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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although cyclosporin is effective for the treatment of severe atopic dermatitis, phototherapy is the standard second-line treatment for this disease. An open, randomized, controlled, parallel-group study was conducted to compare the efficacy, influence on quality of life and safety of cyclosporin and UVAB phototherapy during 1 year of intermittent treatment of atopic dermatitis in adult patients. The main endpoints of the study were the number of days in remission and the influence on quality of life. Seventy-two patients were treated, 36 in each group. Cyclosporin produced significantly more days in remission than UVAB phototherapy during the 1-year study period. At the end of the study no difference between the 2 groups was noted in terms of quality of life. A significant increase in serum creatinine occurred in 2 patients and 7 patients developed mild or moderate hypertension during cyclosporin treatment. It can be concluded that intermittent cyclosporin seems to be more effective than UVAB and is reasonably safe for the treatment of atopic dermatitis over a 1-year treatment period.
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PMID:Comparison of cyclosporin and UVAB phototherapy for intermittent one-year treatment of atopic dermatitis. 1141 8

Despite psoriasis being a common skin disease, there are still a number of unanswered questions. One of these is the prevalence of the disease, as there is a lack of specific data, with the majority of studies reporting estimates only. Population based studies are rare and longitudinal observations on changing prevalence rates are lacking. This contrasts with other T-cell mediated autoimmune diseases where the number of those affected is rising. Epidemiological studies revealed that a distinct group of diseases is quite frequently associated with psoriasis, e.g. arthritis, colitis, diabetes and hypertension. In contrast, atopic dermatitis and allergies are less frequently seen compared to normal rates of occurrence. As the psoriatic immune response pattern relates to activated Th-1 cells, psoriasis and atopic dermatitis appear to be mutually exclusive due to the Th-1/Th-2 dichotomy.
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PMID:Psoriasis--epidemiology and clinical spectrum. 1142 82

Poor adherence with prescribed therapy often results in decreased efficacy, annoying for patient both and physician. Negative health improvement adds extensive costs to the healthcare system. Thus, physicians need to carefully examine medication adherence before investigating possible pharmacologic reasons for drug failure or initiating alternative treatments and special diagnostic tests. Documenting medication adherence can also help with the development of new drugs and establishing optimized treatment regimens. Reliable distinction between non-adherence and nonresponse is a new issue for medicine, the pharmaceutical industry and its regulators. Investigation of adherence patterns has been established on evidence-based clinical and biostatistical research agendas. Originally, the term 'compliance' was used to describe how a patient adheres to a recommended therapy plan. Subsequently, 'compliance' has been changed to the more appropriate term 'adherence'. Several approaches to studying the relationship between medication adherence and medical outcome exist. This article provides an overview on medical adherence and methods of measuring adherence, especially electronic monitoring. Traditional methods of adherence assessment (patient interview, diaries, questionnaires, pill counts, prescription refill surveys) often do not deliver reliable data. Thus, researchers have tried to approach adherence by measuring serum drug concentrations or other biologic or chemical markers to gain more objective data. However, the state of the art for analyzing adherence is the use of electronic monitoring devices, electronic event monitors. Such devices not only provide more reliable data but also more detailed data about actual patient adherence, such as dose frequency, dose time, dose interval and dose timing--details that traditional methods do not show. Electronic monitoring shows that poor adherence, especially dosage omission or changing intervals, is more prevalent than previously recognized. The detailed adherence patterns provided by electronic monitoring show the need for a new kind of drugs. These drugs should provide good therapeutic coverage despite dosage omission and are therefore called 'forgiving pharmaceuticals'. Adherence and medical outcome have been extensively studied in patients with psychiatric disorders, hypertension and other cardiovascular disorders and most recently in patients receiving HIV/AIDS therapy. But non-adherence can be found in any medical field. Regarding the lack of equivalent studies on adherence and therapeutic efficacy in treating skin diseases, this topic should be looked at more closely in dermatology. Recalcitrant atopic dermatitis, psoriasis, tinea pedis and acne would be ideal study areas.
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PMID:Electronic monitoring in medication adherence measurement. Implications for dermatology. 1170 22

