American journal of therapeutics
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Review Case Reports
Acute hypotensive transfusion reaction with concomitant use of angiotensin-converting enzyme inhibitors: a case report and review of the literature.
Hypotension can be a manifestation of transfusion reactions, including acute hemolysis, bacterial contamination, transfusion-related acute lung injury, and anaphylaxis. In addition to hypotension, these reactions usually present with other characteristic symptoms and signs. In rare cases, hypotension is the only manifestation of a transfusion reaction. ⋯ We report a case of AHTR observed in a patient on angiotensin-converting enzyme inhibitor therapy. The Naranjo adverse drug reaction probability scale score indicated that the association between angiotensin-converting enzyme inhibitor therapy and AHTR was probable. If a patient on angiotensin-converting enzyme inhibitor therapy develops AHTR, it is important to recognize the need to switch to another class of antihypertensive medication, at least while the patient continues to require transfusion.
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Inducible nitric oxide synthase (iNOS) plays an important role in mediating inflammation. In our studies, we found that iNOS-derived NO was significantly increased in the serum samples of 150 patients infected with influenza A virus in comparison with samples of 140 healthy individuals. In human lung epithelial cells, infection with influenza A virus or stimulation with poly(I:C) + interferon-gamma resulted in increased mRNA and protein levels of both interleukin-32 and iNOS, with subsequent release of NO. ⋯ The protective effects of orally applied nonhydrolized formulated species of carnosine include at least direct interaction with nitric oxide, inhibition of cytotoxic NO-induced proinflammatory condition, and attenuation of the effects of cytokines and chemokines that can exert profound effects on inflammatory cells. These data are consistent with the hypothesis that natural products, such as chicken soup and chicken breast extracts rich in carnosine and its derivative anserine (beta-alanyl-1-methyl-L-histidine) could contribute to the pathogenesis and prevention of influenza virus infections and cold but have a limitation due to susceptibility to enzymatic hydrolysis of dipeptides with serum carnosinase and urine excretion after oral ingestion of a commercial chicken extract. The developed and patented by the authors formulations of nonhydrolized in digestive tract and blood natural carnosine peptide and isopeptide (gamma-glutamyl-carnosine) products have a promise in the Influenza A (H1N1) virus infection disease control and prevention.
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Aging is associated with a host of alterations in thyroid gland structure and function. Some of these changes have favorable effects on longevity, whereas others are maladaptive and contribute to a decline in health and quality of life. ⋯ The biochemical profile of subclinical hypothyroidism includes normal serum levels of thyroid hormones with mildly elevated serum thyrotropin concentrations in the range of 4.5 to 10 mIU/L. In this article, the epidemiology of subclinical hypothyroidism in the elderly is reviewed, the potential advantages of mild hypothyroidism in people over the age of 75 years are discussed, and some guidelines for screening and management of this common thyroid dysfunction are suggested.
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Review Case Reports
Severe extrapiramidal symptoms after nonintentional risperidone exposure in a child: case report and review of the literature.
Increase in use of atypical antipsychotics has been paralleled by an increase in the incidence of intentional and nonintentional overdose. Pediatric cases are uncommon, but may be severe. We describe a case of a child presenting with severe extrapiramidal symptoms, initially interpreted as seizures, caused by a nonintentional intoxication with risperidone, and review management options and the literature.
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Fibromyalgia (FM) is a mysterious pain syndrome with progressive and widespread pain, explicit areas of tender points, stiffness, sleep disturbance, fatigue, and psychological distress without any obvious disease. FM is commonly perceived as a condition of central pain and sensory augmentation. There are documented functional abnormalities in pain and sensory processing in FM. ⋯ Pre-emptive analgesia and pro-active treatment may offer the momentum for acute pain control based on model of central sensitization and pain in FM. This review article on FM appraises the modern practice of multimodal therapy focus on both acute and chronic pain management. Meanwhile, the evolving nonpharmacological approach is summarized and stressed as an essential component of integrated care in FM.