Upper Respiratory Tract Infections Ebook

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Causes of allergic rhinitis

There are many occupational allergic hazards which can give rise to allergic rhinitis and, more important, to the associated asthma. Workers dealing with castor beans (Ricin spp.), whether in the fields, during transport, at the dockside or in ships, are particularly at risk. They are such a strong sensitizers that they will cause allergic inhalent problems to the so-called 'normal' population when downwind from a castor bean factory or when actively working with the beans. It must be remembered that ingestants as well as inhalants may cause rhinitis. Traditionally, milk is supposed in some people to cause catarrh but this symptom is difficult to evaluate. Both the mediators of nasal allergy and also the resulting clinical symptoms including nasal obstruction can be measured after provocation tests. However, the nose, which has its own neurogenic system and complicated blood supply, is exposed to so many stimuli, only some of these specifically allergic and only some from the external...

Treatment of rhinitis

Find the cause of the rhinitis and get away from the cause is easy advice to give, but often impossible to follow. There should be obvious causes of symptoms if they are strictly seasonal or environmental, as has already been mentioned. When the symptoms persist throughout the year the most likely cause is the major allergen of the house dust mite. Dust mites of the genus Dermatophagoides are the most important indoor allergens found worldwide in dust samples. The two major mite species are D. pteronyssimus (Der. p) and D. farinae (Der. f). Although monoclonal antibodies are available for groups I, II and III antigens, most information is available about Dei. p 1. The fecal pellets are relatively large, 10-30 jxm, and cause allergic conjunctivitis as well as allergic-rhinitis and asthma. Airborne levels of Der. p I give a more appropriate idea of allergen level than arc-obtained in dust, where the highest concentrations are in the mattress and bedding. The allergens arc-also present...

Rhinitis

'Rhinitis' which literally means inflammation of the nasal mucosa is a non-specific term. The multifactorial aetiology and overlapping symptomatology makes 'rhinitis' extremely difficult to classify. Up to date, the classification proposed by the 'International Rhinitis Management Working Group' in 1994 is the most comprehensive one although is still far from being universally accepted. The commonest cause being allergy. For a long time, allergic rhinitis is classified as seasonal or perennial. More recently, it is being reclassified as intermittent or persistent depending on the total duration of the symptomatic period. Management of rhinitis is dependent on the underlying cause. Superimposed infection is not uncommon and should be treated accordingly.

Rhinitis Allergic

When hayfever is seasonal or environmental, it will almost certainly be allergic, but the first distinction must be made between infectious and noninfectious rhinitis. In both of these types nasal polyps may be present and the patient is often anosmic. Lack of smell (and taste) may be so insidious in onset that only when leading questions are posed from the doctor taking the history may these symptoms be mentioned. In noninfectious rhinitis that is perennial, it may be very difficult to decide whether there is an allergic basis to the symptoms. A rational classification of symptoms is not always easy in rhinitis, which is a heterogeneous group of diseases with multiple etiologies. History, skin tests and possibly cytology of the nasal smear when symptoms are present should allow a basic classification of the appropriate subgroups (Tables t and 2). The term used in the past when rhinitis was not obviously allergic or infective was 'vasomotor rhinitis', however the International Table 1...

Cold Remedies

Capsules and tablets for relieving symptoms of colds account for a large percentage of OTC drug sales. Like the cough syrups, they are a mixed bag of different formulas and strengths. Common ingredients are antihistamines, aspirin and other pain relievers, nightshade drugs to dry up excess secretion in the nose and throat, and caffeine and phenylpropanolamine to offset the sedative effects of the other ingredients. Usually these mixtures are packaged in multicolored tablets and flashy capsules to make them look exotic and powerful. Whether they affect the course of a cold or significantly reduce the symptoms is questionable. (Even when they do suppress symptoms, they may actually prolong colds by making people less aware of their illness and less likely to take good care of themselves.) What is more certain is that OTC cold remedies can affect mood, usually in undesirable ways. Alternate methods of treating colds to avoid these problems include taking hot baths, forcing fluids, eating...

What is the difference between an intervention in a clinical trial and in an observational study

The major goals of medical treatment are to reduce or eliminate the symptoms and signs of a disease, to slow or halt disease progression, or to prevent specific complications, including premature death. The natural history of most diseases is unpredictable in individual patients. Several acute conditions such as the common cold are self-limiting other diseases such as multiple sclerosis are often intermittent with unpredictable remissions. The time course of many chronic conditions is highly variable and the risk of complications of degenerative conditions such as atherosclerosis is unpredictable, although one can differentiate between low- and high-risk subjects. Consequently, distinguishing between real treatment effects and the natural course of a disease can be a major challenge. By using comparable groups of study subjects in a clinical trial, one receiving the new treatment and the other not, we are able to make a good estimate of both favorable and unfavorable treatment effects.

Why is blindingmasking so important

A classic illustration is a placebo-controlled vitamin C trial for the prevention and treatment of the common cold that was conducted among employees at the National Institutes of Health.4 Many of the enrollees could not resist the temptation to analyze the content of their blinded study medications. Among the participants who did not break the blind, the mean duration of colds was similar in the two groups. In contrast, participants who knew they were taking vitamin C reported shorter cold durations than those who knew they took placebo

Description Of The Infection Spectrum

Bacterial colonization of ciliated respiratory epithelia in the trachea and bronchi. The incubation period is 6-20 days. Classical pertussis is an illness of three stages. It starts with a catarrhal stage, with nonspecific symptoms similar to those of the common cold (duration 1 to 2 weeks). At the paroxysmal stage (duration 2 to 6 weeks), the cough becomes more prominent with staccato attacks, postussive whooping, and vomiting. At the convalescent stage (duration several weeks), the frequency and severity of coughing attacks gradually decrease. The most severe cases of whooping cough occur in unvaccinated children under 1 year of age. This group accounts for most deaths. 1,2

Bordetella Infection And Immunity

It is estimated that over 60 million cases of pertussis occur worldwide each year, resulting in 700000 deaths. Clinically, pertussis has three phases. The disease begins with the catarrhal phase which may last from 7 to 21 days and is typified by symptoms similar to a common cold. The paroxysmal phase begins with severe, violent coughing spells and an inspiratory 'whoop' typical of the disease. This intense coughing lasts 2-4 weeks and can result in cyanosis, vomiting, severe exhaustion and death in infants. During the final or convalescent phase, cough paroxysms gradually decrease over 3 4 weeks. Although pertussis is considered a childhood disease, recent studies have demonstrated a high incidence of pertussis in adults.

Stressinduced Immunosuppression And Health

Stress has repeatedly been linked to poorer health, greater incidence of the common cold and upper respiratory infections, faster progression of chronic diseases such as cancer and AIDS, and exacerbation of autoimmune disorders. Despite these consistent findings of stress-related impairments in health, relatively few studies have demonstrated that stress-related immunosuppression could serve as a mechanism through which stress could lead to disease. Although the extent to which stress-related immunosuppression is clinically relevant is debated, recent research has attempted to prospectively show relationships among stress, immunity, and health.

What are the advantages of casecontrol studies

In a case-control study of women aged 18 to 49 years,3 it was reported that the use of phenylpropanolamine for weight reduction was associated with an odds ratio of 16.6 (95 confidence interval (CI)1.5-182 p 0.02) for subarachnoid or intracerebral hemorrhage for the indication common cold, the OR was 3.1 (95 CI 0.86-11.5 p 0.08). If these study findings are true, is the temporary symptomatic relief of a common cold worth the risk of a rare but potentially fatal adverse event

Clinical Features

The clinical presentation of empyema generally blends with that of an underlying pneumonia. Community-acquired S. aureus pneumonia is usually preceded by a viral upper respiratory infection or right-sided endocarditis in intravenous drug users. Patients with empyema are initially seen by a variety of physicians due to the indolent course of the disease. Typical symptoms include pyrexia, pleuritic chest pain, cough, dyspnea, and general malaise. Atypical presentations may include weight loss and anemia. Patients may have decreased breath sounds and dullness to percussion on examination of the chest. Symptoms are often masked by protracted treatment with antibiotic therapy for upper respiratory tract infections, which may result in the delayed diagnosis.