Ciclosporin, produced by the fungus Tolypocladium inflatum GAMS is endowed with potent immunosuppressive properties. Ciclosporin interferes with nuclear factors of activated T-cells, specifically by preventing cytokine gene transcription, particularly interleukin-2, which induces maturation and proliferation of helper T-cells. Initially, a traditional formulation of Sandimmun(R) was used, but its oral bioavailability varies. Absorption of a new formulation, Neoral(R), is significantly better and more reproductible. Ciclosporin has become a major agent in the prevention and treatment of organ transplant rejection. It is also efficient in treating various immune-related diseases. In dermatology, its efficacy has been proven in numerous double-blind, placebo-controlled studies for severe psoriasis and atopic dermatitis. Treatment with ciclosporin is also beneficial for many dermatologic diseases. However, the effect of this drug has principally been studied in open trials and in small cohorts. Ciclosporin provokes serious adverse reactions especially nephrotoxicity and arterial hypertension. Treatment is occasionally stopped because of these complications. The other common side-effects include muco-cutaneous, neurological and gastro-intestinal symptoms. Increased risk for malignancy is reported with ciclosporin. However, in patients with cutaneous diseases, the incidence is low.
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PMID:[Ciclosporin]. 1205 38

Atopic dermatitis is a chronic inflammatory skin disease, with inherited predisposition. It has typical morphology and distribution. Patients generally can be controlled with the use of moisturizers and topical steroids. In severe cases, it is recommended the use of alternative management. Cyclosporine is an immunosuppressor drug which inhibit the expression of T activated cells. Many open and placebo-controlled trials have been made evaluating its use, efficacy and security, in adults and children. The results suggest an initial dose of 5-6 mg/kg per day and reducing the amount according to response (load dose and maintenance dose) at long term in order to reach complete remission after withdrawal of treatment and limit adverse effects, like renal toxicity and hypertension. The immunological changes in AD patients treated with cyclosporine include eosinophil count reduction, besides lower levels of E-selectin, and soluble CD30 (known as disease markers), but overall, it corrects the imbalance between Th1 and Th2 response present in these kinds of diseases.
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PMID:[Cyclosporin A in atopic dermatitis]. 1237 46

In the last few years, there has been growing interest in the use of cyclosporin to treat canine skin diseases. Cyclosporin exhibits potent immunomodulating properties that reflect its ability to block the transcription of cytokines genes in activated T lymphocytes. Cyclosporin also inhibits a number of immune allergic reactions that occur after activation of mast cells, Langerhans cells, eosinophils and keratinocytes. In randomized controlled trials, cyclosporin has proven to be as effective as glucocorticoids for treatment of canine atopic dermatitis at the inducing dosage of 5 mg kg(-1). The drug has also proven beneficial for the treatment of perianal fistulas in dogs. Other potential applications are suggested from small pilot open trials using dogs affected with various immune-mediated dermatological diseases. The pharmacokinetic properties of cyclosporin are very similar in dogs and man, but its safety margin is much wider in dogs. Therefore, routine cyclosporin blood level monitoring does not appear necessary. Although in man renal impairment and hypertension are often seen, even at low doses, these effects are not observed in dogs. Adverse reactions consist mainly of transient emesis and diarrhoea occurring during the first days of treatment. Other adverse reactions, such as gingival hyperplasia, verruciform lesions and hypertrichosis, appear to be dose-dependent, and occur rarely at therapeutic doses. An increased susceptibility to infections has not been reported in dogs receiving this drug.
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PMID:Cyclosporin A: a new drug in the field of canine dermatology. 1503 May 55

