h pylori symptoms

25 Eylül 2012 Salı

Epinephrine autoinjectors are expensive, allergists suggest low-cost alternative: a prefilled syringe

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The wholesale price of 1 epinephrine autoinjector increased annually from $35.59 in 1986 to $87.92 in 2011 (147%). Among patients prescribed autoinjectors, only 40% of teens/adults and 60% of children less than 12 years of age had them refilled over a 6-year period. The retail price of the new "EpiPen 2-pak" that the patients often quote is more than $250 for each "pak". In August 2012, the FDA approved Auvi-Q - the first-and-only epinephrine autoinjector with audio and visual cues that guide patients and caregivers step-by-step through the injection process. No information about the price of Auvi-Q is available at this time but it is not expected to cost significantly less than EpiPen.

There are lower-cost alternatives to epinephrine autoinjectors. Recently, three allergists from the University of South Florida suggested in JACI thar prefilled epinephrine syringes made in a clinic can be safely provided to patients who cannot afford prescription autoinjectors.

Prefilled syringes are stable and sterile for 2 months in dry climates and 3 months in humid climates.

Materials needed to prepare a prefilled syringe are simple:

1. ampule containing 1 mg/mL epinephrine plus a preservative
2. disposable plastic 1-mL syringe
3. 23-gauge, 2.5-cm needle

Parents take 140 seconds to withdraw epinephrine from an ampule into a syringe, therefore a prefilled syringe is recommended.

Epinephrine is light sensitive, and the ampule and prefilled syringes should be protected from light by:

- wrapping them in aluminum foil
- keeping them in a light-free container, such as an eyeglasses case

This 2-minute video shows the Sanofi's new voice guided Auvi-Q epinephrine injector in action:

References:

Increasing cost of epinephrine autoinjectors. The Journal of Allergy and Clinical Immunology
Volume 130, Issue 3 , Pages 822-823, September 2012.

Image source: OpenClipArt.org, public domain.

Comments from Twitter:

Allergic Living @AllergicLiving: Would anyone prescribe epi syringe? + short shelf life. Should allergists press for a 1-pak too, as 1 better than 0? #foodallergy

‏@Allergy: As you know, EpiPen Single Packages were Discontinued 1 year ago. Only "2-paks" are available now: http://bit.ly/P7J0Ch

Allergic Living @AllergicLiving: That's my point, should they be "encouraged' to return as an additional option, perhaps by AAAAI?

Craig, CEN, CCRN @CraigCCRNCEN: My ANA kit with Benadryl also is cheaper and less painful to administer.

Tiffany @iknowtiffany: Yah, right. That's *perfect* for schools, parents in midst of crisis, carrying around at all times. #not

Neutrophilic inflammation as a possible explanation for a reduced treatment response in obese patients with asthma

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Increased number of neutrophils are present in the airways during the late-phase reaction after allergen challenge, in fatal or nocturnal asthma, and in severe asthma.

The incidence of asthma and obesity is increasing worldwide, and reports suggest that obese patients may have more severe asthma or reduced response to therapy. This study from the Netherlands included data from four asthma cohorts.

At baseline, FEV(1) and bronchial hyperresponsiveness were comparable in 63 obese (BMI equal or more than 30 kg/m(2) ) and 213 lean patients (BMI lower than 25 kg/m(2) ).

After a two-week treatment with corticosteroids, there was less corticosteroid-induced improvement in FEV(1) in obese patients (median 1.7% vs 6.3% respectively, P = 0.04). The percentage of sputum eosinophils improved significantly less with higher BMI.

The smaller improvement in FEV(1) and sputum eosinophils suggests a worse corticosteroid treatment response in obese asthmatics.

Editor’s note: Previous studies of anti-IL-5 agents showed benefit only in some asthmatic patients with predominantly eosinophilic inflammation. As a future research avenue, it would be interesting to see if localized anti-neutrophilic therapies can bring improvement in obese patients with asthma.