Exercise and immunity

It has been known for about 100 years that exercise or training before exposure to infection decreases morbidity or mortality, whereas exercise during the infection has the opposite effect. Thus, acute exercise to exhaustion after infecting laboratory animals with anthrax bacilli or Streptococcus pyogenes resulted in increased mortality compared to sedentary controls. In contrast, repeated exposures to exercise prior to exposure with type 1 Pneumococcus was associated with reduced mortality in experimental animals relative to sedentary-controls. Epidemiological studies suggest that the relative risk for upper respiratory tract infections (URTI) is increased during and for 1-2 weeks following overtraining or marathon-type exercise in endurance athletes. Since prolonged, intense exercise is also associated with some immune suppression, this has led to the 'open window' hypothesis (Figure 1). This hypothesis suggests that during the period immediately following heavy and prolonged...

Early Infancy 0 to 6 Months

PHYSICAL ASPECTS Rapid growth rate is a characteristic feature of young infants, for whom the major work is eating. After a 5 to 10 percent loss over the first 3 days of life, term infants regain birth weight by 10 days of age. A 20- to 30-g day weight gain is the best overall sign of health. Normal infants double their birth weight by 5 months. Young infants have a high surface area to body mass ratio with a proportionally large head, resulting in a high rate of heat loss and risk of hypothermia. The normal anterior fontanelle is slightly depressed when a child is upright. Young infants are obligate nose breathers and may experience partial airway obstruction with abnormal positioning or viral upper respiratory tract infections. Normal neonates may exhibit periodic breathing, or 5 to 10 s pauses followed by tachypnea, due to immature central control of respiration. Both cardiac output and minute ventilation are relatively rate dependent in early infancy. A heart rate greater than 180...

TABLE 1123 Clinical Assessment of Severity of Dehydration

Temperature, pulse, and blood pressure all provide information concerning the degree of illness. The rest of the physical examination should focus on signs of concurrent viral illness, such as upper respiratory tract infections, that may be associated with gastroenteritis, as well as abdominal findings. A rectal examination is often useful in obtaining a stool sample for detection of occult blood, culture, examination for leukocytes, measurement of pH, and detection of reducing substances. It can also rule out anal fissures as the cause of bloody stools.

Neuromuscular Disease

Any form of muscle weakness may be associated with shallow breathing and an increase in respiratory rate as a compensatory mechanism. Cough and Nasal Congestion Cough may be a prominent feature of most of the primary respiratory conditions listed in T ble , 1.1 2.-4. It may also be the initial presentation of a variety of congenital anomalies, including cleft palate, laryngotracheomalacia, laryngotracheal cleft, tracheal webs, tracheoesophageal fistula, tracheal hemangiomas, and vascular rings. Although congenital malformation resulting in cough and nasal congestion is more likely to occur in neonates, in most instances, cough is due to a viral upper respiratory infection and may be associated with sneezing and nasal congestion. It may also be a prominent feature of bronchiolitis and chlamydial and pertussis infections. Treatment of the underlying condition is required. Cough suppressants should be used with extreme caution in neonates. Nasal congestion is best treated with...

Key Nutrients Involved in Host Resistance to Infection

Ascorbic acid (vitamin C) Ascorbic acid is rapidly mobilized and utilized in infection and high levels of ascorbic acid are found in leucocytes. Studies in humans and animals have found a reduced T-cell response, delayed cutaneous hypersensitivity, and reduced epithelial integrity in vitamin C deficiency. Vitamin C supplementation is associated with increased lymphocyte proliferation in response to mitogen, increased phagocytosis by neutrophils, and decreased serum lipid peroxides. A role for vitamin C has been suggested in the treatment of autoimmune diseases as well as in delaying the progression of HIV to AIDS however, further research is required to confirm such a role. The effectiveness of ascorbic acid in preventing and reducing the duration of acute respiratory infection also remains controversial. Claims that high intakes of vitamin C can prevent the common cold have not been corroborated, although there is evidence of a decrease in duration and alleviation of symptoms of the...

Hemorrhagic Shock and Encephalopathy Syndrome

Hemorrhagic shock and encephalopathy syndrome (HSES) was first reported by Levin et al.65 in 1983. This acute, frequently lethal syndrome usually occurs at about 3 to 4 months of age.66 The cause remains unknown.67 There is a prodromal period lasting on average 2 to 3 days during which the child exhibits fever, irritability, diarrhea, or signs of an upper respiratory tract infection. It then deteriorates into profound shock, seizures, coma, DIC, and oliguria. Cerebral edema, hypoxia, and boundary zone infarction may be seen. Rarely, SDH and retinal hemorrhages are seen in these cases and are attributed to the coagulation disorders present. The

TABLE 1153 Differential Diagnosis of Congestive Heart Failure Based on Age of Presentation

MYOCARDITIS AND CARDIOMYOPATHIES Myocarditis affects children of all ages and is the leading cause of end-stage cardiomyopathy requiring transplantation. Viral etiologies include enteroviruses (coxsackie, echovirus, and poliovirus), as well as mumps, influenza virus, and Varicella zoster. An emerging cause is HIV-associated myocarditis and chronic Epstein-Barr myocarditis. Many bacterial species have been associated with myopericarditis, but not myocarditis alone. Noninfectious causes include lupus erythematosus, toxins such as tricyclic antidepressants, and cocaine. Myocarditis is often preceded by a viral respiratory illness and needs to be differentiated from pneumonia. As with the latter diagnosis, presenting signs and symptoms are often respiratory distress, fever, tachypnea, and tachycardia. Clues that suggest myocarditis include generalized malaise, fever, and myalgias in age-appropriate children. 17,18

Definition and Etiology

Allergens (e.g., house-dust mite, pollen, and moulds). Nonspecific bronchial stimuli include upper respiratory tract infections, cold air, exercise, cigarette smoke, excitement, emotional stress, and chemical irritants. Aspirin and other nonsteroidal antiinflam-matory medications provoke asthma in some patients.

Reflexology In Disorders Of The Respiratory System

PROBLEMS OF THE NOSE Colds Blockage of Nose Unfortunately, the nose is often the victim of an ailment called 'common cold'. Cold is a viral infection of the inner surface of the nose characterized by sneezing and discharge of a watery or thick fluid, which also blocks the nose. Though not a serious disease, cold causes a lot of discomfort, misery and embarrassment to the sufferer. It is admitted even by doctors that 'cold takes full seven days to get cured but if treated with medicines, it takes just one week ' However, experience has shown that Reflex Zone Therapy can cut short the duration of a cold.

High Altitude Sickness

Acute mountain sickness (AMS) encompasses a wide spectrum of ill effects ranging in severity from minor discomfort to life-threatening emergencies. The two major life-threatening manifestations of AMS are pulmonary edema and cerebral edema. These are extremes in a continuum of which milder forms of AMS are common and probably underrecognized. The incidence, severity, and duration of AMS are highly correlated to the speed of ascent, the ultimate height reached, and the level of physical exertion. The syndrome is not seen in normal healthy subjects below an altitude of 2500 m. True incidence is difficult to estimate because the size of the population at risk is not known, but figures as high as 30 of those exposed to 3000 m and 75 at 4500 m have been reported 14 . The incidence of AMS is unrelated to gender or to recent respiratory illness however, the development of high altitude pulmonary edema (HAPE) is related to strenuous exercise, exposure to cold, and the presence of underlying...

