A One-Year Trial of Triamcinolone Acetonide Aerosol in Severe Steroid-Dependent Asthma

CorticosteroidsCorticosteroids have proven to be valuable in the treatment of asthma, but their use is limited because of the undesirable and often serious side effects from their prolonged administration. Al-temate-day administration has reduced, but not eliminated, these difficulties. As another means of reducing systemic side effects, administration of aerosol hydrocortisone, prednisolone, and dexa-methasone has been evaluated. These steroids were effective only at doses which suppressed adrenal function. Fluorinated steroid esters that are highly active topically show promise of controlling asthma at doses that do not produce systemic effects.

Triamcinolone acetonide, a nonpolar water-insoluble fluorinated corticosteroid, had been prepared in a metered-dose aerosol device propelled by dichlorodifluoromethane (Freon 12 J.” In a one-month double-blind controlled study involving 25 steroid-dependent severely asthmatic patients, triamcinolone acetonide aerosol proved superior to a placebo in reducing the oral requirement for corticosteroids. Herein we present the results of treatment of these severely asthmatic patients with triamcinolone acetonide aerosol for 12 months, emphasizing the long-term efficacy, side effects, and adrenal recovery. Hopefully, our experience will guide physicians in the management of asthmatic patients who will soon be making the transition from oral steroid therapy to aerosol steroid therapy.
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Canadian Health&Care Mall: Effects of Cigarette Reduction on Cardiovascular Risk Factors and Subjective Measures

cardiovascular risk factorsAlthough smoking cessation has been clearly demonstrated to reduce subsequent cardiovascular mor-tality, whether smoking reduction or “reduced exposure” products confer any health benefits is still unknown. Due to the difficulty in carrying out prospective, randomized studies assessing long-term outcomes data, use of other measures (ie, biomarkers) that are known to be altered during smoking and normalize during smoking cessation is an attractive alternative in researching risk reduction approaches. Partial normalization of reliable biomarkers during smoking reduction may indicate that this approach confers some health benefits especially if changes in the selected biomarkers are the underlying cause for smoking-related disease. To date, few studies have systematically examined the reliability and dose-responsiveness of biomarkers for CVD.

This study demonstrated that certain biomarkers of CVD risk factors (eg, hemoglobin, hematocrit, RBC count, WBC count, lipoproteins concentrations, heart rate, respiratory symptoms) known to be affected by smoking are relatively stable over time when amount smoking is maintained at a constant rate but are altered in response to changes in smoking behavior. This suggests that some of these measures are likely to be sensitive to changes in tobacco toxin exposure. The results seen in this study are consistent with two previous studies that assessed the effect of smoking reduction on various biomarkers. An open-label study in which subjects were encouraged to reduce smoking by at least 50% for 8 weeks and then quit smoking entirely for 8 weeks while using ad libitum nicotine nasal spray found significant decreases in WBC blood count, RBC count, hemoglobin, hematocrit, and fibrinogen with significantly increased HDL/low-density lipoprotein (LDL) ratio after both reduction and cessation. For WBC and RBC counts, greater improvements were observed after cessation than after reduction. Changes to LDL and HDL (decrease and increase, respectively) were statistically significant only after cessation, although nonsignificant changes were seen with reduction as well. A study of 25 subjects able to reduce smoking by > 50% found that these subjects had significantly higher HDL levels and significantly lower total cholesterol/HDL ratio, LDL, hemoglobin, hematocrit, FEV1, and systolic BP than observed prior to reduction. Canadian Health&Care Mall – http://healthcaremall4you.com/antihistamine-preparations-sold-by-canadian-health-care-mall.html is full of various drugs including Antihistamine Preparations.

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Results of Effects of Cigarette Reduction on Cardiovascular Risk Factors and Subjective Measures

SmokedRecruitment and Characteristics of Subjects

A total of 151 subjects were enrolled in this study, Of these, 102 subjects were randomized to the experimental group and 49 subjects were randomized to the wait list control (Fig 1). Among those in the wait list control, 3 patients dropped out during the wait list portion of the study and 13 patients dropped out during the reduction phase of the study. Of the participants randomized to the experimental group, no subjects dropped out prior to or during baseline measurements; a total of 25 subjects dropped out by week 6, 34 subjects by week 8, and 37 subjects by week 12 of treatment. In total, 98 of 151 subjects completed treatment through week 12, and 53 subjects dropped out. Table 2 describes the characteristics of all randomized subjects, subjects who reduced by at least 40% at week 4, from weeks 4 to 6, and from weeks 4 to 12. Logistic regression was used to compare the groups on differences in demographics and smoking history. The only significant differences among these groups were for age between all randomized subjects compared to those subjects who constituted the sample for visit 4 (p = 0.0031), visit 6 (p = 0.001), and visit 12 (p = 0.02); for years smoked between all randomized subjects and subjects who comprised the sample for visit 4 (p = 0.04) and visit 6 (p = 0.01); and for motivation to quit between all randomized subjects, compared to subjects who comprised the sample for visit 12 (p = 0.03) and between subjects who comprised the sample for visit 4 compared to visit 12 (p = 0.05). The results show that subjects who were older (odds ratio, 1.04, p = 0.02) and reported more motivation to quit (odds ratio, 1.13; p = 0.04) were more successful in sustaining reduction through week 12.