Question & Answer

In patients with asthma and chronic productive cough, polymorphonuclear (PMN) neutrophil leukocytes in sputum suggest:

(A) infection
(B) GERD
(C) presence of a foreign body
(D) exercise-induced asthma
(E) extrinsic asthma

Correct answers: A, B, C

References:

Obesity in asthma: more neutrophilic inflammation as a possible explanation for a reduced treatment response. Telenga ED, Tideman SW, Kerstjens HA, Hacken NH, Timens W, Postma DS, van den Berge M. Allergy. 2012 Aug;67(8):1060-8. doi: 10.1111/j.1398-9995.2012.02855.x. Epub 2012 Jun 12.

Image source: Wikipedia, free GNU license.

Practice parameter for allergy to furry animals

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Here are some excerpts from the new practice parameter for allergy to furry animals:

Patients with allergic disorders should be evaluated for sensitization to cat and dog allergens by skin prick testing or in vitro testing for cat and dog specific IgE.

Avoidance

Avoidance is the most effective way to manage cat and dog allergy. Patients should be advised to consider removing the cat or dog from the environment, if present, to improve respiratory health.

To reduce exposure to cat allergens with the cat still living in the house, a combination of measures, such as removing reservoirs, keeping the cat out of the bedroom, washing the cat, air cleaning with a HEPA room air cleaner, improving ventilation, and mattress and pillow covers, may be helpful.

Exposure to cat allergen

Complete removal of all cats is necessary to minimize cat allergen exposure in a home.

Cat characteristics, such as length of hair, sex, reproductive status, and time spent indoors, are not associated with levels of Fel d 1 in the environment.

To reduce transport of cat allergen, people should consider changing their clothes when traveling from a high cat allergen environment to a low cat allergen environment.

Hypoallergenic cats

Because 1 or more cat allergens are present in all cats, patients should not be advised that it is safe to obtain a hypoallergenic cat.

Exposure to dog allergen

Dogs should be excluded from rooms in which reduced exposure is desired.

Because 1 or more dog allergens are present in all dogs, patients should not be advised that it is safe to obtain a hypoallergenic dog.

Washing cats and dogs

Washing cats or dogs at least weekly can reduce airborne cat Fel d 1 or dog Can f 1; however, the clinical benefit is yet to be proven and the effect of washing is not sustained.

Primary prevention to avoid IgE sensitization

Although exposure to elevated cat or dog allergen concentrations before 3 months of age may reduce the likelihood of developing cat or dog sensitization, the risk reduction is not sufficient to justify a decision to get a cat or dog to avoid IgE sensitization.

Secondary prevention to avoid disease in IgE sensitized individuals

Cat and dog exposure should be minimized in cat sensitized individuals to reduce the likelihood of developing asthma.

Tertiary prevention to treat furry animal allergy

Exposure to cat and dog allergens should be minimized to reduce the likelihood of an asthma exacerbation in cat and dog sensitized schoolchildren and adults who already have asthma.

List of measure that are not proven efective to reduce clinical symptoms:

- washing the cat
- dry heat
- dust cleaning with vacuum cleaners
- air cleaning with a HEPA room air cleaner
- improving ventilation
- chemical treatments, such as tannic acid or hypochlorite bleach
- mattress and pillow covers

Animal Dander Avoidance (click to enlarge the image).

References:

Environmental assessment and exposure control: a practice parameter—furry animals. Annals of Allergy, Asthma & Immunology, Volume 108, Issue 4 , Pages 223.e1-223.e15, April 2012.
Image source: Wikipedia, GNU Free Documentation License.

Mobile Phone Spirometry with SpiroSmart App from University of Washington Computing Lab

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SpiroSmart is a mobile phone based platform that allows for the analysis of common lung function measures (FEV1, FVC, PEF). By analyzing lip reverberation, it is capable of monitoring pulmonary ailments such as asthma, chronic obstructive pulmonary disease, and cystic fibrosis.