Central nervous system

This devastating affliction comes on with brutal suddenness, usually after an ill-defined upper respiratory illness. It resembles postinfectious encephalomyelitis in the sense that perivenular inflammatory foci are found but in addition there is fibrinoid necrosis of blood vessels, multiple foci of petechial hemorrhage and frank necrosis of brain substance. A model for it has been developed by superimposing a Sanarelli-Shwartzman reaction on to the standard immunization protocol for induction of EAE.

Pasteurella Infection And Immunity

Pasteurella multocida is primarily a veterinary pathogen that produces septicemic or respiratory diseases in both domesticated and wild mammals and birds. The organism can occur as a commensal in the nasopharyngeal region of apparently healthy animals. Uncomplicated diseases in which P. multocida is the primary etiologic agent are hemorrhagic sep-'ticemia of cattle and water buffalo, fowl cholera of poultry and free-flying birds, and rhinitis (snuffles) and pneumonia of rabbits. Diseases in which P. multocida is a complicating or secondary pathogen are atrophic rhinitis and pneumonia of swine, and shipping fever and pneumonia of cattle. In humans, most P. multocida infections arise from pet animal bites, particularly cats and dogs.

Respiratory infections

These are divided into two anatomically separate categories. First, there are those of the upper respiratory tract, which extends from the nose to the vocal cords. These include the common cold (coryza), sinusitis, pharyngitis, laryngitis and epiglottitis. Secondly, there are infections of the lower respiratory tract. These may affect the large airways (bronchitis), the alveoli and parenchyma (pneumonia) or the pleura space, leading to an empyema. The source of infection is variable. Droplet inhalation is the most frequent although pathogens may be introduced to the lung by alternative routes, such as the aspiration of pharyngeal contents as seen in neurological conditions leading to bulbar palsy and defective swallowing, hematogenous spread as in miliary tuberculosis or staphylococcal septicemia, and direct extension from surrounding tissues. In patients with comorbid illness, impaired host responses or damaged respiratory tract, organisms normally regarded as nonvirulent can become...

Hayfever on the increase

It is remarkable that in 1934 it was found that 3.5 of the Japanese population resident in southern California were found to have allergic rhinitis due to pollen, a disease that had never been recognized in Japan. However, in 1986 not only was the increase recognized, but an incidence as high as 33.3 for children aged between 6 and 17 years had been noted. The major allergen in Japan comes from trees - the Japanese cedar tree. The frequency of allergy to this particular pollen is more common in people living within 50-100 m of a motorway, compared with those living in the country who are surrounded by trees.

Excipients For Overthecounter Drugs

(eventually the number of therapeutic classes reached approximately 80). During this review, the FDA attempted to keep the task at a manageable level by not reviewing specific marketed products, but rather by creating various monographs (standards) for OTC active ingredients in numerous therapeutic classes. Expert Panels were advised only to consider excipients (or complete product formulations) when such excipients or formulations materially impacted the drug's efficacy or diminished its safety. In therapeutic classes such as antacids, laxatives, antidiarrheals, expectorates, antitussives (cough suppressants), sleep aids, and numerous oral products, excipients such as lactose, starch, methylcellulose, magnesium stearate, etc., had long been used in the manufacturing of OTC finished products without raising safety concerns, and were therefore not examined. However, there were a number of exceptions where inactive ingredients had a noticeable (and usually detrimental) impact on safety...

Seasonal Patterns of Disease

A third factor subject to seasonal changes is morbidity. In most cases the slack season is also a wet season and the environmental changes may lead to seasonal outbreaks of diseases, such as acute respiratory infections, gastrointestinal tract infections, but also other infectious diseases such as measles, malaria, and guinea worm. Overall mortality also increases. A study in Mali showed that the duration of disease episodes in the rainy season was more than double that in other seasons and that the morbidity episodes in the rainy season accounted for more than half the yearly episodes, particularly fever, diarrhea, and respiratory illness.

Stress and immunity in human studies

Ous than those who did not, and the students who reported greater social support also gave a stronger immune response to the vaccine. In another study, volunteers completed questionnaires assessing degrees of perceived psychological stress and then were inoculated intranasally with rhinovirus under controlled conditions in an isolation unit. They were then monitored for the development of evidence of infection and common cold symptoms. The results showed that perceived psychological stress at the outset correlated strongly with increased risk of acute respiratory infection, increased viral shedding in the nasal mucosa and decreased antiviral antibody titers. Recent research on elderly people experiencing the chronic stress of long-term caring for relatives with dementia discovered that, compared with a suitably-matched control group, their inflammatory cytokine responses were diminished, they healed wounds more slowly, and their immune responses to influenza virus vaccination was...

Type V hypersensitivity

See also Acute inflammatory reaction Allergens Anaphylatoxins Antiglobulin (Coombs') test Arthus reaction Atopic allergy Autoimmune diseases Blood transfusion reactions Cell-mediated immunity Contact hypersensitivity Delayed-type hypersensitivity Eczema Food allergy Granuloma Hemolytic disease of the newborn Immune complexes Rhinitis, allergic Sarcoidosis.

Selected Issues in Clinical Development

Randomized, double-blinded, placebo-controlled clinical trials, while generally regarded as the gold standard for scientific proof of the efficacy and safety of most new drugs, are limited in their application by ethical, scientific, and practical considerations (Fig. 8.38). In certain instances, while generally accepted effective standard treatment does exist, withholding it and using placebo may be acceptable, as in, for example, antihistamines in allergic rhinitis. In other clinical settings as, for example, in virtually all serious infections, the sequelae of withholding treatment would be medically unacceptable, thus mandating the use of a positive control of currently available approved therapy.

A A Biological Clock in Hypothalamus

Evidence that the hypothalamus is involved in the control of sleep emerged from a large literature dating to the early 1900s. Lesion studies correlating anterior hypothalamic damage with insomnia and caudal hypothalamic damage with somnolence were particularly informative. These and subsequent studies resulted in the concept of hypothalamic sleep centers. A fascinating recent literature has demonstrated a cellular basis for hypothalamic influences on sleep and also provided insights into the means through which temporal organization is imparted on this behavior. It is now apparent that at least two distinct populations of neurons in the rostral and caudal hypothalamus are responsible for the hypothalamic effects on sleep. Using a creative experimental approach, it was demonstrated that neurons in a circumscribed region of the preoptic area the ventrolateral preoptic nucleus (VLPO) in rats express Fos, the protein product of the protooncogene c-fos, shortly following the onset of...

Applying an Integrated Cultural Epidemiological Approach

Culture influences the patterning of disease through many pathways, ranging from who is counted to what is noticed to where people obtain help for suffering. Its influence can be seen in the varying ways parents try to protect their children from the common cold, as well as in the differential power of epidemiology across nations. More complete understanding of the range of cultural influences on disease patterning will come as more frequent and profound interactions take place between the disciplines of medical anthropology and epidemiology, among others. Some examples of existing collaborative projects are summarized in this volume. As a start, let us consider a cultural approach to a biomedically accepted entity, epilepsy, and an epidemiological approach to a culture-specific syndrome, ataque de nervios.

Developing Countries Perspective

The significant precipitating risk factors for FS include the degree of fever20 and the frequency of febrile illnesses.21 The most commonly reported febrile illnesses are upper respiratory tract infections and otitis media.10 Children with primary infection with human herpes virus-6 (HHV6) often develop FS.2 The pattern of the underlying febrile illness is similar in both developed and developing countries.10,26 However, certain infections like exanthematous fevers and malaria are still endemic in the developing countries. In Central Africa, malaria accounts for five per cent of pediatric emergencies.27,28 Vivax malaria is a frequent cause of typical FS in the endemic regions and FS can be the presenting feature of Falciparum malaria.14,27

False food allergy or pseudoallergy

These types of reaction outnumber the true immunologically mediated ones. Various clinical syndromes are also known to be induced by such reactions, for example chronic urticaria, anaphylactic shock, intermittent diarrhea and irritable bowel syndrome, migraines, rhinitis and asthma. Table 3 lists some of the substances and mechanisms implicated in false food reactions.