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Canadian Health&Care Mall: Research about Effects of Cigarette Reduction on Cardiovascular Risk Factors and Subjective Measures

Cigarettes per dayStudy Design

Details of the study design have been described previously. In brief, cigarette smokers from 18 to 70 years of age and interested in significantly reducing cigarette use were recruited. Inclusion criteria included the following: (1) smoking from 15 to 45 cigarettes per day (CPD) for the past year (in order to reduce heterogeneity); (2) uninterested in and no plans for quitting in the next 30 days; (3) good physical health (no unstable medical condition); (4) no contraindications for nicotine replacement use; (5) good mental health (eg, not meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,11 criteria for any psychiatric diagnosis, including substance abuse, within the past 6 months); (6) not using other tobacco or nicotine products or medications that might affect tobacco use or be affected by reduction of tobacco use; and (7) for female subjects, not pregnant or nursing. The University of Minnesota Institutional Review Board approved this study and the informed consent procedures. Improve your mental state with Wellbutrin sold by Canadian Health&Care Mall – http://healthcaremall4you.com/canadian-healthcare-mall-wellbutrin-sr-300-mg-in-treatment-of-mental-disorders.html.

Subjects who met inclusion criteria monitored their use of cigarettes (and other tobacco products) on a daily basis for a period of 2 weeks to assess baseline tobacco use. The following week, subjects returned for the baseline visit (visit – 1), when they were randomly assigned to the experimental cigarette reduction group or to the wait list control group for 6 weeks. Subjects monitored their smoking for another week, after which baseline measures were repeated at a second baseline visit (visit 0). Subjects assigned to the wait list control were the basis for the analysis that examined the consistency or intrasubject reliability across the various biomarkers for health risks or tobacco toxin exposure. This group was required to maintain and monitor smoking for a total period of 8 weeks. Subjects were assessed on all dependent measures during the first two baseline visits and then at weeks 4 and 6 after the second baseline visit. After the 8 weeks of ad libitum smoking, subjects entered the treatment reduction phase as described below.

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Autoimmune attack underlying kidney failure

Autoimmune DiseasesInterstitial nephritis, a common cause of kidney failure, has a complex and largely unknown pathogenesis. In a new published paper in The Journal of the American Society of Nephrology (JASN), a team of researchers led from Karolinska Institutet shows how interstitial nephritis can develop from an autoimmune attack on the kidney’s collecting duct.

Interstitial nephritis describes a type of morbid lesion often seen in patients with kidney failure that is characterised by tubular atrophy and interstitial scarring. The condition can develop from diverse backgrounds, such as adverse reactions to drugs, hypertension and diabetes; in many patients, however, the underlying cause is never identified. Continue reading “Autoimmune attack underlying kidney failure”

Effects of Cigarette Reduction on Cardiovascular Risk Factors and Subjective Measures

Cardiovascular diseaseAlthough the idea of reducing tobacco toxin exposure among continuing smokers is not a new concept, recent efforts by the tobacco industry to develop and market potential reduced-exposure products have resulted in an increased interest in examining this approach. The escalating introduction of potential reduced-exposure products has prompted the US Food and Drug Administration to sponsor a report from the Institute of Medicine and for the National Cancer Institute to convene an expert panel to consider the feasibility of this approach, the necessary science and systems that need to be in place in order to ensure public health, and the specific research areas that will need to be pursued. The identification of reliable and valid biomarkers for tobacco toxin exposure was determined to be a particularly important area of research.

Biomarkers can be considered as measures of the following: (1) toxins specifically related to exposure of tobacco constituents, such as nicotine or tobacco-specific nitrosamines; (2) risk contributors to disease, such as lipoproteins, C-reactive protein, WBC count; (3) disease markers such as pulmonary function; or (4) clinical outcome measures, such as hospitalizations, occurrence of disease, or death. Smokers compared to nonsmokers have significantly elevated risk factors for cardiovascular disease (CVD), and these risk factors improve among smokers after cessation of cigarettes. To date, few studies have examined the effects of changes in cigarette dose on cardiovascular risk factors. Of the studies that currently exist, the results show significant improvement on these measures; however, the sample sizes have tended to be small, and no control groups have been used.

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Consideration of A Nosocomial Outbreak of Influenza A

influenza seasonThe first reported outbreak of influenza A during 1974 occurred in the third week of February at the University of Illinois in Urbana. Within two weeks, outbreaks were reported on the east coast. During the 1973-1974 influenza season, the mortality due to pneumonia and influenza for all 121 reporting cities in the United States did not rise significandy above the endemic level, except during the weeks of March 1 through April 30. The late onset of the outbreak almost certainly accounted for the delay in considering the diagnosis in the present series. This small epidemic was six days old, and all nosocomial cases had become symptomatic before the correct diagnosis was even considered. The present nosocomial outbreak lasted only seven days, and thereafter, no new cases of influenza-like illness were seen in the hospital.

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Outcomes of A Nosocomial Outbreak of Influenza A with Canadian Health&Care Mall

bilateral bronchopneumoniaIndex Case

The index case was a 38-year-old woman hospitalized a week earlier for hypertension and hyper-lipidemia. She developed fever and signs of bilateral bronchopneumonia. The patient had been transferred to the intensive care unit, where a diagnosis of hospital-acquired viral respiratory disease was considered because of the negative cultures of blood and sputum, the bilateral diffuse involvement on the chest x-ray film, and the lack of evidence for hematogenously disseminated bacterial pneumonia, aspiration, or congestive heart failure. A search of this patient’s original hospital ward revealed seven other cases, which are described in Table 1.

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