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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

While evolution by natural selection has long been a foundation for biomedical science, it has recently gained new power to explain many aspects of disease. This progress results largely from the disciplined application of what has been called the adaptations program. We show that this increasingly significant research paradigm can predict otherwise unsuspected facets of human biology, and that it provides new insights into the causes of medical disorders, such as those discussed below: 1. Infection. Signs and symptoms of the host-parasite contest can be categorized according to whether they represent adaptations or costs for host or parasite. Some host adaptations may have contributed to fitness in the Stone Age but are obsolete today. Others, such as fever and iron sequestration, have been incorrectly considered harmful. Pathogens, with their large populations and many generations in a single host, can evolve very rapidly. Acquisition of resistance to antibiotics is one example. Another is the recently demonstrated tendency to change virulence levels in predictable ways in response to changed conditions imposed incidentally by human activities. 2. Injuries and toxins. Mechanical injuries or stressful wear and tear are conceptually simpler than infectious diseases because they are not contests between conflicting interests. Plant-herbivore contests may often underlie chemical injury from the defensive secondary compounds of plant tissues. Nausea in pregnancy, and allergy, may be adaptations against such toxins. 3. Genetic factors. Common genetic diseases often result from genes maintained by other beneficial effects in historically normal environments. The diseases of aging are especially likely to be associated with early benefits. 4. Abnormal environments. Human biology is designed for Stone Age conditions. Modern environments may cause many diseases-for example, deficiency syndromes such as scurvy and rickets, the effects of excess consumption of normally scarce nutrients such as fat and salt, developmental diseases such as myopia, and psychological reactions to novel environments. The substantial benefits of evolutionary studies of disease will be realized only if they become central to medical curricula, an advance that may at first require the establishment of one or more research centers dedicated to the further development of Darwinian medicine.
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PMID:The dawn of Darwinian medicine. 205 70

The clinical efficacy and tolerability of gastroprotected ferritin were assessed in children affected by iron deficiency and/or sideropenic anemia. Forty-seven children with iron-deficiency and/or sideropenic anemia were included in the study and were treated with gastroprotected ferritin at a dose of 4-5 mg/kg/day per os for 4 months. Only 33 children correctly completed the entire treatment cycle, achieving a marked improvement of blood parameters (increased Hb, accompanied by higher levels of sideremia and in particular ferritin, with a contemporary decrease in erythrocytic protoporphyrin and transferrinemia) and clinical symptoms, especially pallor, anorexia, debility, somnolence, hyperactivity, disturbed sleep and excessive sweating. Of the remaining 14 children, 9 failed to present for the planned control after the 4 months of therapy, 3 abandoned therapy due to difficulties of assumption and 2 because of intolerance phenomena, such as nausea and diarrhoea. In conclusion, gastroprotected proteoferrin is efficacious and well tolerated in the treatment of iron deficiency in children.
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PMID:[Evaluation of the effectiveness of gastro-protected proteoferrin in the therapy of sideropenic anemia in childhood]. 228 21

The purpose of this study was to investigate the prevalence and type of lesions in the upper gastrointestinal tract and to identify characteristics associated with ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Two thousand five hundred and four patients aged 60-98 (mean, 82) years admitted to a geriatric clinic for rehabilitation were screened by faecal occult blood test, for B-haemoglobin, and, in a case of anaemia, analyses of serum levels of mean corpuscular volume, mean corpuscular haemoglobin concentration, iron, and total iron-binding capacity. One hundred and seventy patients were included in the study. A high prevalence of ulcer disease (22%) was found. Significantly higher proportions of non-steroidal anti-inflammatory drugs and steroid users and of patients with rheumatoid arthritis and osteoarthrosis were found among ulcer patients than among patients without ulcerative upper gastrointestinal lesions. The clinical picture of ulcer disease differed from the classic presentation: abdominal pain occurred in only 7 of 38 patients (18%), whereas appetite and weight loss and nausea/vomiting were common. It is important to be aware of the high prevalence and the clinical picture of ulcer disease among geriatric inpatients with iron deficiency anaemia and/or occult gastrointestinal bleeding.
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PMID:Ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. A prospective study. 235 77