Principal Mechanisms and Pathophysiology of Food Intolerance

The term 'allergy' implies a definite immunological mechanism. This could be antibody mediated, cell mediated, or due to circulating immune complexes. The clinical features of an allergic reaction include urticaria (nettle rash), angioedema, rhinitis (sneezing, nasal discharge, blocked nose), worsening of pre-existing atopic eczema, asthma (wheezing, coughing, tightness of the chest, shortness of

Was the result for the primary outcome clearly stated in the conclusion and supported by the confidence interval

Karlowski TR, Chalmers TC, Frenkel LD, et al. Ascorbic acid for common cold. A prophylactic and therapeutic trial. JAMA 1975 231 1038-42. 2. Karlowski TR, Chalmers TC, Frenkel LD, et al. Ascorbic acid for common cold. A prophylactic and therapeutic trial. JAMA 1975 231 1038-42.

Nature And Significance Of Insomnia

Insomnia, characterized by difficulty initiating, maintaining, or obtaining qualitatively satisfying sleep is a widespread health complaint. Like the common cold, most individuals have experienced at least transient bouts of nocturnal sleep difficulty due either to an impending stressful (e.g., final exam) or exciting (e.g., a long-awaited vacation trip) event or due to

TABLE 1192 Standards for Tachypnea in Infants and Children

The clinical presentation may be suggestive of the etiologic agent. Two classic presentations have been described for pneumonia typical pneumonia and atypical pneumonia. Typical pneumonia is characterized by abrupt onset of fever, chills, pleuritic chest pain, and productive cough. Associated physical examination findings include high-grade fever, localized findings on chest examination, and a toxic appearance. Atypical pneumonia is characterized by gradual onset (over days) of headache, malaise, nonproductive cough, and low-grade fever. Associated physical examination findings may include wheezing, prolonged expiration, rhinitis, conjunctivitis, pharyngitis, and rash. The typical pattern is generally thought to be associated with a bacterial pathogen, and the atypical pattern is thought to be more characteristic of a viral infection however, significant overlap exists, and identification of a causal agent based on clinical presentation is not always reliable. 31

Food Intolerance and Allergy

In the blood stream are called basophils. Basophils and mast cells contain granules filled with active chemicals (mediators) thatcanbereleasedduringanallergicor inflammatory response. The mechanism hypersensitivity (Type I Figure 10.1), is composed of two major events. The first event or sensitization is when an allergen(antigen)isconsumed.Otherroutes of exposure can be portals for Serum concentration of IgE is low comparedwiththatofotherimmunoglobulins, and its serum half-life is relatively short (Table ).Once theallergenisconsumed, the individual become sensitized. Sensitization results in production of allergen-specific IgE antibodies, which then bind to local tissue mast cells and on entering the circulation bind to circulating mast cells, basophils, and other tissue mast cells distal to the original site of entrance. The second event occurs after subsequent exposures or reexposure to the allergenic material, whereupon the allergen crosslinks two IgE antibodies on the surface...

Immunity and Vaccination

Immunity (the ability to resist infection based on mobilization of the immune system) to many diseases can result from a prior infection of the same agent. Getting the measles, for example, protects the host from being infected again later. Thus, a person can contract many diseases only once. Colds and influenza, on the other hand, stem from viruses that continue to produce new strains that avoid the body's predeveloped defenses, so that they may be contracted repeatedly. Prior exposure also does not protect against many microbial toxins, such as those involved in botulism food poisoning or against some parasitic infections, such as schistosomiasis, tapeworm, and athlete's foot.

Biological functions of IgE

On the whole, allergy is a concern in the more highly industrialized parts of the world, where immunology is mainly practised and where intensive efforts are being made to understand the 'pathogenesis' of allergy. Allergic conditions include hayfever or rhinitis (the most common), asthma, atopic dermatitis, food allergy and allergic uveitis (affecting the eyes). Anaphylactic shock is the only manifestation of the response that is systemic in nature, and thus differs from the others, which predominantly affect single organs. There has been an alarming increase, corresponding to a 10-year doubling rate, in the incidence of allergic disease in the industrialized parts of the world over the last few decades. Now one in five adults suffers from some form of allergy and a similar proportion of children suffer from asthma. IgE is implicated in the pathogenesis of allergy, as a key component in both the afferent (by way of dendritic cells and B cells) and the efferent (by way of mast cells...

TABLE 1206 Differential Diagnosis of Asthma

INFECTION Fever and focal wheezing implicate infectious etiologies such as pneumonia or bronchiolitis. Nocturnal wheezing, nocturnal cough, and poor exercise tolerance may be clues of more chronic illness. Sinusitis can exacerbate asthma symptoms a history of nasal congestion and nocturnal cough or snoring should be treated with at least a 2-week course of antibiotics and nasal steroids. Recurrent attacks, failure to thrive, and a history of sinusitis and chronic ear infections should raise suspicion of cystic fibrosis as an etiology.

Occupation and smoking

Respiratory diseases have known associations with those working in the food and food-related industries. These include occupational asthma, occupational rhinitis and hypersensitivity pneumonitis. Skin diseases such as contact dermatitis and contact urticaria are also associated with work in these industries.

Answers To Some Questions People Commonly

Dietary restrictions modifications are inevitable for the persons suffering from such disorders like colds, cough, constipation, piles, high B.P., diabetes, liver ailments, kidney ailments, heart ailments and obesity. A diabetic who continues to eat sweets cannot hope to improve with Reflex Zone Therapy.

Human Rhinovirus Coat Protein

The human rhinovirus (HRV) belongs to the family of picornaviruses and is the main cause for common colds and a variety of other respiratory illnesses, including otitis media and sinusitis, and for exacerbations of asthma and reactive airways disease. These illnesses still lack effective antiviral treatment. The viral capsid is a promising and intensively studied target for drug development. This protein shell encapsulates a single, positive RNA strand and consists of 60 copies of four different viral proteins. HRV coat protein inhibitors act as capsid-binding antiviral agents that block the uncoating of the viral particles and or inhibit cell attachment (Hadfield et al., 1999). Their binding site is located within a hydrophobic pocket situated at the bottom of a depression, a so-called canyon, on the capsid surface. In the absence of an inhibitor, this pocket can be empty or occupied by a pocket factor, a lipid or fatty acid. Structural conservation in this region among the different...

Diabetes And Endocrine Disorders

A patient with pheochromocytoma needs preoperative pharmacologic manipulation with alpha-blockade first, followed by possible beta-blockade. This is best accomplished by coordinated treatment of the patient by the surgeon, the anesthesiologist, and the referring physician. Alpha-blockade is suggested for 7-10 days preoperatively using phenoxybenzamine 10-40 mg orally twice daily (titrated to onset of nasal congestion and orthostatic hypotension). Beta-blockade is used only after adequate alpha-blockade. Beta-blockade is attained over the last three preoperative days with propranolol 10 mg orally twice daily. Beta-blockade is indicated in patients with tachycardia or tachyarrhythmia, and is not necessary in all patients.11

Henoch Schonlein Purpura

Henoch-Schonlein purpura (HSP) is a disease that manifests symptoms of purple spots on the skin, joint pain, gastrointestinal symptoms, and glomerulone-phritis. HSP is a type of hypersensitivity vasculitis and inflammatory response within the blood vessel. It is caused by an abnormal response of the immune system. The exact cause for this disorder is unknown. The syndrome is usually seen in children, but people of any age maybe affected. It is more common in boys than in girls. Many people with HSP had an upper respiratory illness in the previous weeks. Purpuric lesions are usually over the buttocks, lower legs, and elbows. Besides purpuric lesions, nephritis, angioedema, joint pains, abdominal pain, nausea, vomiting, diarrhea, and he-matochezia can be seen. The scrotum can also be affected in 13 -35 of cases (Ioannides and Turnock 2001). While the testis and or scrotum can rarelybe involved, usually the scrotum is diffusely tender with erythema distributed all over the scrotum....