The "lifestyle-related disease" has been increasing in Japan as the population advances in age and the food culture becomes westernized. Although prevention, treatment and therapy for this disease have been attempted using certain kinds of food and nutritive elements, so-called "health foods" such as DHA and EPA, which are mostly contained in fish oil, have been a special focus within these attempts. There have been many reports regarding the pharmacological functions and the mechanisms of DHA and EPA. Also, in the past few years, it has become possible to produce ingestible DHA and EPA oils, oils for chemical compounds, oils for animal feed, and highly purified DHA and EPA for medical and pharmaceutical use. EPA ethyl ester has a wide market as a preventive medicine in Japan. Initially in 1990, this medicine was administered in cases of arterisclerosis obliterans, using its anti-platelet aggregation ability. Four years later, in 1994, its effectiveness in triglyceride reduction was recognized, and its application was extended to cases of hyperlipidemia, which has remarkably broadened its market. Clinical studies with DHA have shown improvement in senile dementia (cerebral thrombosis, Alzheimer's disease), atopic dermatitis, and the ability to focus on moving objects, as well as control of aggressiveness against others caused by stress, and prevention of hyperlipidemia, hypertension, and cancer.
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PMID:[Importance of "health foods", EPA and DHA, for preventive medicine]. 1513 25

Essential polyunsaturated fatty acids (PUFA) cannot be synthesised in the body and must be ingested by food. A balanced intake of both n-6 and n-3 PUFA is essential for good health. PUFA are the basic constituents of phospholipid membranes and determine cellular membrane fluidity and modulate enzyme activities, carriers and membrane receptors. They are also precursors of active metabolites known collectively as eicosanoids (prostaglandins, prostacyclins, thromboxanes and leukotrienes) which regulate our cellular functions. Studies indicate that n-3 PUFA have anti-inflammatory, antithrombotic, antiarrhythmic actions and immuno-modulating properties. Erythrocyte fatty acid status is a reflection of dietary fat intake. It also explores PUFA metabolism and gives information about the integration of these fatty acids into cellular membranes. Thus, erythrocyte fatty acid analysis can detect PUFA insufficiencies and imbalances from the diet, but also metabolic abnormalities and lipid peroxidation. It can be helpful in the prevention and the control of chronic diseases in which PUFA alterations have been observed as coronary heart diseases, hypertension, cancer, diabetes, inflammatory and auto-immune disorders, atopic eczema, Alzheimer dementia, major depression, schizophrenia, multiple sclerosis, etc.
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PMID:Alteration of polyunsaturated fatty acid status and metabolism in health and disease. 1546 Jan 66

Angiotensin-II, a product of angiotensin converting enzyme (ACE) action, regulates vascular tone, stimulates the release of pro-inflammatory cytokines, activates NFkappaB, increases oxidant stress, and suppresses nitric oxide synthesis. Thus, angiotensin-II is pro-inflammatory in nature. Hence, increase in ACE activity and the concentrations of angiotensin-II initiate and perpetuate inflammation. Since ACE is present in many tissues including: the uterus, placenta, vascular tissue, heart, brain, adrenal cortex and kidney, leukocytes, alveolar macrophages, peripheral monocytes, neuronal cells and epididymal cells, this suggests that angiotensin-II may have a role in atherosclerosis, congestive cardiac failure, stroke, bipolar disorder, schizophrenia, dementia, Alzheimer's disease, psoriasis, atopic and non-atopic dermatitis, eczema, several acute and chronic inflammatory diseases, and cancer, conditions in which inflammation is known to play a significant role. This suggests that ACE inhibitors and/or angiotensin-II receptor blockers could be of significant benefit in the management of these conditions. Alternatively, structural analogues of presently available ACE inhibitors and angiotensin-II receptor blockers could be developed such that they are not only useful in the treatment of hypertension and CHF but also possess anti-inflammatory actions.
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PMID:Is angiotensin-II an endogenous pro-inflammatory molecule? 1587 6

