urticaria to therapeutic antihistamines; (c) the documented elevation of plasma histamine or local histamine release from urticating tissue in some forms of the condition; and (d) the apparent degranulation of skin mast cells. An association with histamine release, however, has not been made in many forms of urticaria.
For illustration purposes buy suhagra 100 mg with mastercard erectile dysfunction early age, let us mention a few: the Lame-Navier equations for linear elastomechanics and its nonlinear generalizations (geometry and material prop- erties) in biomechanics order 100mg suhagra otc erectile dysfunction 38 cfr, Maxwell s equations and the bio-heat-transfer equation in the cancer therapy hyperthermia 100 mg suhagra with mastercard causes for erectile dysfunction and its symptoms, the Navier-Stokes equations for the anal- ysis of uid motion in the context of plaque building in blood vessels and in aneurysms. Whenever the required answers to the questions from medicine al- low, then simpler, so-called reduced models will do. Generally speaking, math- ematical models are only useful, if their input parameters have been analyzed with respect to their sensitivity. A typical feature of medical models is their multiscale structure: The mathe- matical equations express relations between microscopic spatial dimensions and our everyday life dimensions. By intruding suciently deep into the mathemat- ical description, we obtain a whole hierarchy of scales to be taken into account, depending on the problems in question. An illustrative example is given by the 15 international project Physiome , which spans scales from nm (molecules) via mm (tissue) up to m (organs). The partial dierential equations arising in the model must be solved numerically fast and reliably and, in view of clinical application, embed- ded in a 3D visualization environment, a virtual lab. As for the simulation of the mathematical models, the aims of mathematics and medicine are in accor- dance: Both disciplines want the solution in 3D, within short computing times and with reliable accuracy. Only, if these requirements are met, a mathemat- ical therapy or operation planning can hope to be accepted in the clinics and serve as a basis for responsible medical decisions. Among ecient algorithms available are: (a) domain decomposition methods for xed meshes in connection with parallelization or (b) multigrid methods in combination with adaptivity in space and time. Upt to now, research in regional hyperthermia has been restricted for ethical reasons to the treatment of deeply seated, non- operable tumors, i. The aim of this treatment is to heat cancer cells locally thus sensitizing them to radio or chemotherapy without damaging healthy tissue by too high temperatures. The patient is positioned in an applicator with (here) eight antennas that emit radio waves into the body. By separate control of the individual antennas, the interference eld can be adjusted to each individual patient, to locally apply high thermal energy to the tumor region only. The scientic question is: How should the antennas be tuned (in terms of amplitudes and phases) such that the tumor is heated within a temperature window between 42,5 and 45 C, but no healthy tissue. The impact of the dierent tuning parameters on the therapeutically eective temperature distribution is so complex that optimal therapy plans can be determined only via numerical simulation. The associated functional patient model here comprises Maxwell s equations for the description of the electric elds and the bio-heat-transfer equation which governs the heat distribution inside the body. The applied multigrid methods require computing times proportional to the number of nodes, which implies that adaptive methods are about a factor of 130 faster in this medically relevant example and at a comparable accuracy! In cranio-maxillo-facial surgery the mathematical model consists of the biomechanical dierential equations. They are to be solved numerically (by ecient multigrid methods) to permit a reliable prediction of the postoperative facial appearance assuming the operation went well as planned. On an intermediate time scale, it would be reasonable to open more space in public health to mathematics. The following lines of devel- opment can be foreseen: Radiology will more and more move on from mere 2D image interpretation to 3D model reconstruction. This requires substantial screening of individual im- age data by means of automated segmentation techniques. The corresponding increase of patient specic data will lead to a twofold development: (a) the build- up of centralized medical data bases in large hospitals, and (b) a population-wide introduction of (only personally disposable) individual data carriers (the elec- tronic patient ). Google-med may be a possible format of storing such