Disorders associated with food allergens

Acute or chronic allergic rhinitis due to food is a problem well known to all allergists however, its true incidence is a matter of debate. According to various studies it varies from 2 to 25 of all rhinitis. Additionally, in chronic rhinitis, there is almost always a hyperactive component that can be ascertained following nasal challenge with histamine. According to various reports, secretory otitis media, particularly in its chronic form, may possess an allergic component in some cases. This is especially true where there exists a known allergy to foods with respiratory and gastrointestinal symptoms. The verification of such a problem is usually indirect, e.g. a clinical improvement being observed following an exclusion diet. According to some studies, up to 80 of patients with secretory otitis media also have an allergic rhinitis therefore investigation of the rhinitis can eventually help to identify the food component of the otitis. Patients with food-related migraine represent a...

Other symptomatic treatment

Ketotifen with antihistaminic and anti-inflammatory properties has been used in food allergic reactions such as urticaria and bronchospasm. It may be useful as an additional therapy in some patients. Beta-2 agonists such as salbutamol or terbutalin may be used when bronchospasm is a prominent feature in an allergic reaction. These drugs can be delivered by inhalation through a metered dose inhaler, in an aerosol form through a nebuliser, or by intravenous route. Food-related eczema and rhinitis should be treated along the standard line with topical steroids and antihistamine in addition to allergen avoidance.

Comparing Cultural Knowledge Across Different Settings

A closer look at what can be learned through a comparative approach. Three different approaches are examined here. The most ambitious of these is a collaborative, multisite study using a shared methodology to study intra- and inter-cultural variation in beliefs (Weller, Pachter, Trotter, & Baer, 1993, p. 109) for four geographically separated and distinctive Latin American samples. The illnesses are considered to be either biomedical or folk conditions. Weller and Baer (2001) present findings for five of the eight illnesses studied (AIDS, diabetes, the common cold, empacho, and mal de ojo with asthma, nervios, and susto also included in the larger design) and some detailed studies, comparing beliefs for individual illness conditions have been published (Weller et al., 1993, 1999). Noting that it is usually impossible to know if reported differences between cultures are due to cultural differences or due to a difference in methods used to study the cultures, the researchers...

Table 142 Etiology of epistaxis

Local irritants Cocaine, nasal sprays, cigarette smoke, toxic gases Inflammatory Rhinitis, sinusitis, granulomatous disease Mass lesions Nasal sinus tumors, carotid artery aneurysm Medications Anti-platelet agents, NSAID's, warfarin, heparin Systemic disease Liver renal failure, DIC, thrombocytopenia

The Paediatric Patient

Pre-operative assessment in children should be as rigorous as in adults and questions should be addressed to the child even though the parents may answer for them. Most children are healthy but chronic conditions such as asthma, multiple allergies, congenital heart disease and systemic conditions (such as muscular dystrophy) may also be encountered. The presence of one congenital abnormality should stimulate the search for others. Chromosomal abnormalities may be linked particularly with congenital heart disease. Except for true emergency surgery, children with colds or upper respiratory tract infections should have their surgery cancelled and rescheduled to a later date. The inflamed airway is exquisitely sensitive to any kind of manipulation, resulting in laryngeal spasm. Laryngeal spasm in children is particularly dangerous because of the rapid onset of severe desaturation, made more marked by their higher metabolic rate.

Assessment Of Children Suspected Of Having Heart Disease

The initial evaluation of ill children begins with the process of assessment and triage. Often, children present with symptoms unrelated to the underlying disease, and careful neurologic, pulmonary, and cardiac assessment must be performed to determine the stability of patients and the need for supportive care. From a cardiovascular perspective, this assessment determines whether the cardiac output is low, normal, or hyperdynamic. Concurrent conditions often exist, making definition of physical findings challenging. For instance, the symptoms and signs of increasing pulmonary venous pressure and the signs of a viral upper respiratory tract infection appear similar. What appears to be a feeding disorder with easy fatigue during routine feeds may represent congestive heart failure, particularly if diaphoresis is present with labored breathing. The physical examination of children with significant congenital heart disease is often not as dramatic as the diagnosis of congestive heart...

Metabolism of Chemotherapeutic Agents

While most significant associations between GST genotypes and clinical phenotype have not been replicated, a minority have been independently confirmed. For example, GSTP1 Val105 Val105 has been associated with reduced risk of airway hyperresponsiveness (odds ra-tio 0.23-0.38) in three studies in asthmatic adults and children. 20 This genotype is also protective against childhood respiratory illness. 21 The advent of high-throughput genotyping, availability of new SNP, and ease of deriving haplotypes should place an emphasis on large studies incorporating some assessment of reproducibility. Furthermore, assessment of further allelic GST sites associated with binding of peptides involved with cell signaling warrants further investigation.

Immunotherapy Of Allergic Diseases

Allergen immunotherapy represents the dominant immunologic, as opposed to environmental or pharmacologic, approach to management of allergic diseases such as allergic rhinitis, conjunctivitis and asthma. It was developed empirically, coincident with the modern-day discovery of allergy by Portier, Richer and von Pirquet. In essence, it involves identification of the allergen(s) to which a patient exhibits immunoglobulin E (IgE)-dependent sensitivity followed by subcutaneous administration of minute amounts of natural extracts containing these allergens. The goal is lasting modification of immune processes responsible for the maintenance of atopic symptoms. Other, infrequently used, forms of desensitization (i.e. IgE-mediated drug reactions)

Autonomic Dysreflexia

Common symptoms and signs of autonomic dysreflexia are a pounding headache, profuse sweating and flushing above the level of the lesion with pallor below the level of the lesion, nasal congestion, feeling of apprehension or anxiety, visual changes, and, most significant, a marked increase in systolic and diastolic blood pressure above baseline.12 Patients with spinal cord injury at or above the T6 level often have lower baseline systolic blood pressures, in the 90- to 110-mmHg range. Therefore, blood pressure elevations of 20 to 40 mmHg or systolic pressures of 130 to 150 mmHg are significant. Acute elevation in blood pressure is the most worrisome and potentially life-threatening manifestation of this syndrome.

The question of efficacy

In insect venom immunotherapy, protection is achieved in well over 90 of subjects following a short (usually several day) course of injections. Efficacy is commonly tested by deliberate administration of an insect sting challenge in the presence of a physician, yielding clear-cut evidence of success or failure. In contrast, the efficacy of immunotherapy for inhalant allergens, used in therapy of allergic rhinitis or allergic asthma, remains controversial. Proponents argue that allergen immunotherapy is highly effective and that the equivocal results are attributable to use of insufficient or poorly prepared allergen extracts, use of inappropriate or insufficiently rigorous criteria for patient selection or unwillingness of patients to complete a sufficiently long course of treatment. They draw support from statistically significant differences that have been observed in a number of parameters measured in randomized, double-blind, placebo-controlled studies. On this basis, the formal...

Otitis media with effusion

Clinical diagnosis is straightforward when otological examination shows a fluid level (Fig. 20.2) or bubbles behind the eardrum. In more subtle cases, tympanometric studies may be required. The finding of a flat (type b) tympanogram is diagnostic. Initial treatment of OME should be conservative. Coexisting allergic rhinitis, URTI should be adequately treated. The use of antibiotics is controversial. However if there is any evidence of acute otitis media, a course of antibiotics is advisable. Persistent OME is more effectively treated with myringotomy and insertion of a grommet (Fig. 20.3). In infants and young children, adenoidectomy

Type I hypersensitivity

Factors determining IgE rather than IgG production are not fully understood however, the nature of the antigen-presenting cells may be relevant. In atopic eczema and allergic rhinitis Langerhans cells which are HLA-DR positive and bear high-affinity IgE receptors have been described. Class switching to IgE is promoted by cytokines IL-4 and IL-13 and is inhibited by interferon y. In atopics increased levels of Th2 type T cells producing IL-4 have been described, e.g. in vernal conjunctivitis.