Aim of this multicentric clinical trial was to evaluate the efficacy and tolerability of a new iron compound: iron proteinsuccinylate. 3,200 patients affected with iron deficiency due to obstetric or gynecologic etiology were treated with iron proteinsuccinylate, at a daily dose of 80 mg Fe3+, for at least 30 days. Iron proteinsuccinylate induced a statistically significant improvement (p less than 0.01) in mean values of hemoglobin and serum iron. The compound also caused a disappearance or improvement of subjective symptomatology (asthenia, anorexia) and of clinical conditions deriving from iron deficiency state (polypnea, cutaneous and mucous pallor). The treatment was well tolerated and caused a few slight side effects (diarrhea, epigastralgia, nausea) in 2.4% of patients.
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PMID:[Ferroprotein succinylate: treatment of iron deficiency in obstetrics and gynecology]. 237 53

Although consequences of zinc deficiency have been recognized for many years, it is only recently that attention has been directed to the potential consequences of excessive zinc intake. This is a review of the literature on manifestations of toxicity at several levels of zinc intake. Zinc is considered to be relatively nontoxic, particularly if taken orally. However, manifestations of overt toxicity symptoms (nausea, vomiting, epigastric pain, lethargy, and fatigue) will occur with extremely high zinc intakes. At low intakes, but at amounts well in excess of the Recommended Dietary Allowance (RDA) (100-300 mg Zn/d vs an RDA of 15 mg Zn/d), evidence of induced copper deficiency with attendant symptoms of anemia and neutropenia, as well as impaired immune function and adverse effects on the ratio of low-density-lipoprotein to high-density-lipoprotein (LDL/HDL) cholesterol have been reported. Even lower levels of zinc supplementation, closer in amount to the RDA, have been suggested to interfere with the utilization of copper and iron and to adversely affect HDL cholesterol concentrations. Individuals using zinc supplements should be aware of the possible complications attendant to their use.
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PMID:Zinc toxicity. 240 97

In this prospective study, we investigated the relationship between dietary practices and pregnancy discomforts among 50 urban black American women during their first and third trimesters of pregnancy. Subjects were interviewed during their regular prenatal clinic visits for information about their previous 24-hour dietary intake, the presence and severity of pregnancy discomforts occurring in the previous month, and pertinent demographic data. Findings indicated that high intake of meat products but low or no intake of vegetables was correlated with nausea, little or no intake of milk products was correlated with heartburn, and low or no intake of citrus fruit but intake of vitamin and iron supplements was correlated with heartburn, constipation, and sleeping difficulty. Replication of the study with a larger sample is warranted so as to provide further validity to the findings.
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PMID:Dietary practices and pregnancy discomforts among urban blacks. 280 80

Mifepristone, a new steroid and progesterone antagonist, was administered to 150 women with amenorrhea of less than 42 days who were seeking abortions. A single dose of 600 mg was given to each woman to take orally at home in the evening. The clinical events that should occur were explained to the women and they were given a permanent emergency telephone number. Follow-up visits were scheduled on the 8th day, when clinical tests, ultrasound examinations, and blood sampling were performed. Success was assumed if vaginal bleeding occurred between days 3-8, ultrasonic examination confirmed uterine vacuity, and a decrease in plasma HCG level was observed. A total of 131 of the 150 women were considered to have had complete abortion. The remaining 19 women included 14 developing pregnancies, 2 curettages for heavy bleeding, and 1 extrauterine pregnancy. Daily amount and duration of bleeding were compared to abundant menstruation. Only 2 women reported heavy bleeding leading to curettage. Only 16 women had hemoglobin levels low enough to justify iron therapy. None needed a transfusion. Several other side effects were reported--uterine contractions and pelvic pain, transient asthenia, and slight nausea. All biological tests remained in the normal range. Having shown a success rate of 87.3% and with mild side effects, Mifepristone appears to be a simple and safe agent for termination of early pregnancy, and a good alternative to surgical abortion.
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PMID:Termination of early pregnancy by a single dose of mifepristone (RU 486), a progesterone antagonist. 320 66