data; it 17 will, however, need to be modied due to national dierences in health organi- sations and mentality as well as with respect to its non-guaranteed security of individual data. Provokingly, the function of an organ will not be fully understood, before it has been expressed by a realistic mathe- matical model covering both the healthy and the unhealthy case. Radi- ologists will certainly continue to bear the legal responsibility for the correctness of the interpretation of medical image data and the therefrom derived anatomi- cal models. However, in countries like Germany, insurance companies will need to include model assisted planning on the basis of geometrical 3D models and mathematical functional models into their catalogue of nancially supported ser- vices. Apart from medical indication, the new kind of planning tools is useful in view of an improved patient information as well as of education, documentation, and quality assurance. However, there is still a long way to go, until anatomically correct and medically useful functional models will be available even for the most essential body parts and the most frequent diseases. Within the German funding system, the corresponding research will, on a quite long run, remain dependent on public funding. In any case, political frames in health and research will need to be adjusted in close cooperation with selected medical doctors, engineers, and mathematicians! Pavarino: Adaptivity in Space and Time for Reaction-Diusion Systems in Electro- cardiology. Deuhard: Dierential Equations in Technology and Medicine: Compu- tational Concepts, Adaptive Algorithms, and Virtual Labs. Hochmuth: Multiscale abnalysis of thermoregulation in the human microvasular system. Dossel: Kausalitat bei der Entstehung, der Diagnose und der Therapie von Krankheiten aus dem Blickwinkel des Ingenieurs. Smoak: Anisotropy, ber curva- ture, and bath loading eects on activation in thin and thick cardiac tissue preparations: simulations in a three-dimensional bidomain model. Lamecker: Shape constrained automatic seg- mentation of the liver based on a heuristic intensity model. Louis: Combining Image Reconstruction and Image Analysis with an Application to Two-dimensional Tomography. Dossel: Multiple wavelets, rotos, and snakes in atrial brillation a computer simulation study. Laguna: Bioelectrical signal processing in cardiac and neu- rological applications. Zachow: Computergestutzte 3D-Osteotomieplanung in der Mund-Kiefer- Gesichtschirurgie unter Berucksichtigung der raumlichen Weichgewe- beanordnung. Technology Special Is- sue on Computer-Based Craniofacial Modelling and Reconstruction, pp. The members of the Committee responsible for the report were chosen for their special competences and with regard for appropriate balance. N01-0D-4-2139 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government.
In about 3% of cases there is mosaicism with some cells demonstrating a normal Down syndrome karyotype quality 100mg suhagra thyroid causes erectile dysfunction. Denition Pathophysiology Down syndrome is the clinical condition usually result- The Alzheimer s disease seen with Down syndrome is ing from a trisomy of chromosome 21 rst described by thought to be due to the presence of three copies of the Langdon Down in 1865 suhagra 100 mg impotence low testosterone. Chronic granulomatous Recessive Cytochrome Neutrophils can phagocytose material order generic suhagra on line impotence yahoo, but are unable disease b245 to generate respiratory burst and hence kill bacteria. Duchenne muscular dystrophy Recessive Dystrophin Progressive proximal muscle weakness with calf psuedohypertrophy. Causes progressive intellectual deterioration, loss of purposeful use of hands and jerky truncal ataxia. Leber optic atrophy Multiple loci Sudden onset adult blindness, cardiomyopathy, cardiac conduction defects. Short into adult life, but by 40 almost all have Alzheimer s middle phalynx of little nger, single horizontal pal- disease. Klinefelter syndrome r Congenitalheartdiseasein30%,mostcommonlyatri- Denition oventricular septal defects. Tracheo-oesophageal stula, duodenal atresia, annu- lar pancreas, Hirschsprung s disease. Denitive diagnosis is made by chori- more X chromosomes the more severe the phenotype. All appear normal until puberty when hypogo- tions for testing include maternal age and a Down nadism becomes prominent. As there is nor- mally only one copy of the X chromosome, females Incidence suffer from X linked recessive conditions such as 1in5000 live births. O verdose, poisoning 1 and addiction Alcohol and drugs of abuse, 521 Overdose and poisoning, 526 r Alcohol dependence is dened as a maladaptive pat- Alcohol and drugs of abuse tern of use associated with tolerance and withdrawal syndrome despite signicant physical and psycholog- Alcohol abuse and dependence ical