Motivation for Micronutrient Supplement

Major health reasons given for taking supplements include a sense of well-being and 'feeling better' (especially multivitamins minerals), preventing colds and flu (especially vitamin C), preventing chronic disease (especially vitamin E and calcium), increasing 'energy,' coping with stress, and improving the immune system. Many vitamin E users believe that the vitamin helps prevent heart disease, and most calcium users know that calcium use helps prevent osteoporosis. Using micronutrient supplements is one way by which people who may be at high risk for certain diseases try to gain some degree of personal control over their health outcomes. Ironically, many individuals who take supplements regularly report that they do not discuss the supplement use with their physicians because they believe that physicians are biased against supplements and are not knowledgeable about the products.

TABLE 2194 Emergency Department Treatment Options for Migraine Headache

Cluster headaches are characterized by very severe, unilateral orbital, supraorbital, or temporal pain lasting 15 to 180 min. The pain is such that patients can rarely lie still, and most are pacing and restless. The headaches are associated with at least one of the following signs on the ipsilateral side conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial swelling, miosis, or ptosis. They tend to occur in clusters, that is, daily on the same side of the face for several weeks, before remitting for anywhere from weeks to years.3

Hemodynamically Stable Symptomatic Patients

Moderate-sized VSDs cause elevated right ventricular pressure and subsequent increased pulmonary artery pressure. Infants with this defect present with increased cough with mild upper respiratory tract infections and may have mild increase in pulmonary vascularity and early congestive heart failure. Typically, the chest radiograph is interpreted as mild congestive heart failure, and treatment consists of furosemide and, occasionally, digoxin.

Pulmonary Disease

Early and late postoperative pulmonary complications were leading causes of morbidity and mortality in surgery. A detailed history should be obtained to evaluate the history of asthma, bronchospasm, duration of prior asthma therapy, previous hospitalization, steroid use, and prior need for mechanical ventilation. Elective surgery should be postponed in cases of acute upper respiratory tract infections. Additional information regarding smoking history (pack-years), nutritional status, concomitant heart disease, and current therapy including home oxygen use should be sought. Physical findings that suggest right ventricular failure include peripheral edema, a prominent right ventricular impulse, or neck vein distention.

Epidemiology

There is a close concordance between asthma, allergic rhinitis and atopic dermatitis the presence of one of these entities increases the relative risk of the other two by 3- to 30-fold over the lifetime of the subject. All three of these diseases are associated with high levels of nonspecific and antigen-specific serum immunoglobulin E (IgE).

Conclusions

In fatalities resulting from WFS in infancy and childhood, the question almost inevitably arises as to whether the child could have been saved if the diagnosis had been made earlier.9 Especially if a physician was consulted at the beginning of the disease, medical malpractice seems obvious to the parents. Because of the rapid clinical course of the disease and the rather unspecific findings at its beginning, even the clinical professional may not be able to distinguish WFS from a common cold or enteritis. Even if medical help is sought at an early stage of the disease, predicting the outcome in an individual case is impossible.142 By the time DIC presents, it often is too late to save the child's life.

Immunologic findings

These subjects seem to be vulnerable to a much more severe disorder characterized by the production of autoantibodies to blood components and or clotting factors. There is also a clinical impression that these subjects have an increased frequency of upper respiratory tract infections.

Tonsillitis

A common way of treating swollen tonsils is to remove them by surgery. This operation, called tonsillectomy, is considered the bread and butter of ENT surgeons. Indeed, millions of tonsillectomies are performed every year by doctors who make gullible parents to believe that tonsils are potent sources of infection and unless removed, may cause repeated attacks of colds, cough, sore throat, etc. In cities, very few children reach their teens with the tonsils intact. However, numerous studies conducted world-wide have shown that there is no reduction in the incidences of colds and cough in children without tonsils as compared to children with tonsils.

Novel treatments

Peptides have been synthesised which are able to bind to the IgE receptors. This will competitively inhibit IgE binding to the receptor. These peptides, therefore, have the capacity to block IgE-mediated reactions non-specifically. They may be useful in patients with multiple food allergies or other IgE-mediated diseases such as asthma and rhinitis. Several such peptides are in the developmental phase.

Conclusion

Over the years, whereas the collaboration between psychiatry and psychology has decreased, the interaction and reliance between psychologists and other medical specialists has increased. Specifically, psychologists often serve core roles in the treatment of patients under the care of cardiology, gastroenterology, obstetrics and gynecology, rehabilitation and physical medicine, oncology, surgery, pain clinics, and others. Each period in history made significant contributions to the development of behavioral medicine. Today, 75 of all patient visits in primary care practices can be attributed to psychological problems that present through physical complaints (Roberts, 1994 cited in Wickramasekera, Davies, & Davies, 1996). Furthermore, behavioral factors seem to be the bases of at least half of deaths seen or medical problems treated by physicians (McGinnis & Foege, 1993). These statistics do not differ greatly from 1977, when a study of U.S. family physicians showed that onehalf...

Coccidioidomycosis

Infection with the fungus Coccidioides immitis may manifest in an acute or chronic illness and may, in some persons, be maintained in an asymptomatic state. This fungus is endemic in the southwestern United States. Those demonstrating symptoms usually complain of an influenza-like febrile respiratory illness. The disease may disseminate in approximately 0.5 percent.

Influenza

Influenza viruses are divided into three types A, B, and C. Influenza types A and B are responsible for epidemics of respiratory illness that occur every winter. Type A viruses are divided into subtypes based on two surface antigens hemagglutinin (H) and neuraminidase (N). Three subtypes of H (H1, H2, and H3) and two subtypes of N (N1 and N2) are found among influenza A viruses. Currently circulating subtypes of influenza A are A(H1N1) and A(H3N2).

Latex Allergy

Immune reactions to latex products may take three forms irritant, contact dermatitis (type IV), and IgE (type I). Irritant reactions are nonimmune in nature and result in dry dermal erythema limited to the site of contact. Contact dermatitis occurs as a result of dermal exposure to chemicals used in the manufacturing of latex products. Thiurams and thiazoles are the most common chemicals to induce this type IV response.91 This reaction, which may extend beyond the site of contact, results in a dry dermal erythema, pruritus, weeping, and vesiculation. Such loss of skin integrity permits the access of latex proteins to the immune system and may result in an IgE-mediated response. IgE (type I) response is an immunologic reaction to protein allergens contained in latex. Clinical manifestations of such reactions include urticaria, asthma, rhinitis, angioedema, laryngeal edema, and anaphylaxis. IgE reactions may occur as a result of mucosal, dermal, contact, or inhalational exposure....

Respiratory symptoms

Difficulty and bronchospasm as part of a systemic reaction. Mild laryngeal symptoms are more frequently seen in food allergic patients and include throat tightness, itching in the throat or a dry cough. Patients at risk of systemic reactions should be very vigilant in avoidance and may need to carry a preloaded adrenaline syringe if there is a history of severe bronchospasm or respiratory difficulty. Some highly atopic patients with atopic dermatitis, in addition to asthma or rhinitis, may develop respiratory symptoms following ingestion of foods. This should be established, by history or double-blind challenge if required, and appropriate avoidance should be practised.

Icam1

ICAM-1 has been subverted by some human pathogens for their own use the major group of human rhinoviruses (causative agents of the common cold) use ICAM-1 as an obligate receptor for cell entry and infection, and red blood cells infected with the malarial parasite Plasmodium falciparum bind to ICAM-1 expressed on endothelial cells.