This study assesses the effect of oral iron therapy on the upper gastrointestinal tract and fecal occult blood testing. Fourteen healthy volunteers completed a checklist of gastrointestinal symptoms, underwent endoscopy and biopsy of the stomach and duodenum, and supplied a fresh stool sample for Hemoccult and HemoQuant testing. They then took ferrous sulfate 325 mg per os tid for two weeks and had the same evaluation repeated. Gastrointestinal symptoms were rated by the patients on a scale of 0-3, endoscopic findings were numerically scored (0-4), and the biopsies were graded blindly. Thirteen other healthy volunteers took ferrous sulfate 325 mg per os tid for one week and had Hemoccult testing of stool at days 0 and 7. All subjects developed dark stools, and significant nausea and diarrhea were noted (0.1 +/- 0.1 to 0.9 +/- 0.3, P less than 0.05 for both symptoms). Only 1/27 had a questionably trace-positive Hemoccult test (two observers disagreed) and no significant difference was seen in HemoQuant testing (1.4 +/- 0.5 to 1.8 +/- 0.7 mg Hb/g). A significant increase was seen in endoscopic abnormalities in the stomach (0.1 +/- 0.1 to 1.5 +/- 0.3, P = 0.003), consisting of erythema, small areas of subepithelial hemorrhage, and, in two subjects, erosions. Biopsies showed no significant change after iron therapy. We conclude that (1) oral ferrous sulfate rarely causes Hemoccult-positive stools, and patients with positive Hemoccult tests on iron therapy require further evaluation; and (2) oral iron may cause mild endoscopic abnormalities in the stomach which are of uncertain clinical significance.
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PMID:Effect of oral iron therapy on the upper gastrointestinal tract. A prospective evaluation. 325 37

In 1980, the National Clearinghouse for Poison Control Centers (NCPCC) received 126,000 reports from Poison Control Centers, but the true incidence of ingestions was actually much higher. Only 1 in 50 ingestions may be reported, indicating that the majority of ingestions are innocuous. 70% of reported episodes occurred in children under 5 years of age. Nontoxic ingestions occur when a victim consumes a nonedible product that usually does not produce symptoms. No product is entirely safe and all can produce symptoms if a large enough concentration is consumed. Knowledge of nontoxic ingestions helps avoid overtreatment and its risks and serves as a warning of inadequate supervision or an improper and unsafe environment. The designation of nontoxic ingestion has 6 criteria: 1) absolute identification of the product 2) absolute assurance that only 1 product was ingested 3) no signal word (danger, poison, warning, caution) on the container 4) a good approximation of the amount ingested 5) assurance that the victim is free of symptoms and 6) the ability to call back at intervals to determine that no symptoms have developed. A good rule of thumb for the average drug that 5 times the therapeutic dose may be a toxic dose; opiate narcotics are the exception and require medical observation because of their narrow margin of safety. There are several points to consider in deciding wheter to decontaminate the gastrointestinal tract, including the toxicity of the ingested agent, the amount ingested, the elapsed time since ingestion, and the presence of symptoms. Emergency room referral is mandatory in case of exposure to highly toxic agents, of a dose sufficient to lead to anticipation of servere symptoms, of manifestations of toxic exposure such as alterations in vital signs already present, or of a history of intentional ingestion. A detailed discussion of frequently ingested nontoxic household items and related items that may be toxic includes writing and art materials, toiletries and laundry agents, deordorizers and disinfectants, tobacco and matches, medicinals, pesticides and insecticides, miscellaneous substances, petroleum distillate hydrocarbons, and plants. Hormonal contraceptives have been reported to produce almost no toxicity. A 1962-65 report from the NCPCC of 962 ingestions listed only 40 producing nausea nd vomiting even after consumption of 21 pills. An iron additive could make the ingestion toxic for iron.
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PMID:Ingestions considered nontoxic. 614 71

Zygomycosis is an uncommon, but frequently fatal, fungal infection caused by members of the class Zygomycetes. The risk factors include diabetes mellitus, uremia, leukemia and use of deferoxamine as an iron-chelating agent; healthy persons also are occasionally infected. Those fungi, spread by their ubiquitous spores, most frequently involve the respiratory system. Rhinocerebral zygomycosis occurs predominantly in patients with uncontrolled diabetic ketoacidosis. Pulmonary zygomycosis most frequently is observed in granulocytopenic and corticosteroid-treated patients. Other clinical manifestations are gastrointestinal, cutaneous, disseminated and miscellaneous. This report concerns a previously robust farmer who suffered from left upper lung abscess caused by Rhizopus spp.-one member of the order Mucorales. Initially, it was intended to administer amphotericin B to a total dose of 2,000 mg; however, the patient could not tolerate such side effects as nausea, vomiting and refused further management when the cumulative dose was 948 mg. However, he did recover without further fever and cough. Chest X-ray, followed every three months, disclosed satisfactory improvement.
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PMID:Zygomycotic lung abscess: a case report. 755 21


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