problems. Patients often exhibit a stereotyped drinking pattern with alcohol consumption taking Denition preference over other activities. Regular or binge consumption of alcohol sufcient to A history of alcohol consumption should be taken from cause physical, neuropsychiatric or social damage. In addi- Incidence/prevalence tion signs of chronic liver disease and other complica- 3 4%ofthepopulationreportalcohol-relatedproblems. Health care professionals Blood alcohol levels are of limited value, a persistently with access to opiates may abuse drugs like fentanyl. Incidence/prevalence Heroin abuse fell during the late 1990s, but rose again Management rapidly in 2000 and 2001. A fall in use since then has 1 Identication and advice at an early stage may be been attributed to the fall in supply after the Taliban enough to avert serious medical, neuropsychiatric banned production in Afghanistan. Precipitating fac- numbers of users, the number of heroin-induced deaths tors should be identied and psychological sup- has remained static. Abusers and diazepam or lorazepam in the treatment of repeatedly take the drug to achieve the euphoric effect; seizures. Withdrawal in acetaldehyde accumulation resulting in ushing, symptoms also occur, and so further doses are taken to headache, anxiety and nausea. Heroincanbesmoked( chasingthedragon ),snorted, or injected into a vein ( shooting up or mainlining ), or subcutaneously ( skin popping ) or intramuscularly. Opium contains morphine and A history should be taken of recent and previous codeine. Itisnormallyboughtasawhitepowder, Withexcessivedoses,comaanddeathfromrespiratory which is usually snorted or smoked. This combusts more readily making the when tolerance is reduced, or if other drugs or alcohol cocaine more potent. Social problems include loss of job, deterioration in The street term freebasing means smoking cocaine, ei- relationships and criminal activities to obtain money ther as the salt or base. Cocaine and crack can also be to buydrugs,includingstealing,prostitutionanddrug injected, although this is far less common. Incidence/prevalence Investigations 7% of 20 24 year olds have tried cocaine, mainly snort- These depend on the presentation of the individual. About 10 15% of those who try snorting cocaine vestigations may be needed for possible complications become abusers. Crack is linked with areas of social depending on the history and clinical diagnosis. Heroin intoxication is treated by ensuring airway pro- tection, and giving the opiate antagonist naloxone. Tolerance does seem to occur to some not cause euphoria, is used as a method of programmed extent. Baseformsofcocaine, Supportive therapy is needed to prevent the patient from including crack, have a more rapid onset but a much seeking increased doses (either of heroin, other drugs or shorter duration of action. In alcohol, its effects are increased by an active metabolite, some cases, patients stay on long-term methadone at which only forms in the presence of alcohol. Within half an 2 Agitation and hypertension often respond to di- hour of the last dose of a binge, there is a crash when the azepam. Haloperidol and phenothiazines should be user feels intense cravings, depression and anxiety. Long-term users coronary vasoconstriction due to unopposed alpha may become persistently restless, with anorexia, weight effects). Smok- physical effects from withdrawal so sedatives or a re- ing can cause granulomas and pulmonary oedema. Other medical tension or myocardial ischaemia) and antidepressants complications include hypertension, myocardial in- may be indicated. Denition r Social: The most common reason for a cocaine ad- Amphetamines were originally widely used for medical dict to present for treatment of dependency is run- reasons such as appetite suppressants and for insom- ning out of money, as a cocaine or crack binge can nia, but are now recreationally used. Other prob- phetamine (and derivatives) is now limited to selected lems include loss of job and criminal activities such as cases of narcolepsy and attention decit hyperactivity stealing, prostitution and drug dealing. There are several derivatives of amphetamine, such Investigations as methamphetamine, which can be smoked, and there- These depend on the presentation of the individual. Co- fore became popular for their increased speed of on- caine use can be tested for using a urine screen. Amphetamines can be taken gations may be needed for possible complications such orally, intranasally, smoked or injected. Management Cocaine intoxication: Initial management includes en- Incidence/prevalence suring a clear airway and ventilation if needed. Amphetamineandderivatives(includingecstasy)arethe 1 Seizures are treated with diazepam or lorazepam. The excre- tion of amphetamine depends on urine pH acid urine increases its clearance.