Pulmonary System

NSAID-induced bronchospasm is a well-described phenomena in patients with reactive airway disease. The spectrum of hypersensitivity reaction varies from rhinitis to severe bronchospasm with laryngeal edema. Patients with underlying reactive airway disease and nasal polyps appear to be at greater risk for these complications. Aspirin is most often involved in hypersensitivity reactions. Aspirin-induced bronchospasm occurs in 8 to 20 percent of all asthmatics and in 14 to 23 percent of asthmatics with nasal polyps.5 Cross-sensitivity between aspirin and other NSAIDs is believed to be as high as 90 percent. 6 The mechanism of this hypersensitivity to NSAIDs in asthmatics has not been identified but does not appear to be an immunoglobulin E-mediated event.

Basis of atopy

Environmental influences are also important smoking and the use of 3-blocking drugs in pregnancy increase the incidence of atopy in offspring. Early contact with highly allergenic proteins (as in cow's milk, eggs, fish, nuts, Der pi, Fel dl) before mucosal protective mechanisms, especially IgA, are fully established appears to contribute to allergy in genetically predisposed infants. Environmental risk factors for seasonal rhinitis include higher social class, being the first-born child and not having to

Prevalence

Since the 1980s there has been a worldwide increase in the prevalence of asthma in both children and adults. This escalating prevalence has led to significant increases in morbidity and mortality due to the disease. It is the most common chronic respiratory disorder, affecting 3-5 of adults and 10-15 of schoolchildren. Half of the people with asthma develop it before age 10, and most develop it before age 30. In childhood, it is twice as common in boys as in girls, but by adolescence equal numbers are affected. Asthma symptoms can decrease over time, especially in children. Many people with asthma have an individual and or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies or evidence of allergic problems.

Respiratory System

Lower Respiratory System Inferior Lobe

The upper respiratory system includes the nose and nasal cavity, the nasal sinuses, and the pharynx. The sinuses are open chambers in the face, connected to the nasal cavity by passages. Their function is to lighten the head, add timbre to the voice, and to produce mucus to moisten and lubricate the surfaces of the nasal cavity. Air passing through the nasal cavity is warmed, humidified, and filtered of large particles. The pharynx is the part of the respiratory system shared with the digestive system, extending from the back of the mouth down to the larynx.

NK cells in disease

Human diseases associated with NK cell abnormalities can be categorized as NK cell deficiencies or excessive NK cell activity. In either case, only chronic abnormality in NK cell activity is considered pathologic, because transient changes accompany a variety of physiologically normal events (e.g. circadian variations, daily stress, exercise or common cold). In every individual, NK activity fluctuates over time, but it can be quite precisely defined as a baseline level of NK cell activity SD by performing serial NK cell assays. The baseline level of NK cell activity is a characteristic trait for every individual. On the other hand, persistently low or high levels of NK cell activity are likely to be associated with disease. Chronically low levels of NK cell activity are seen in cancer, acquired or congenital immunodeficiency diseases (e.g. acquired immune deficiency syndrome, AIDS), severe life-threatening viral infections (HSV.

Nervemuscle junction

Approximately two-thirds of patients recall an antecedent acute infectious illness that has usually abated by the time neuropathic symptoms begin. The interval between the prodromal infectious episode, usually an acute respiratory illness or a dysenteric episode, is most often from 1 to 3 weeks, occasionally longer. Twenty per cent of cases follow Campylobacter jejuni enteritis. Ten per cent of cases follow the glandular fever-like syndrome caused by cytomegalovirus (CMV). At times, IgM antibody to CMV, presence of which argues strongly for infection with CMV in the immediate past, may be detected even when no recent illness can be recalled. It follows that the severity of the antecedent infection in no way correlates with the occurrence of a complicating polyneuritis. Five per cent of cases follow a surgical procedure. Usually blood transfusions have been given in such cases, and it is distinctly possible that CMV was introduced in the transfused blood. Five per cent of cases are...

Varicella Zoster

The varicella-zoster virus causes chickenpox in its primary infection, resulting in the typical vesicular eruption. It occurs most commonly in childhood but may affect patients at any age. The rash begins on the face and trunk, spreading to involve the entire body over the course of several days. Fever, malaise, pharyngitis, and rhinitis are associated. Vesicular involvement of the oropharynx is common and may precede skin involvement. Treatment is palliative, although special care in

Gm Csf Hantes

Figure 1 Mechanism of allergic rhinitis. (Reproduced with permission from Durham SR Hypothesis on mechanisms of allergic rhinitis.) To understand the role of different mediators that generate the signs and symptoms of allergic rhinitis, provocation tests with the mediator in question have been done, and the symptoms monitored. The other way to elucidate the problem is to use specific mediator antagonists which should produce further clues as to the effects of the mediator itself. So long as the effect is on the receptor mechanism it will be relevant. This is certainly the case as far as histamine with the antihistamines is concerned. There are variable amounts of histamine in nasal secretions in normal as well as in allergic nasal secretions. During a nasal infection some bacteria will increase the histamine level. Even so, histamine still remains the only mediator that behaves consistently in terms of release with local challenge, as well as producing most of the major symptoms....

Nasal blood vessels

In order to understand the pathological changes that occur in allergic and vasomotor rhinitis, it is necessary to consider in some detail the vasculature of the nose. It consists of four groups of blood vessels 1 ) precapillary resistance vessels, 2) capillaries. 3) veins and venous erectile tissue with venous sinusoids, and 4) arteriovenous anastomoses. Transudation of albumin occurs in nasal inflammation. This very stable protein may give a more reliable estimate of the inflammation than the relatively unstable mediators. The venous erectile tissue ma> be filled with blood. This filling determines the stare of con

Case scenario

Upper respiratory tract infection, he relapsed and within 3 weeks had progressed to alopecia totalis universalis once again. A second course of prednisolone failed to stimulate any regrowth. Topical immunotherapy over 6 months failed to initiate regrowth. Michael bought a wig, but found it uncomfortable to wear due to the heat in summer. In sympathy a friend at school shaved his head. Michael wore glasses with ordinary glass to disguise the loss of eyebrows and protect his eyes from dust etc. He elected to have intralesional corticosteroids into the eyebrows, which produced patch regrowth, around which he pencilled in his eyebrows. No other treatment was sought.

Nasal Decongestants

A few oral forms of decongestants are available for example, pseudoephednne (Sudafed), a close relative of the natural stimulant ephedrine. Since it goes into the mouth rather than the nose, it is less likely to cause rebound and dependence, but for some people and in high doses it is definitely a stimulant. Our old friend phenylpropanolamine is often identified as an oral decongestant when it appears in OTC cold remedies and cough syrups of course, it, too, is a stimulant.

Info

Infection As noted previously, a vicious cycle exists between VA deficiency and infection thus, infection can be viewed as a cause of deficiency. Prospective studies show that severe infections, such as measles, chicken pox, diarrhea, and acute respiratory illness, decrease serum as well as apparent hepatic levels of retinol and increase the risk of xerophthalmia. In some settings, measles has been observed to increase the risk of children developing corneal xerophthalmia by > 13-fold. In Indonesia, young children with diarrhea and acute respiratory infections were also twice as likely to develop mild xerophthalmia (XN or X1B) than apparently disease-free children. Similar patterns have been observed in undernourished populations of women, whereby maternal infection early in gestation raises the risk of becoming night blind later in pregnancy. Explanations for a role of infection as a cause of VA deficiency include decreased absorption of vitamin A, increased metabolic requirements,...