Headache and/or migraine, a common problem in pediatrics and internal medicine, affect about 5% to 10% children and adolescents, and nearly 30% of middle-aged women. Headache is also one of the most common clinical manifestations of acquired Toxoplasma gondii infection of the central nervous system (CNS) in immunosuppressed subjects. We present 11 apparently nonhuman immunodeficiency virus-infected children aged 7 to 17 years (8 girls, 3 boys) and 1 adult woman with recurrent severe headaches in whom latent chronic CNS T. gondii infection not manifested by enlarged peripheral lymph nodes typical for toxoplasmosis, was found. In 7 patients, the mean serum IgG Toxoplasma antibodies concentration was 189 +/- 85 (SD) IU/mL (range 89 to 300 IU/mL), and in 5 other subjects, the indirect fluorescent antibody test titer ranged from 1:40 to 1:5120 IU/mL (n= <1:10 IU/mL). Some of the patients suffered also from atopic dermatitis (AD) and were exposed to cat and/or other pet allergens, associated with an increased IL-4 and decreased IFN-gamma production. These cytokine irregularities caused limited control of cerebral toxoplasmosis probably because IL-4 down-regulated both the production of IFN-gamma and its activity, and stimulated production of a low NO-producing population of monocytes, which allowed cysts rupture, increased parasite multiplication and finally reactivation of T. gondii infection. The immune studies performed in 4 subjects showed a decreased percentage of T lymphocytes, increased total number of lymphocytes B and serum IgM concentration, and impaired phagocytosis. In addition, few of them had also urinary tract diseases known to produce IL-6 that can mediate immunosuppressive functions, involving induction of the anti-inflammatory cytokine IL-10. These disturbances probably resulted from the host protective immune reactions associated with the chronic latent CNS T. gondii infection/inflammation. This is consistent with significantly lower enzyme indoleamine 2,3-dioxygenase (IDO) activity reported in atopic than in nonatopic individuals, and an important role that IDO and tryptophan degradation pathways plays in both, the host resistance to T. gondii infection and its reactivation. Analysis of literature information on the subjects with different types of headaches caused by foods, medications, and other substances, may suggest that their clinical symptoms and changes in laboratory data result at least in part from interference of these factors with dietary tryptophan biotransformation pathways. Several of these agents caused headache attacks through enhancing NO production via the conversion of arginine to citrulline and NO by the inducible nitric oxide synthase enzyme, which results in the high-output pathway of NO synthesis. This increased production of NO is, however, quickly down-regulated by NO itself because this biomolecule can directly inactivate NOS, may inhibit Ia expression on IFN-gamma-activated macrophages, which would limit antigen-presenting capability, and block T-cell proliferation, thus decreasing the antitoxoplasmatic activity. Moreover, NO inhibits IDO activity, thereby suppressing kynurenine formation, and at least one member of the kynurenine pathway, 3-hydroxyanthranilic acid, has been shown to inhibit NOS enzyme activity, the expression of NOS mRNA, and activation of the inflammatory transcription factor, nuclear factor-kB. In addition, the anti-inflammatory cytokines IL-4 and IL-10, TGF-beta, and a cytokine known as macrophage deactivating factor, have been shown to directly modulate NO production, sometimes expressing synergistic activity. On the other hand, IL-4 and TGF-beta can suppress IDO activity in some cells, for example human monocytes and fibroblasts, which is consistent with metabolic pathways controlled by IDO being a significant contributor to the proinflammatory system. Also, it seems that idiopathic intracranial hypertension, pseudotumor cerebri, and aseptic meningitis, induced by various factors, may result from their interference with IDO and inducible nitric oxide synthase activities, endogenous NO level, and cytokine irregularities which finally affect former T. gondii status 2mo in the brain. All these biochemical disturbances caused by the CNS T. gondii infection/inflammation may also be responsible for the relationship found between neurologic symptoms, such as headache, vertigo, and syncope observed in apparently immunocompetent children and adolescents, and physical and psychiatric symptoms in adulthood. We therefore believe that tests for T. gondii should be performed obligatorily in apparently immunocompetent patients with different types of headaches, even if they have no enlarged peripheral lymph nodes. This may help to avoid overlooking this treatable cause of the CNS disease, markedly reduce costs of hospitalization, diagnosis and treatment, and eventually prevent developing serious neurologic and psychiatric disorders.
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PMID:Recurrent headache as the main symptom of acquired cerebral toxoplasmosis in nonhuman immunodeficiency virus-infected subjects with no lymphadenopathy: the parasite may be responsible for the neurogenic inflammation postulated as a cause of different types of headaches. 1730 77


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