From the manufacture's YouTube channel: SpiroSmart is a low-cost smartphone based system that performs "spirometry sensing" using the built-in iPhone microphone. It allows patients to keep track of their pulmonary "impairments" without going to the clinic. SpiroSmart can be effectively used by pulmonologists to diagnose varying degrees of obstructive lung ailments.

Home spirometry is gaining acceptance in the medical community because of its ability to detect pulmonary exacerbations and improve outcomes of chronic lung ailments. However, cost and usability are significant barriers to its widespread adoption. SpiroSmart is a low-cost mobile phone application that performs spirometry sensing using the built-in microphone. SpiroSmart was evaluated in 52 subjects, showing that the mean error when compared to a clinical spirometer is 5.1% for common measures of lung function.

To increase compliance, the target monitoring platform is the mobile phone, a sufficiently small device that is always with the patient. Additionally, the researchers are investigating methods to make the lung testing procedure part of a simple, yet engaging, game on the phone.

References:

Computing Lab - University of Washington http://bit.ly/Qtk8GY

23 Eylül 2012 Pazar

Healthy Lungs Tips - Surely will help you

Breathing is one of the most crucial functions carried out by the lungs.

Each and every breath taken by the lungs adds oxygen to the body and expels carbon dioxide.

They also protect the body from the harmful effects of the environment like infections and pollution.

Milk thistle or silymarin extract helps the lungs in fighting against toxins found in the environment.

There are many benefits of drinking green tea. It is highly effective in protecting the lungs against the development of cancer.

Avoid smoking or exposure to second-hand smoke. Smoking is the leading reason behind the development of lung cancer.

Avoid second hand smoke. If anyone smokes close to you, it is best to leave the area or ask them to stop smoking.

Patients who are dealing with lung cancer should seriously avoid second hand smoke as it can aggravate their condition.

Exercising is a good way to have healthy lungs. You can include running, walking, swimming and other cardiovascular exercises in your schedule to improve the functioning of your lungs. The more you exercise, the stronger your lungs will become.

It is also essential that you consume a nutritious diet in order to have healthy lungs. Different food types to eat should include:

Cereals, grains and breads that are high in fiber content.

Lean proteins like fish, eggs, turkey and chicken.

Sufficient amounts of water as it also helps in flushing out toxins.

You should avoid consuming excess amounts of oily food, salt, alcohol and caffeine. It has been found that proper nutrition and dietary habits have a strong effect on the functioning of lungs, and avoiding unhealthy foods can also help in avoiding lung diseases. In fact anti-inflammatory and anti-oxidant rich food has been found to be helpful in improving lung function and minimizing the development of lung diseases.

Avoid working in environments where there is excessive amount of particulate matter in the air. For example, people working in textile factories are prone to contracting Byssinosis caused due to intake of cotton and other dust particles.

Natural Yeast Infection Remedies - They will really work

Yeast Infection is common disease for both women and men.

Water is the most natural and important substance that we need to give our bodies.If do not have enough water it can contribute to the onset or worsening of almost any condition.

In the specific case of yeast infection drinking enough water will help to flush out the unwanted sugars in the system that feed the yeast.

Plain yogurt is a very effective natural remedy for this condition.The bacteria in the plain yogurt fight the yeast and help to bring the infection under control.

It can be used internally and externally, but it really must be plain, sugar free yogurt.

If you make the mistake of using yogurt with sugar you may actually feed the infection and make it worse, so please be careful.

One way to ensure your yogurt has only the ingredients you want is to make it yourself specifically as a remedy.

This way you can ensure that there are no unwanted additives in the mix.

Garlic , most people find it to be a really quick and effective remedy and like water and yogurt is easy to get hold of.

Applying it to the affected area can provide almost instant relief from the irritation you are experiencing from the infection.

It is best to used fresh garlic puree but you can buy garlic tabs from health shops. Either way garlic will provide great and quick results.

Apple Cider Vinegar - For this purpose it is best to put some into a hot bath and it will have a very soothing effect on the irritated area.