Associated morbidity

Markers of atopy as a whole are associated with an increased risk of developing adverse food reactions. Thus asthma, eczema and rhinitis are increased in children with food allergy compared to the general population (Zeiger and Heller 1995, Hide et aJ. 1996). The strongest association is between eczema and food allergy, and the risk appears to be greatest in infancy and in those with moderate to severe eczema (Burks et aJ. 1998, Sampson 1996). The literature appears to be best for peanut allergy. One study found that in peanut-allergic children atopy in some other form was present in up to 96 of subjects (Ewan 1996). In the Isle of Wight birth cohort study half of the children with peanut allergy had asthma and two-thirds had eczema, considerably higher than the rates in the cohort as a whole (Tariq et aJ. 1996).

Genetic factors

If either parent has a history of an allergic disease then siblings are at increased risk of developing allergic disease, which includes eczema, asthma, allergic rhinitis and food allergy (Zeiger and Heller 1995). The risk is greater if either parent is atopic, and increases if both parents are atopic. In children with cows' milk allergy, a family history of atopy in first-degree relatives has been found in 23-80 of cases (Goldman 1963, Ventura 1988, Host 1990). Findings from a Danish study looking at skin reactions to foods are presented in Table 10.14, confirming the association of food allergy and family history of atopy (Kjellman 1983).

Immune Function

The immune system appears to be particularly sensitive to zinc deficiency, in comparison with the rest of the body. Lymphopenia and thymic atrophy are observed, and both cell-mediated and antibody-mediated responses are reduced. As with growth, multiple mechanisms appear to be at play. In addition to its generalized effects on DNA synthesis, zinc deficiency appears to induce apoptosis, resulting in a loss of B-cell and T-cell precursors within the bone marrow. Thymulin is a zinc-dependent enzyme that stimulates the development of T cells within the thymus. The production of cytokines by mono-nuclear cells is also reduced by zinc deficiency. It appears likely that these effects can be of clinical significance. Infections occur more frequently in individuals with acrodermatitis enteropathica, and reduced immune function is accompanied by zinc deficiency in several other conditions, including sickle-cell anemia and various gastrointestinal disorders. In the USA, zinc lozenges have become...

Zinc Toxicity

Fact is clinically useful in individuals with Wilson's disease, a condition of copper toxicity. In the USA, an upper limit of 40mgday-1 has been set for adults, because of the threat to copper status. The popularity of zinc lozenges for treatment of the common cold could lead to this intake being exceeded. Thus, the use of these treatments should be of limited duration.

Fast Cardiac Rates

Most children younger than 3 or 4 months of age will have no cause for the tachycardia that can be easily identified. Children over this age often have underlying structural defects or precipitators, such as fever or exposure to sympathomimetic cold remedies. Older children and adolescents are more likely to have accessory pathways. Recurrence rates for accessory pathway disease are as high as 90 percent, and recognition allows for more directed therapy at the AV node.

Thyroiditis

Subacute thyroiditis, also known as de Quervain's, granulomatous, or giant cell thyroiditis, is an acute, self-limited inflammatory condition of the thyroid gland. It is characterized by neck pain, fever, myalgias, malaise, mild to moderate thyroid enlargement, exquisite neck tenderness and symptoms of thyrotoxicosis which occur during the initial phase of inflammation. Most patients have a history of an antecedent flu-like or upper respiratory illness. The cause for subacute thyroiditis is multifactorial. It appears that a viral infection triggers an abnormal cell mediated immune response directed at the thyroid follicular cells causing follicular cell destruction and release of preformed thyroid hormone. In addition to infection and autoimmune factors, a genetic predisposition may also be important in the patho-genesis as suggested by the association of the HLA BW35 haplotype with subacute thyroiditis in certain patients.9 The diagnosis is supported by the presence of a markedly...

Therapeutic Uses

Because of the bronchial muscle relaxant effect, caffeine is used in chronic obstructive pulmonary disease and for the treatment of asthma. The use of caffeine in the treatment of children with minimal brain dysfunction, to increase the duration of elec-troconvulsive therapy-induced seizure, for allergic rhinitis, as well as for atopic dermatitis has also been described. Recently, caffeine has been used as a diagnostic test for malignant hyperthermia and in the diagnosis of neuroleptic malignant syndrome, a complication of neuroleptic therapy. Caffeine is found in many drug preparations, both prescription and over-the-counter. Caffeine is present in drugs used as stimulants, pain relievers, diuretics, and cold remedies. When used as an analgesic adjuvant, the potency of the analgesic drug is significantly enhanced by the addition of caffeine.

Neck Masses

These cysts commonly enlarge after an upper respiratory illness. Lymphangiomas are most commonly found in the lateral cervical region along the jugular chain of lymphatics as a result of sequestration of lymphatic channels and failure to communicate with the internal jugular system. Sixty-five percent of these soft, painless, compressible lymphangiomas are present at birth, and 90 percent are clinically detectable by the end of the second year of life. 44 Large lesions may result in airway and feeding problems. Hemangiomas are congenital vascular malformations that on physical

Acute otitis media

Following an upper respiratory tract infection (URTI), as ascending infection through the Eustachian tube. The natural course of acute otitis media is best described in four stages hyperaemic, inflammatory, suppurative and resolution phases. In the hyperaemic phase, the patient has otalgia without hearing loss and otoscopy reveals a hyperaemic eardrum. The inflammatory phase that follows is characterized by increasing otalgia and hearing loss. Fever is usually present at this phase. Otoscopy reveals a hyperaemic eardrum and middle ear effusion. The disease reaches a climax at the suppurative phase. The patient often becomes irritable because of intense otalgia and hyperpyrexia is frequently present. Otoscopy reveals pus collecting behind a bulging and intensely hyperaemic eardrum. The eardrum is now under severe tension and may rupture spontaneously. Once the eardrum ruptures, the condition enters the resolution phase. All the symptoms especially otalgia resolves rapidly.

Demodicosis

Infestation with D. cati and generalised skin disease involving the head neck, trunk and limbs may be associated with variable pruritus and should prompt a close examination for underlying factors. These may include feline leukaemia virus (FeLV) infection, FIV infection, toxoplasmosis, long-term glucocorticoid therapy, iatrogenic hyperadrenocorticism, diabetes mellitus, upper respiratory tract infection and systemic lupus erythematosus (SLE).

SARSCoV Protease

Severe acute respiratory syndrome (SARS) is a respiratory illness that had a widespread dramatic outbreak in Asia, North America, and Europe in early 2003 (Lee et al., 2003). Evidence indicates that a previously unrecognized coronavirus exists, called SARS coronavirus, which is the leading hypothesis for the cause of SARS (Rota et al., 2003). It was known that the cleavage process of the SARS-CoV polyproteins by a special proteinase, the so-called SARS coronavirus 3C-like proteinase (CoV Mpro), is a key step for the replication of SARS-CoV (Fan et al., 2004). The SARS coronavirus 3C-like proteinase is considered as a potential drug design target for the treatment of SARS.

Sinusitis

This usually present with chronic nasal congestion and recurrent mucopurulent rhinorrhoea (Level 2 symptoms). There is usually an underlying cause such as nasal polyposis, a septal deviation, an abnormal middle turbinate, etc. The presence of any condition which obstructs mucous transportation out of the sinus will lead to recurrent infection and sinusitis becomes chronic. Therefore, surgery is frequently required as a definitive procedure. Functional endoscopic sinus surgery (FESS) which aims at re-establishing normal

Bronchiolitis

Bronchiolitis is acute wheezing-associated respiratory illness in early life preceded by signs and symptoms of an upper respiratory infection. Bronchiolitis is a highly A number of other viral agents also can cause bronchiolitis, although the illness is milder. The parainfluenza viruses are the second most common cause of bronchiolitis and are responsible for autumn and spring epidemics, usually preceding and following RSV outbreaks. Influenza type A virus can also precipitate bronchiolitis, along with adenovirus, rhinovirus, and Mycoplasma pneumoniae. The latter two agents are responsible for an increasing number of cases of wheezing-associated respiratory illness with increasing age, but RSV and parainfluenza viruses have been shown to provoke wheezing at all ages.